Urine biomarkers give early prediction of acute kidney injury and outcome after out-of-hospital cardiac arrest

Sigrid Beitland, Bård Endre Waldum-Grevbo, Espen Rostrup Nakstad, Jens-Petter Berg, Anne-Marie Siebke Trøseid, Berit Sletbakk Brusletto, Cathrine Brunborg, Geir Øystein Andersen, Kjetil Sunde, Sigrid Beitland, Bård Endre Waldum-Grevbo, Espen Rostrup Nakstad, Jens-Petter Berg, Anne-Marie Siebke Trøseid, Berit Sletbakk Brusletto, Cathrine Brunborg, Geir Øystein Andersen, Kjetil Sunde

Abstract

Background: Post-resuscitation care after out-of-hospital cardiac arrest (OHCA) is challenging due to the threat of organ failure and difficult prognostication. Our aim was to examine whether urine biomarkers could give an early prediction of acute kidney injury (AKI) and outcome.

Methods: This was a prospective observational study of comatose OHCA patients at Oslo University Hospital Ullevål, Norway. Risk factors were clinical parameters and biomarkers measured in spot urine (cystatin C, neutrophil gelatinase-associated lipocalin (NGAL) and the product of tissue inhibitor of metalloproteinase 2 (TIMP-2) and insulin-like growth factor-binding protein 7 (IGFBP7)) at admission and day 3. Outcome variables were AKI within 3 days using the Kidney Disease Improving Global Outcomes definition, 6-month mortality, and poor neurological outcome (PNO) defined as cerebral performance category 3-5.

Results: Among 195 included patients (85 % males, mean age 60 years), 88 (45 %) died, 96 (49 %) had PNO, and 88 (45 %) developed AKI. In univariate analysis, increased urine cystatin C and NGAL concentration sampled at admission and day 3 were independent risk factors for AKI, mortality and PNO. Increased urine TIMP-2 × IGFBP7 levels was associated with AKI only at admission. In multivariate analyses combining clinical parameters and biomarker concentrations, the area under the receiver operating characteristics curve (AuROC) with 95 % confidence interval (CI) were 0.774 (0.700-0.848), 0.812 (0.751-0.873), and 0.819 (0.759-0.878) for AKI, mortality and PNO, respectively.

Conclusions: In comatose OHCA patients, urine levels of cystatin C and NGAL at admission and day 3 were independent risk factors for AKI, 6-month mortality and PNO.

Trial registration: Clinicaltrials.gov NCT01239420 . Registered 10 November 2010.

Keywords: Acute kidney injury; Biomarker; Cardiac arrest; Outcome; Prognosis.

Figures

Fig. 1
Fig. 1
Flow chart of the study. AKI acute kidney injury, OHCA out-of-hospital cardiac arrest, CA cardiac arrest, CPR cardiopulmonary resuscitation, ICU intensive care unit, NORCAST Norwegian Cardiorespiratory Arrest Study, PNO poor neurological outcome (defined as cerebral performance category 3–5)

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Source: PubMed

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