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Non-inferiority of creatinine excretion rate to urinary L-FABP and NGAL as predictors of early renal allograft function

BACKGROUND: We evaluated accuracy of urinary liver type fatty acid-binding protein (L-FABP) for prediction of early allograft function and compared it to neutrophil gelatinase associated lipocalin (NGAL), diuresis and urinary creatinine excretion rate (UCr). METHODS: Urine samples from 71 consecutiv...

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Autores principales: Pajek, Jernej, Škoberne, Andrej, Šosterič, Klara, Adlešič, Barbara, Leskošek, Bojan, Bučar Pajek, Maja, Osredkar, Joško, Lindič, Jelka
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2014
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4107724/
https://www.ncbi.nlm.nih.gov/pubmed/25027586
http://dx.doi.org/10.1186/1471-2369-15-117
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author Pajek, Jernej
Škoberne, Andrej
Šosterič, Klara
Adlešič, Barbara
Leskošek, Bojan
Bučar Pajek, Maja
Osredkar, Joško
Lindič, Jelka
author_facet Pajek, Jernej
Škoberne, Andrej
Šosterič, Klara
Adlešič, Barbara
Leskošek, Bojan
Bučar Pajek, Maja
Osredkar, Joško
Lindič, Jelka
author_sort Pajek, Jernej
collection PubMed
description BACKGROUND: We evaluated accuracy of urinary liver type fatty acid-binding protein (L-FABP) for prediction of early allograft function and compared it to neutrophil gelatinase associated lipocalin (NGAL), diuresis and urinary creatinine excretion rate (UCr). METHODS: Urine samples from 71 consecutive patients were taken 4, 10, 24 and 48 h after transplantation. We classified recipients into two groups: immediate graft function (IGF), with more than 70% reduction of serum Cr at 7th day post-transplant, and delayed graft function (DGF)/slow graft function (SGF) group (DGF - the need for hemodialysis procedure in the first week, SGF - less than 70% reduction of serum Cr in the first week). RESULTS: Thirty-one recipients had IGF and 40 had DGF/SGF. L-FABP was only useful 48 h post-transplant with ROC AUC of 0.85 (95% C.I. 0.74-0.92); NGAL 24 h post-transplant had ROC AUC of 0.82 (0.7-0.91). Sensitivity, specificity, PPV and NPV for prediction of DGF/SGF with L-FABP > 9.5 mg/mmol Cr and NGAL > 33.1 μg/mmol Cr were: 86, 80, 83 and 83% (L-FABP), and 68, 93, 91, and 73% (NGAL). The difference in urine output between the groups was largest 4 h post-transplant (p = 0.001), later on the difference diminished. There were no significant differences in ROC AUC between L-FABP at 48 h, NGAL at 24 h, urine output at 4 h and UCr excretion rate at 10 h post-transplant. UCr < 0.56 mmol/h 10 h post-transplant predicted DGF/SGF with 94% sensitivity, 84% specificity, 89% PPV and 91% NPV, ROC AUC was 0.9. Classification tree with urine output 4 h and UCr 10 h post-transplant accurately predicted 89% of outcomes. When L-FABP or NGAL were added, the prediction was accurate in 92 or 90%, respectively. CONCLUSIONS: L-FABP is comparable to NGAL for prediction of first week allograft function, however UCr and diuresis were non-inferior.
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spelling pubmed-41077242014-07-24 Non-inferiority of creatinine excretion rate to urinary L-FABP and NGAL as predictors of early renal allograft function Pajek, Jernej Škoberne, Andrej Šosterič, Klara Adlešič, Barbara Leskošek, Bojan Bučar Pajek, Maja Osredkar, Joško Lindič, Jelka BMC Nephrol Research Article BACKGROUND: We evaluated accuracy of urinary liver type fatty acid-binding protein (L-FABP) for prediction of early allograft function and compared it to neutrophil gelatinase associated lipocalin (NGAL), diuresis and urinary creatinine excretion rate (UCr). METHODS: Urine samples from 71 consecutive patients were taken 4, 10, 24 and 48 h after transplantation. We classified recipients into two groups: immediate graft function (IGF), with more than 70% reduction of serum Cr at 7th day post-transplant, and delayed graft function (DGF)/slow graft function (SGF) group (DGF - the need for hemodialysis procedure in the first week, SGF - less than 70% reduction of serum Cr in the first week). RESULTS: Thirty-one recipients had IGF and 40 had DGF/SGF. L-FABP was only useful 48 h post-transplant with ROC AUC of 0.85 (95% C.I. 0.74-0.92); NGAL 24 h post-transplant had ROC AUC of 0.82 (0.7-0.91). Sensitivity, specificity, PPV and NPV for prediction of DGF/SGF with L-FABP > 9.5 mg/mmol Cr and NGAL > 33.1 μg/mmol Cr were: 86, 80, 83 and 83% (L-FABP), and 68, 93, 91, and 73% (NGAL). The difference in urine output between the groups was largest 4 h post-transplant (p = 0.001), later on the difference diminished. There were no significant differences in ROC AUC between L-FABP at 48 h, NGAL at 24 h, urine output at 4 h and UCr excretion rate at 10 h post-transplant. UCr < 0.56 mmol/h 10 h post-transplant predicted DGF/SGF with 94% sensitivity, 84% specificity, 89% PPV and 91% NPV, ROC AUC was 0.9. Classification tree with urine output 4 h and UCr 10 h post-transplant accurately predicted 89% of outcomes. When L-FABP or NGAL were added, the prediction was accurate in 92 or 90%, respectively. CONCLUSIONS: L-FABP is comparable to NGAL for prediction of first week allograft function, however UCr and diuresis were non-inferior. BioMed Central 2014-07-16 /pmc/articles/PMC4107724/ /pubmed/25027586 http://dx.doi.org/10.1186/1471-2369-15-117 Text en Copyright © 2014 Pajek et al.; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Pajek, Jernej
Škoberne, Andrej
Šosterič, Klara
Adlešič, Barbara
Leskošek, Bojan
Bučar Pajek, Maja
Osredkar, Joško
Lindič, Jelka
Non-inferiority of creatinine excretion rate to urinary L-FABP and NGAL as predictors of early renal allograft function
title Non-inferiority of creatinine excretion rate to urinary L-FABP and NGAL as predictors of early renal allograft function
title_full Non-inferiority of creatinine excretion rate to urinary L-FABP and NGAL as predictors of early renal allograft function
title_fullStr Non-inferiority of creatinine excretion rate to urinary L-FABP and NGAL as predictors of early renal allograft function
title_full_unstemmed Non-inferiority of creatinine excretion rate to urinary L-FABP and NGAL as predictors of early renal allograft function
title_short Non-inferiority of creatinine excretion rate to urinary L-FABP and NGAL as predictors of early renal allograft function
title_sort non-inferiority of creatinine excretion rate to urinary l-fabp and ngal as predictors of early renal allograft function
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4107724/
https://www.ncbi.nlm.nih.gov/pubmed/25027586
http://dx.doi.org/10.1186/1471-2369-15-117
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