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Urinary Liver-Type Fatty-Acid-Binding Protein Predicts Long-Term Adverse Outcomes in Medical Cardiac Intensive Care Units

We prospectively investigated the prognostic value of urinary liver-type fatty-acid-binding protein (L-FABP) levels on hospital admission, both independently and in combination with serum creatinine-defined acute kidney injury (AKI), to predict long-term adverse outcomes in 1119 heterogeneous patien...

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Autores principales: Naruse, Hiroyuki, Ishii, Junnichi, Takahashi, Hiroshi, Kitagawa, Fumihiko, Nishimura, Hideto, Kawai, Hideki, Muramatsu, Takashi, Harada, Masahide, Yamada, Akira, Fujiwara, Wakaya, Hayashi, Mutsuharu, Motoyama, Sadako, Sarai, Masayoshi, Watanabe, Eiichi, Izawa, Hideo, Ozaki, Yukio
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7073895/
https://www.ncbi.nlm.nih.gov/pubmed/32050627
http://dx.doi.org/10.3390/jcm9020482
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author Naruse, Hiroyuki
Ishii, Junnichi
Takahashi, Hiroshi
Kitagawa, Fumihiko
Nishimura, Hideto
Kawai, Hideki
Muramatsu, Takashi
Harada, Masahide
Yamada, Akira
Fujiwara, Wakaya
Hayashi, Mutsuharu
Motoyama, Sadako
Sarai, Masayoshi
Watanabe, Eiichi
Izawa, Hideo
Ozaki, Yukio
author_facet Naruse, Hiroyuki
Ishii, Junnichi
Takahashi, Hiroshi
Kitagawa, Fumihiko
Nishimura, Hideto
Kawai, Hideki
Muramatsu, Takashi
Harada, Masahide
Yamada, Akira
Fujiwara, Wakaya
Hayashi, Mutsuharu
Motoyama, Sadako
Sarai, Masayoshi
Watanabe, Eiichi
Izawa, Hideo
Ozaki, Yukio
author_sort Naruse, Hiroyuki
collection PubMed
description We prospectively investigated the prognostic value of urinary liver-type fatty-acid-binding protein (L-FABP) levels on hospital admission, both independently and in combination with serum creatinine-defined acute kidney injury (AKI), to predict long-term adverse outcomes in 1119 heterogeneous patients (mean age; 68 years) treated at medical (non-surgical) cardiac intensive care units (CICUs). Patients with stage 5 chronic kidney disease were excluded from the study. Of these patients, 47% had acute coronary syndrome and 38% had acute decompensated heart failure. The creatinine-defined AKI was diagnosed according to the “Kidney Disease: Improving Global Outcomes” criteria. The primary endpoint was a composite of all-cause death or progression to end-stage kidney disease, indicating the initiation of maintenance dialysis therapy or kidney transplantation. Creatinine-defined AKI occurred in 207 patients, with 44 patients having stage 2 or 3 disease. During a mean follow-up period of 41 months after enrollment, the primary endpoint occurred in 242 patients. Multivariate Cox regression analyses revealed L-FABP levels as independent predictors of the primary endpoint (p < 0.001). Adding L-FABP to a baseline model with established risk factors further enhanced reclassification and discrimination beyond that of the baseline model alone, for primary-endpoint prediction (both; p < 0.01). On Kaplan–Meier analyses, increased L-FABP (≥4th quintile value of 9.0 ng/mL) on admission or presence of creatinine-defined AKI, correlated with an increased risk of the primary endpoint (p < 0.001). Thus, urinary L-FABP levels on admission are potent and independent predictors of long-term adverse outcomes, and they might improve the long-term risk stratification of patients admitted at medical CICUs, when used in combination with creatinine-defined AKI.
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spelling pubmed-70738952020-03-19 Urinary Liver-Type Fatty-Acid-Binding Protein Predicts Long-Term Adverse Outcomes in Medical Cardiac Intensive Care Units Naruse, Hiroyuki Ishii, Junnichi Takahashi, Hiroshi Kitagawa, Fumihiko Nishimura, Hideto Kawai, Hideki Muramatsu, Takashi Harada, Masahide Yamada, Akira Fujiwara, Wakaya Hayashi, Mutsuharu Motoyama, Sadako Sarai, Masayoshi Watanabe, Eiichi Izawa, Hideo Ozaki, Yukio J Clin Med Article We prospectively investigated the prognostic value of urinary liver-type fatty-acid-binding protein (L-FABP) levels on hospital admission, both independently and in combination with serum creatinine-defined acute kidney injury (AKI), to predict long-term adverse outcomes in 1119 heterogeneous patients (mean age; 68 years) treated at medical (non-surgical) cardiac intensive care units (CICUs). Patients with stage 5 chronic kidney disease were excluded from the study. Of these patients, 47% had acute coronary syndrome and 38% had acute decompensated heart failure. The creatinine-defined AKI was diagnosed according to the “Kidney Disease: Improving Global Outcomes” criteria. The primary endpoint was a composite of all-cause death or progression to end-stage kidney disease, indicating the initiation of maintenance dialysis therapy or kidney transplantation. Creatinine-defined AKI occurred in 207 patients, with 44 patients having stage 2 or 3 disease. During a mean follow-up period of 41 months after enrollment, the primary endpoint occurred in 242 patients. Multivariate Cox regression analyses revealed L-FABP levels as independent predictors of the primary endpoint (p < 0.001). Adding L-FABP to a baseline model with established risk factors further enhanced reclassification and discrimination beyond that of the baseline model alone, for primary-endpoint prediction (both; p < 0.01). On Kaplan–Meier analyses, increased L-FABP (≥4th quintile value of 9.0 ng/mL) on admission or presence of creatinine-defined AKI, correlated with an increased risk of the primary endpoint (p < 0.001). Thus, urinary L-FABP levels on admission are potent and independent predictors of long-term adverse outcomes, and they might improve the long-term risk stratification of patients admitted at medical CICUs, when used in combination with creatinine-defined AKI. MDPI 2020-02-10 /pmc/articles/PMC7073895/ /pubmed/32050627 http://dx.doi.org/10.3390/jcm9020482 Text en © 2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Naruse, Hiroyuki
Ishii, Junnichi
Takahashi, Hiroshi
Kitagawa, Fumihiko
Nishimura, Hideto
Kawai, Hideki
Muramatsu, Takashi
Harada, Masahide
Yamada, Akira
Fujiwara, Wakaya
Hayashi, Mutsuharu
Motoyama, Sadako
Sarai, Masayoshi
Watanabe, Eiichi
Izawa, Hideo
Ozaki, Yukio
Urinary Liver-Type Fatty-Acid-Binding Protein Predicts Long-Term Adverse Outcomes in Medical Cardiac Intensive Care Units
title Urinary Liver-Type Fatty-Acid-Binding Protein Predicts Long-Term Adverse Outcomes in Medical Cardiac Intensive Care Units
title_full Urinary Liver-Type Fatty-Acid-Binding Protein Predicts Long-Term Adverse Outcomes in Medical Cardiac Intensive Care Units
title_fullStr Urinary Liver-Type Fatty-Acid-Binding Protein Predicts Long-Term Adverse Outcomes in Medical Cardiac Intensive Care Units
title_full_unstemmed Urinary Liver-Type Fatty-Acid-Binding Protein Predicts Long-Term Adverse Outcomes in Medical Cardiac Intensive Care Units
title_short Urinary Liver-Type Fatty-Acid-Binding Protein Predicts Long-Term Adverse Outcomes in Medical Cardiac Intensive Care Units
title_sort urinary liver-type fatty-acid-binding protein predicts long-term adverse outcomes in medical cardiac intensive care units
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7073895/
https://www.ncbi.nlm.nih.gov/pubmed/32050627
http://dx.doi.org/10.3390/jcm9020482
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