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Urinary biomarkers of AKI and mortality 3 years after cardiac surgery.

Publication ,  Journal Article
Coca, SG; Garg, AX; Thiessen-Philbrook, H; Koyner, JL; Patel, UD; Krumholz, HM; Shlipak, MG; Parikh, CR; TRIBE-AKI Consortium,
Published in: J Am Soc Nephrol
May 2014

Urinary biomarkers of AKI provide prognostic value for in-hospital outcomes, but little is known about their association with longer-term mortality after surgery. We sought to assess the association between kidney injury biomarkers and all-cause mortality in an international, multicenter, prospective long-term follow-up study from six clinical centers in the United States and Canada composed of 1199 adults who underwent cardiac surgery between 2007 and 2009 and were enrolled in the Translational Research in Biomarker Endpoints in AKI cohort. On postoperative days 1-3, we measured the following five urinary biomarkers: neutrophil gelatinase-associated lipocalin, IL-18, kidney injury molecule-1 (KIM-1), liver fatty acid binding protein, and albumin. During a median follow-up of 3.0 years (interquartile range, 2.2-3.6 years), 139 participants died (55 deaths per 1000 person-years). Among patients with clinical AKI, the highest tertiles of peak urinary neutrophil gelatinase-associated lipocalin, IL-18, KIM-1, liver fatty acid binding protein, and albumin associated independently with a 2.0- to 3.2-fold increased risk for mortality compared with the lowest tertiles. In patients without clinical AKI, the highest tertiles of peak IL-18 and KIM-1 also associated independently with long-term mortality (adjusted hazard ratios [95% confidence intervals] of 1.2 [1.0 to 1.5] and 1.8 [1.4 to 2.3] for IL-18 and KIM-1, respectively), and yielded continuous net reclassification improvements of 0.26 and 0.37, respectively, for the prediction of 3-year mortality. In conclusion, urinary biomarkers of kidney injury, particularly IL-18 and KIM-1, in the immediate postoperative period provide additional prognostic information for 3-year mortality risk in patients with and without clinical AKI.

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Published In

J Am Soc Nephrol

DOI

EISSN

1533-3450

Publication Date

May 2014

Volume

25

Issue

5

Start / End Page

1063 / 1071

Location

United States

Related Subject Headings

  • Urology & Nephrology
  • United States
  • Prospective Studies
  • Prognosis
  • Postoperative Period
  • Middle Aged
  • Male
  • Humans
  • Follow-Up Studies
  • Female
 

Citation

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ICMJE
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Coca, S. G., Garg, A. X., Thiessen-Philbrook, H., Koyner, J. L., Patel, U. D., Krumholz, H. M., … TRIBE-AKI Consortium, . (2014). Urinary biomarkers of AKI and mortality 3 years after cardiac surgery. J Am Soc Nephrol, 25(5), 1063–1071. https://doi.org/10.1681/ASN.2013070742
Coca, Steven G., Amit X. Garg, Heather Thiessen-Philbrook, Jay L. Koyner, Uptal D. Patel, Harlan M. Krumholz, Michael G. Shlipak, Chirag R. Parikh, and Chirag R. TRIBE-AKI Consortium. “Urinary biomarkers of AKI and mortality 3 years after cardiac surgery.J Am Soc Nephrol 25, no. 5 (May 2014): 1063–71. https://doi.org/10.1681/ASN.2013070742.
Coca SG, Garg AX, Thiessen-Philbrook H, Koyner JL, Patel UD, Krumholz HM, et al. Urinary biomarkers of AKI and mortality 3 years after cardiac surgery. J Am Soc Nephrol. 2014 May;25(5):1063–71.
Coca, Steven G., et al. “Urinary biomarkers of AKI and mortality 3 years after cardiac surgery.J Am Soc Nephrol, vol. 25, no. 5, May 2014, pp. 1063–71. Pubmed, doi:10.1681/ASN.2013070742.
Coca SG, Garg AX, Thiessen-Philbrook H, Koyner JL, Patel UD, Krumholz HM, Shlipak MG, Parikh CR, TRIBE-AKI Consortium. Urinary biomarkers of AKI and mortality 3 years after cardiac surgery. J Am Soc Nephrol. 2014 May;25(5):1063–1071.

Published In

J Am Soc Nephrol

DOI

EISSN

1533-3450

Publication Date

May 2014

Volume

25

Issue

5

Start / End Page

1063 / 1071

Location

United States

Related Subject Headings

  • Urology & Nephrology
  • United States
  • Prospective Studies
  • Prognosis
  • Postoperative Period
  • Middle Aged
  • Male
  • Humans
  • Follow-Up Studies
  • Female