Novel biomarkers for prediction of acute kidney injury in acute heart failure.

Bjectives: Acute kidney injury (AKI) is a frequent event in patients with an acute heart failure (AHF) and is associated with a poor short and long-term outcome. The aim of this study was to describe diagnostic yield of selected novel biomarkers in prediction of AKI in patients admitted for AHF.

Methods: We performed a prospective cohort study of 72 consecutive patients (46/26 M/F) aged 69±10,3 years admitted for AHF. Renal damage was defined according to KDIGO guidelines. Patients were divided into the two groups: AKI- (without renal injury, n=52) and AKI+ (with renal injury, n=20). Urine samples for AKI biomarkers measurements (NGAL, TIMP2, IGFBP7) were collected at the admission. The ROC and linear logistic regression of new biomarkers and selected clinical variables was performed for the evaluation of the AKI prediction.

Results: The patients with AKI+ were older (median age: 75 vs 64 years, p=0.01), had lower BMI (median: 28 vs 29.5 kg/m2, p=0.04), were with a higher proportion of patients with HF with a reduced ejection fraction (55 % vs 23.1 %, p=0.01) and a higher level of serum NTproBNP. Urinary NGAL at admission was significantly higher in the AKI+ compared to the AKI - group (152 vs 19.5 ng/mL, p<0.0001); also median of u-TIMP-2 and u-IGFBP-7 in the AKI+ patients was significantly higher: 194.1 versus 42.5 ng/mL (p<0.0001) and 379 versus 92.4 pg/mL (p<0.0001) resp. Age, u-NGAL, u-TIMP2, u-IGFBP7, s-haemoglobin, NTproBNP and LVEF were associated with the development of AKI. Urine concentration of IGFBP-7 was measured, which is the best marker for the prediction of AKI (AUC 0.94).

Conclusion: Urine concentrations of NGAL, TIMP2, IGFBP7 at the time of admission for AHF predicted a development of AKI. Age, NTproBNP, LVEF and s-haemoglobin were also associated with AKI in AHF patients (Tab. 3, Fig. 3, Ref. 22). Text in PDF www.elis.sk Keywords: biomarkers, cardiorenal syndrome, acute heart failure.