The clinical utility window for acute kidney injury biomarkers in the critically ill

The clinical utility window for acute kidney injury biomarkers in the critically ill.  Critical Care, Nov 2014, 18:601

Ralib, A.M., et al.

http://ccforum.com/content/pdf/s13054-014-0601-2.pdf

Acute Kidney Injury (AKI) biomarker utility depends on sample timing after the onset of renal injury. We compared biomarker performance on arrival in the emergency department (ED) with subsequent performance in the intensive care unit (ICU). Urinary and plasma Neutrophil Gelatinase-Associated Lipocalin (NGAL), and urinary Cystatin C (CysC), alkaline phosphatase, Glutamyl Transpeptidase (GGT), and-Glutamyl S-Transferase (GST), and albumin were measured on ED presentation, and at 0, 4, 8, and 16 hours, and days 2, 4 and 7 in the ICU in patients after cardiac arrest, sustained or profound hypotension or ruptured abdominal aortic aneurysm. AKI was defined as plasma creatinine increase 26.5??mol/l within 48?hours or ?50% within 7 days. Results: In total, 45 of 77 patients developed AKI. Most AKI patients had elevated urinary NGAL, and plasma NGAL and CysC in the period 6 to 24?hours post presentation. Biomarker performance in the ICU was similar or better than when measured earlier in the ED. Conclusion: Early measurement in the ED has utility, but not better AKI diagnostic performance than later ICU measurement. Plasma NGAL diagnosed AKI at all time points. Urinary NGAL best predicted mortality or dialysis compared to other biomarkers.