The Role of Urinary Liver-Type Fatty Acid-Binding Protein in Critically Ill Patients

다국어 초록 (Multilingual Abstract)

Although several urinary biomarkers have been validated as early diagnostic markers of acute kidney injury (AKI), their usefulness as outcome predictors is not well established.

This study aimed to determine the diagnostic and prognostic abilities of urinary liver-type fatty acid-binding protein (L-FABP) in heterogeneous critically ill patients. We prospectively collected data on patients admitted to medical and surgical intensive care units (ICUs) from July 2010 to June 2011. Urine neutrophil gelatinase-associated lipocalin (NGAL) and L-FABP at the time of ICU admission were quantitated. Of the 145 patients, 54 (37.2%) had AKI defined by the Acute Kidney Injury Network (AKIN) criteria. AKI patients showed significantly higher level of urinary NGAL and L-FABP and also higher mortality than non-AKI patients. The diagnostic performances, assessed by the area under the ROC curve,were 0.773 for NGAL and 0.780 for L-FABP, demonstrating their usefulness in diagnosing AKI. In multivariate Cox analysis, urinary L-FABP was an independent predictor for 90-day mortality. Urinary L-FABP seems to be promising both for the diagnosis of AKI and for the prediction of prognosis in heterogeneous ICU patients. It needs to be further validated for clinical utility.

참고문헌 (Reference)

1 Yang HN, "Urine neutrophil gelatinase-associated lipocalin: an independent predictor of adverse outcomes in acute kidney injury" 31 : 501-509, 2010

2 Makris K, "Urinary neutrophil gelatinaseassociated lipocalin (NGAL) as an early marker of acute kidney injury in critically ill multiple trauma patients" 47 : 79-82, 2009

3 Ferguson MA, "Urinary liver-type fatty acid-binding protein predicts adverse outcomes in acute kidney injury" 77 : 708-714, 2010

4 Manabe K, "Urinary liver-type fatty acid-binding protein level as a predictive biomarker of contrast-induced acute kidney injury" 42 : 557-563, 2012

5 Nakamura T, "Urinary liver-type fatty acid-binding protein in septic shock: effect of polymyxin B-immobilized fiber hemoperfusion" 31 : 454-459, 2009

6 Kamijo A, "Urinary liver-type fatty acid binding protein as a useful biomarker in chronic kidney disease" 284 : 175-182, 2006

7 Yokoyama T, "Urinary excretion of liver type fatty acid binding protein accurately reflects the degree of tubulointerstitial damage" 174 : 2096-2106, 2009

8 Kang HK, "Urinary N-acetyl-β-D-glucosaminidase and malondialdehyde as a markers of renal damage in burned patients" 16 : 598-602, 2001

9 Lisowska-Myjak B, "Serum and urinary biomarkers of acute kidney injury" 29 : 357-365, 2010

10 Mishra J, "Neutrophil gelatinase-associated lipocalin (NGAL) as a biomarker for acute renal injury after cardiac surgery" 365 : 1231-1238, 2005

11 Prabhu A, "Neutrophil gelatinase associated lipocalin as a biomarker for acute kidney injury in patients undergoing coronary artery bypass grafting with cardiopulmonary bypass" 24 : 525-531, 2010

12 Portilla D, "Liver fatty acid-binding protein as a biomarker of acute kidney injury after cardiac surgery" 73 : 465-472, 2008

13 Shum HP, "Interaction between fluid balance and disease severity on patient outcome in the critically ill" 26 : 613-619, 2011

14 Bagshaw SM, "Fluid balance as a biomarker: impact of fluid overload on outcome in critically ill patients with acute kidney injury" 12 : 169-, 2008

15 Bouchard J, "Fluid accumulation and acute kidney injury: consequence or cause" 15 : 509-513, 2009

16 Doi K, "Evaluation of new acute kidney injury biomarkers in a mixed intensive care unit" 39 : 2464-2469, 2011

17 Matsui K, "Clinical significance of tubular and podocyte biomarkers in acute kidney injury" 15 : 220-225, 2011

18 Bagshaw SM, "Changes in the incidence and outcome for early acute kidney injury in a cohort of Australian intensive care units" 11 : 68-, 2007

19 Devarajan P, "Biomarkers for the early detection of acute kidney injury" 23 : 194-200, 2011

20 Coca SG, "Biomarkers for the diagnosis and risk stratification of acute kidney injury: a systematic review" 73 : 1008-1016, 2008

21 Hoste EA, "Acute kidney injury: epidemiology and diagnostic criteria" 12 : 531-537, 2006

22 Mehta RL, "Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury" 11 : 31-, 2007

23 Haase M, "Accuracy of neutrophil gelatinase-associated lipocalin (NGAL) in diagnosis and prognosis in acute kidney injury: a systematic review and metaanalysis" 54 : 1012-1024, 2009

24 Vaidya VS, "A rapid urine test for early detection of kidney injury" 76 : 108-114, 2009

25 Le Gall JR, "A new Simplified Acute Physiology Score (SAPS II) based on a European/North American multicenter study" 270 : 2957-2963, 1993