Performance of kidney injury molecule-1 and liver fatty acid-binding protein and combined biomarkers of aki after cardiac surgery

Chirag R. Parikh, Heather Thiessen-Philbrook, Amit X. Garg, Deepak Kadiyala, Michael G. Shlipak, Jay L. Koyner, Charles L. Edelstein, Prasad Devarajan, Uptal D. Patel, Michael Zappitelli, Catherine D. Krawczeski, Cary S. Passik, Steven G. Coca

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Background and objectives AKI is common and novel biomarkers may help provide earlier diagnosis and prognosis of AKI in the postoperative period. Design, setting, participants, & measurements This was a prospective, multicenter cohort study involving 1219 adults and 311 children consecutively enrolled at eight academic medical centers. Performance of two urine biomarkers, kidney injury molecule-1 (KIM-1) and liver fatty acid-binding protein (L-FABP), alone or in combination with other injury biomarkers during the perioperative period was evaluated. AKI was defined as doubling of serum creatinine or need for acute dialysis. Results KIM-1 peaked 2 days after surgery in adults and 1 day after surgery in children,whereas L-FABP peaked within 6 hours after surgery in both age groups. In multivariable analyses, the highest quintile of the first postoperative KIM-1 levelwas associatedwithAKI comparedwith the lowest quintile in adults,whereas the first postoperative L-FABP was not associated with AKI. Both KIM-1 and L-FABP were not significantly associated with AKI in adults or children after adjusting for other kidney injury biomarkers (neutrophil gelatinaseassociated lipocalin and IL-18). The highest area under the curves achievable for discrimination forAKI were 0.78 in adults using urine KIM-1 from 6 to 12 hours, urine IL-18 from day 2, and plasma neutrophil gelatinaseassociated lipocalin from day 2 and 0.78 in children using urine IL-18 from 0 to 6 hours and urine L-FABP from day 2. Conclusions Postoperative elevations of KIM-1 associate with AKI and adverse outcmes in adults but were not independent of other AKI biomarkers. A panel of multiple biomarkers provided moderate discrimination for AKI.

Original languageEnglish
Pages (from-to)1079-1088
Number of pages10
JournalClinical Journal of the American Society of Nephrology
Issue number7
StatePublished - Jul 2013


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