Abstract: TH-PO102
Assessment of Urinary Biomarkers for AKI in Major Elective Nonvascular Abdominal Surgeries
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 Medical School, Sao Paulo, Brazil
- de Souza, Graziela R. B., University of Sao Paulo Medical School, Sao Paulo, Brazil
- Zanetta, Dirce M T, University of São Paulo, S Paulo, Brazil
- Yu, Luis, University of Sao Paulo Medical School, Sao Paulo, Brazil
- Antonangelo, Leila, University of Sao Paulo Medical School, Sao Paulo, Brazil
- Burdmann, Emmanuel A., University of Sao Paulo Medical School, Sao Paulo, Brazil
Background
Data on the role of renal injury urinary biomarkers (uBMs) to predict AKI in patients (pts) submitted to major elective non-vascular abdominal surgeries (MENVAS) are scarce.
Methods
A total of 298 pts submitted to MENVAS were prospectively assessed and evaluated, pre, peri-operatively and from the ICU admission up to 7 days. Serum creatinine (SCr) was assessed before surgery and once a day up to 7d or until ICU discharge. Hourly urinary output (UO) (ml/kg/h) was measured. AKI was diagnosed by either SCr or/and UO (KDIGO definitions). Urine was collected 1d before surgery (baseline), 30 min, 12 and 24h after ICU admission. Monocyte chemotactic protein 1 (MCP-1), interleukin 18 (IL-18), kidney injury molecule-1 (KIM-1), neutrophil gelatinase-associated lipocalin (NGAL), tissue inhibitor of metalloproteinase 2 (TIMP-2) and insulin-like growth factor-binding protein 7 (IGFBP-7) were assessed by Luminex x-MAP. Data are median (1st and 3rd quartiles) or frequency. AUC of ROC curves was assessed using non-AKI/AKI KDIGO I as controls and AKI KDIGO II/III as positive results. We assessed different combinations of uBMs to find the better performance. Statistical significance was p<0.05.
Results
Overall, age was 56±15y, 59.1% were female, hospital LoS was 17.7±16.2d, ICU LoS was 3.1±2.9d and 90d mortality was 6.4%. A total of 197 pts (60.1%) developed AKI, mostly KDIGO I (118 pts, 59.9%). The uBMs combination with the higher AUC was KIM-1 vs NGAL vs IGFBP-7 (baseline: 0.65; 30min: 0.72; 12h: 0.79; 24h: 0.72), which was better than any of the uBMs alone, or other combinations, including the product TIMP-2 vs. IGFBP-7(baseline: 0.62; 30min: 0.65; 12h: 0.75; 24h: 0.72).
Conclusion
We found a strikingly high incidence of MENVAS-associated AKI diagnosed by KDIGO criteria in patients admitted at the ICU. The uBM with the better performance to diagnose moderate and severe AKI was the combinations of KIM-1 vs. NGAL vs. IGFBP-7 12h after ICU admission.
Funding
- Government Support - Non-U.S.