Urinary Liver-Type Fatty-Acid-Binding Protein Predicts Long-Term Adverse Outcomes in Medical Cardiac Intensive Care Units
We prospectively investigated the prognostic value of urinary liver-type fatty-acid-binding protein (L-FABP) levels on hospital admission, both independently and in combination with serum creatinine-defined acute kidney injury (AKI), to predict long-term adverse outcomes in 1119 heterogeneous patien...
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MDPI AG
2020-02-01
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Series: | Journal of Clinical Medicine |
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Online Access: | https://www.mdpi.com/2077-0383/9/2/482 |
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doaj-63040cc532f44fe681e76d4932e5f698 |
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record_format |
Article |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Hiroyuki Naruse Junnichi Ishii Hiroshi Takahashi Fumihiko Kitagawa Hideto Nishimura Hideki Kawai Takashi Muramatsu Masahide Harada Akira Yamada Wakaya Fujiwara Mutsuharu Hayashi Sadako Motoyama Masayoshi Sarai Eiichi Watanabe Hideo Izawa Yukio Ozaki |
spellingShingle |
Hiroyuki Naruse Junnichi Ishii Hiroshi Takahashi Fumihiko Kitagawa Hideto Nishimura Hideki Kawai Takashi Muramatsu Masahide Harada Akira Yamada Wakaya Fujiwara Mutsuharu Hayashi Sadako Motoyama Masayoshi Sarai Eiichi Watanabe Hideo Izawa Yukio Ozaki Urinary Liver-Type Fatty-Acid-Binding Protein Predicts Long-Term Adverse Outcomes in Medical Cardiac Intensive Care Units Journal of Clinical Medicine liver-type fatty-acid-binding protein long-term outcomes cardiac intensive care units acute kidney injury |
author_facet |
Hiroyuki Naruse Junnichi Ishii Hiroshi Takahashi Fumihiko Kitagawa Hideto Nishimura Hideki Kawai Takashi Muramatsu Masahide Harada Akira Yamada Wakaya Fujiwara Mutsuharu Hayashi Sadako Motoyama Masayoshi Sarai Eiichi Watanabe Hideo Izawa Yukio Ozaki |
author_sort |
Hiroyuki Naruse |
title |
Urinary Liver-Type Fatty-Acid-Binding Protein Predicts Long-Term Adverse Outcomes in Medical Cardiac Intensive Care Units |
title_short |
Urinary Liver-Type Fatty-Acid-Binding Protein Predicts Long-Term Adverse Outcomes in Medical Cardiac Intensive Care Units |
title_full |
Urinary Liver-Type Fatty-Acid-Binding Protein Predicts Long-Term Adverse Outcomes in Medical Cardiac Intensive Care Units |
title_fullStr |
Urinary Liver-Type Fatty-Acid-Binding Protein Predicts Long-Term Adverse Outcomes in Medical Cardiac Intensive Care Units |
title_full_unstemmed |
Urinary Liver-Type Fatty-Acid-Binding Protein Predicts Long-Term Adverse Outcomes in Medical Cardiac Intensive Care Units |
title_sort |
urinary liver-type fatty-acid-binding protein predicts long-term adverse outcomes in medical cardiac intensive care units |
publisher |
MDPI AG |
series |
Journal of Clinical Medicine |
issn |
2077-0383 |
publishDate |
2020-02-01 |
description |
We prospectively investigated the prognostic value of urinary liver-type fatty-acid-binding protein (L-FABP) levels on hospital admission, both independently and in combination with serum creatinine-defined acute kidney injury (AKI), to predict long-term adverse outcomes in 1119 heterogeneous patients (mean age; 68 years) treated at medical (non-surgical) cardiac intensive care units (CICUs). Patients with stage 5 chronic kidney disease were excluded from the study. Of these patients, 47% had acute coronary syndrome and 38% had acute decompensated heart failure. The creatinine-defined AKI was diagnosed according to the “Kidney Disease: Improving Global Outcomes” criteria. The primary endpoint was a composite of all-cause death or progression to end-stage kidney disease, indicating the initiation of maintenance dialysis therapy or kidney transplantation. Creatinine-defined AKI occurred in 207 patients, with 44 patients having stage 2 or 3 disease. During a mean follow-up period of 41 months after enrollment, the primary endpoint occurred in 242 patients. Multivariate Cox regression analyses revealed L-FABP levels as independent predictors of the primary endpoint (<i>p</i> < 0.001). Adding L-FABP to a baseline model with established risk factors further enhanced reclassification and discrimination beyond that of the baseline model alone, for primary-endpoint prediction (both; <i>p</i> < 0.01). On Kaplan−Meier analyses, increased L-FABP (≥4th quintile value of 9.0 ng/mL) on admission or presence of creatinine-defined AKI, correlated with an increased risk of the primary endpoint (<i>p</i> < 0.001). Thus, urinary L-FABP levels on admission are potent and independent predictors of long-term adverse outcomes, and they might improve the long-term risk stratification of patients admitted at medical CICUs, when used in combination with creatinine-defined AKI. |
topic |
liver-type fatty-acid-binding protein long-term outcomes cardiac intensive care units acute kidney injury |
url |
https://www.mdpi.com/2077-0383/9/2/482 |
work_keys_str_mv |
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doaj-63040cc532f44fe681e76d4932e5f6982020-11-25T01:47:09ZengMDPI AGJournal of Clinical Medicine2077-03832020-02-019248210.3390/jcm9020482jcm9020482Urinary Liver-Type Fatty-Acid-Binding Protein Predicts Long-Term Adverse Outcomes in Medical Cardiac Intensive Care UnitsHiroyuki Naruse0Junnichi Ishii1Hiroshi Takahashi2Fumihiko Kitagawa3Hideto Nishimura4Hideki Kawai5Takashi Muramatsu6Masahide Harada7Akira Yamada8Wakaya Fujiwara9Mutsuharu Hayashi10Sadako Motoyama11Masayoshi Sarai12Eiichi Watanabe13Hideo Izawa14Yukio Ozaki15Department of Joint Research Laboratory of Clinical Medicine, Fujita Health University School of Medicine, Toyoake 470-1192, JapanDepartment of Joint Research Laboratory of Clinical Medicine, Fujita Health University School of Medicine, Toyoake 470-1192, JapanDivision of Statistics, Fujita Health University School of Medicine, Toyoake 470-1192, JapanDepartment of Joint Research Laboratory of Clinical Medicine, Fujita Health University School of Medicine, Toyoake 470-1192, JapanDepartment of Cardiology, Fujita Health University School of Medicine, Toyoake 470-1192, JapanDepartment of Cardiology, Fujita Health University School of Medicine, Toyoake 470-1192, JapanDepartment of Cardiology, Fujita Health University School of Medicine, Toyoake 470-1192, JapanDepartment of Cardiology, Fujita Health University School of Medicine, Toyoake 470-1192, JapanDepartment of Cardiology, Fujita Health University School of Medicine, Toyoake 470-1192, JapanDepartment of Cardiology, Bantane Hospital, Nagoya 454-8509, JapanDepartment of Cardiology, Bantane Hospital, Nagoya 454-8509, JapanDepartment of Cardiology, Fujita Health University School of Medicine, Toyoake 470-1192, JapanDepartment of Cardiology, Fujita Health University School of Medicine, Toyoake 470-1192, JapanDepartment of Cardiology, Fujita Health University School of Medicine, Toyoake 470-1192, JapanDepartment of Cardiology, Bantane Hospital, Nagoya 454-8509, JapanDepartment of Cardiology, Fujita Health University School of Medicine, Toyoake 470-1192, JapanWe prospectively investigated the prognostic value of urinary liver-type fatty-acid-binding protein (L-FABP) levels on hospital admission, both independently and in combination with serum creatinine-defined acute kidney injury (AKI), to predict long-term adverse outcomes in 1119 heterogeneous patients (mean age; 68 years) treated at medical (non-surgical) cardiac intensive care units (CICUs). Patients with stage 5 chronic kidney disease were excluded from the study. Of these patients, 47% had acute coronary syndrome and 38% had acute decompensated heart failure. The creatinine-defined AKI was diagnosed according to the “Kidney Disease: Improving Global Outcomes” criteria. The primary endpoint was a composite of all-cause death or progression to end-stage kidney disease, indicating the initiation of maintenance dialysis therapy or kidney transplantation. Creatinine-defined AKI occurred in 207 patients, with 44 patients having stage 2 or 3 disease. During a mean follow-up period of 41 months after enrollment, the primary endpoint occurred in 242 patients. Multivariate Cox regression analyses revealed L-FABP levels as independent predictors of the primary endpoint (<i>p</i> < 0.001). Adding L-FABP to a baseline model with established risk factors further enhanced reclassification and discrimination beyond that of the baseline model alone, for primary-endpoint prediction (both; <i>p</i> < 0.01). On Kaplan−Meier analyses, increased L-FABP (≥4th quintile value of 9.0 ng/mL) on admission or presence of creatinine-defined AKI, correlated with an increased risk of the primary endpoint (<i>p</i> < 0.001). Thus, urinary L-FABP levels on admission are potent and independent predictors of long-term adverse outcomes, and they might improve the long-term risk stratification of patients admitted at medical CICUs, when used in combination with creatinine-defined AKI.https://www.mdpi.com/2077-0383/9/2/482liver-type fatty-acid-binding proteinlong-term outcomescardiac intensive care unitsacute kidney injury |