Abstract: TH-PO106
Urinary Biomarkers Normalization by Urinary Creatinine in Patients Submitted to Major Elective Nonvascular Abdominal Surgeries: Is It Necessary?
Session Information
- AKI: Biomarkers, Drugs, Onco-Nephrology
November 07, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Acute Kidney Injury
- 102 AKI: Clinical, Outcomes, and Trials
Authors
- Marçal, Lia J., University of Sao Paulo School of Medicine, Sao Paulo, Brazil
- de Souza, Graziela R. B., University of Sao Paulo School of Medicine, Sao Paulo, Brazil
- Zanetta, Dirce M T, University of São Paulo, S Paulo, Brazil
- Yu, Luis, University of Sao Paulo School of Medicine, Sao Paulo, Brazil
- Antonangelo, Leila, University of Sao Paulo School of Medicine, Sao Paulo, Brazil
- Burdmann, Emmanuel A., University of Sao Paulo School of Medicine, Sao Paulo, Brazil
Background
There is no consensus regarding urinary biomarkers (uBM) performance using absolute and normalized by urinary creatinine concentration.
Methods
A total of 298 patients (pts) submitted to major elective non-vascular abdominal surgeries (MENVAS) were prospectively assessed. Serum creatinine (SCr) was assessed before surgery and once a day up to 7d post-op or ICU discharge. Hourly urinary output (ml/kg/h) was measured daily. AKI was diagnosed using either SCr or/and urinary output (UO) according to KDIGO definitions. Urinary samples were collected 1 day before surgery (baseline), and 30 min, 12 and 24h after ICU admission. Urinary Cr (uCr) and 7 uBMs were assessed: monocyte chemotactic protein 1 (MCP-1), interleukin 18 (IL-18), kidney injury molecule-1 (KIM-1), osteopontin (OPN), neutrophil gelatinase-associated lipocalin (NGAL), tissue inhibitor of metalloproteinase 2 (TIMP-2) and insulin-like growth factor-binding protein 7 (IGFBP-7) by Luminex x-MAP method. Data are presented as AUC from ROC curves. Statistical significance was p<0.05.
Results
A total of 197 pts (60.1%) developed AKI, mostly KDIGO I. Those developing AKI KDIGO II and III had significantly higher uBMs compared to AKI KDIGO I or non-AKI in all times. We used non-AKI and AKI KDIGO I as controls and AKI KDIGO II and III as positive results to develop of ROC curve. The uBMs’ AUC results (w/ or w/o uCr) are presented in table 1. AUC w/o uCr normalization results were consistently higher for all uBMs. AUC normalized for uCr loses the AUC significance for NGAL at baseline and IL-18 at 24h.
Conclusion
uBMs had better performance w/o normalization for uCr in all periods after surgery and a similar performance in baseline. These results suggest that uBMs results should not be normalized for uCr after MENVAS.
Difference in AUC of absolute and normalized uBMs concentrations
| uBM | Baseline | 30 minutes -ICU | 12h -ICU | 24h - ICU | ||||
| uBM | uBM/uCr | uBM | uBM/uCr | uBM | uBM/uCr | uBM | uBM/uCr | |
| MCP-1 | 0.60 | 0.60 | 0.67 | 0.64 | 0.69 | 0.63 | 0.64 | 0.59 |
| IL-18 | 0.63 | 0.57 | 0.64 | 0.59 | 0.65 | 0.60 | 0.61 | 0.54 ns |
| KIM-1 | 0.63 | 0.64 | 0.70 | 0.70 | 0.72 | 0.67 | 0.67 | 0.63 |
| OPN | 0.58 | 0.59 | 0.66 | 0.64 | 0.66 | 0.61 | 0.64 | 0.59 |
| NGAL | 0.58 | 0.53 ns | 0.64 | 0.61 | 0.71 | 0.67 | 0.63 | 058 |
| TIMP-2 | 0.56 ns | 0.55 ns | 0.60 | 0.59 | 0.70 | 0.66 | 0.67 | 0.61 |
| IGFBP-7 | 0.64 | 0.65 | 0.68 | 0.65 | 0.74 | 0.70 | 0.72 | 0.67 |
ns AUC not significant
Funding
- Government Support - Non-U.S.