Urine β-2-Microglobulin, Osteopontin, and Trefoil Factor 3 May Early Predict Acute Kidney Injury and Outcome after Cardiac Arrest

Sigrid Beitland, Espen Rostrup Nakstad, Jens Petter Berg, Anne-Marie Siebke Trøseid, Berit Sletbakk Brusletto, Cathrine Brunborg, Christofer Lundqvist, Kjetil Sunde, Sigrid Beitland, Espen Rostrup Nakstad, Jens Petter Berg, Anne-Marie Siebke Trøseid, Berit Sletbakk Brusletto, Cathrine Brunborg, Christofer Lundqvist, Kjetil Sunde

Abstract

Purpose: Acute kidney injury (AKI) is a common complication after out-of-hospital cardiac arrest (OHCA), leading to increased mortality and challenging prognostication. Our aim was to examine if urine biomarkers could early predict postarrest AKI and patient outcome.

Methods: A prospective observational study of resuscitated, comatose OHCA patients admitted to Oslo University Hospital in Norway. Urine samples were collected at admission and day three postarrest and analysed for β-2-microglobulin (β2M), osteopontin, and trefoil factor 3 (TFF3). Outcome variables were AKI within three days according to the Kidney Disease Improving Global Outcome criteria, in addition to six-month mortality and poor neurological outcome (PNO) (cerebral performance category 3-5).

Results: Among 195 included patients (85% males, mean age 60 years), 88 (45%) developed AKI, 88 (45%) died, and 96 (49%) had PNO. In univariate analyses, increased urine β2M, osteopontin, and TFF3 levels sampled at admission and day three were independent risk factors for AKI, mortality, and PNO. Exceptions were that β2M measured at day three did not predict any of the outcomes, and TFF3 at admission did not predict AKI. In multivariate analyses, combining clinical parameters and biomarker levels, the area under the receiver operating characteristics curves (95% CI) were 0.729 (0.658-0.800), 0.797 (0.733-0.861), and 0.812 (CI 0.750-0.874) for AKI, mortality, and PNO, respectively.

Conclusions: Urine levels of β2M, osteopontin, and TFF3 at admission and day three were associated with increased risk for AKI, mortality, and PNO in comatose OHCA patients. This trail is registered with NCT01239420.

Figures

Figure 1
Figure 1
Flow chart of the study. OHCA: out-of-hospital cardiac arrest; NORCAST: Norwegian cardiorespiratory arrest study; ICU: intensive care unit; CA: cardiac arrest; CPR: cardiopulmonary resuscitation.
Figure 2
Figure 2
Area under the receiver operating characteristics curve (AuROC) plots for predictive models of acute kidney injury, mortality, and poor neurological outcome in out-of-hospital cardiac arrest patients. Presented p values are for comparison of models consisting of clinical parameters with and without acute kidney injury biomarkers measured in urine. (a) Predictors of acute kidney injury. (b) Predictors of mortality. (c) Predictors of poor neurological outcome.

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Source: PubMed

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