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Kidney Week

Abstract: TH-PO027

Prognostic Value of Urinary Liver-Type Fatty Acid-Binding Protein (uL-FABP) for Major Adverse Kidney Outcomes Among Critically Ill Adult Septic Patients

Session Information

Category: Acute Kidney Injury

  • 102 AKI: Clinical‚ Outcomes‚ and Trials

Authors

  • Boado, Carlo Antonio, St. Luke's Medical Center, Quezon City, Philippines
  • Bayaca, Jeanne Bernal, St. Luke's Medical Center, Quezon City, Philippines
  • Masbang, Armin N., St. Luke's Medical Center, Quezon City, Philippines
Background

Urinary L-FABP is predominantly located in the proximal tubule and is excreted into the tubular lumen bound to toxic peroxisomal products which accumulate during tubular injury. uL-FABP is detected by a urine test for the early diagnosis of AKI however, its evidence for prognostication remains unclear. This study aimed to determine the utility of uL-FABP to predict the development of major adverse kidney outcomes: critical AKI, initiation of kidney replacement therapy (KRT), and AKI-related mortality over 30 days among critically ill septic patients in an academic medical center.

Methods

Urinary L-FABP was tested among critically ill septic patients upon arrival at the emergency department. Patients were then classified according to the uL-FABP test. Patients were then followed up for 30-day major adverse kidney outcomes which include - critical AKI, initiation of KRT, and AKI-related mortality. We also analyzed independent clinical variables that increase the risk for adverse kidney outcomes.

Results

A total of 118 septic patients were included in the study. AKI was diagnosed among 87.2% of the subjects. Patients positive for uL-FABP (48) had severe organ dysfunction and the proportion of those with critical AKI (85.42% vs. 40.00%, p=0.001), KRT initiation (75.00% vs. 20.00%, p=0.001) and mortality (72.92% vs. 21.43%, p=0.001) were all significantly higher among those who tested positive for the uL-FABP test. Cox proportional-hazard regression analyses showed that uL-FABP was able to predict major adverse kidney outcomes among septic patients - critical AKI (HR 3.26 (2-5.3) p=0.0001, KRT initiation (HR 3.13 (3.29-11.43) p=0.0001 and AKI-related mortality (HR 3.13 (3.29-11.43) p=0.0001 over 30 days of observation. Independent variables such as diabetes and chronic kidney disease and dipstick proteinuria correlated were associated with increased risk for adverse kidney outcomes.

Conclusion

Urinary L-FABP test is a readily available biomarker for prognostication as it was able to predict 30-day major adverse kidney outcomes among critically ill septic patients. Independent variables like diabetes and chronic kidney disease and an increasing level of proteinuria from the dipstick test are correlated with increased risk for major adverse kidney outcomes.