Serum heart-type fatty acid-binding protein level can be used to detect acute kidney injury on admission and predict an adverse outcome in patients with acute heart failure

Circ J. 2015;79(1):119-28. doi: 10.1253/circj.CJ-14-0653. Epub 2014 Nov 8.

Abstract

Background: Different mechanisms of acute kidney injury (AKI) may exist for acute heart failure (AHF) patients compared with other patients.

Methods and results: We analyzed data from 282 patients with AHF. The biomarkers were measured within 30 min of admission. Patients were assigned to a no-AKI (n=213) or AKI group (Class R (n=49), Class I (n=15) or Class F (n=5)) using the RIFLE classifications on admission. We evaluated the relationships between the biomarkers and AKI, in-hospital mortality, all-cause death and HF events (HF re-admission, all-cause death) within 90 days. The serum heart-type fatty acid-binding protein (s-HFABP) levels were significantly higher in the AKI than in the no-AKI group, and the predictive biomarker for AKI was s-HFABP (odds ratio: 6.709; 95% confidence interval: 3.362-13.391). s-HFABP demonstrated an optimal balance between sensitivity and specificity (71.0%, 79.3%; area under the receiver-operating characteristic curve [AUC]=0.790) at 22.8 ng/ml for AKI, at 22.8 ng/ml for Class I/F (90.0%, 71.4%; AUC=0.836) and at 21.0 ng/ml for in-hospital mortality (74.3%, 70.0%; AUC=0.726). The Kaplan-Meier survival curves showed a significantly poorer prognosis in the high s-HFABP group (≥22.9 ng/ml) than in other groups.

Conclusions: The s-HFABP level can indicate AKI on admission, and a high s-HFABP level is associated with a poorer prognosis for AHF patients.

MeSH terms

  • Acute Disease
  • Acute Kidney Injury / blood*
  • Acute Kidney Injury / diagnosis
  • Acute Kidney Injury / etiology
  • Acute Kidney Injury / urine
  • Acute-Phase Proteins / urine
  • Aged
  • Animals
  • Area Under Curve
  • Biomarkers / blood
  • Biomarkers / urine
  • Cause of Death
  • Dogs
  • Fatty Acid Binding Protein 3
  • Fatty Acid-Binding Proteins / blood*
  • Fatty Acid-Binding Proteins / urine
  • Female
  • Follow-Up Studies
  • Heart Failure / blood*
  • Heart Failure / complications
  • Heart Failure / urine
  • Hospital Mortality
  • Humans
  • Kaplan-Meier Estimate
  • Kidney Function Tests
  • Length of Stay
  • Lipocalin-2
  • Lipocalins / urine
  • Male
  • Natriuretic Peptide, Brain / blood
  • Peptide Fragments / blood
  • Prognosis
  • Proportional Hazards Models
  • Proto-Oncogene Proteins / urine
  • ROC Curve

Substances

  • Acute-Phase Proteins
  • Biomarkers
  • FABP1 protein, human
  • FABP3 protein, human
  • Fatty Acid Binding Protein 3
  • Fatty Acid-Binding Proteins
  • LCN2 protein, human
  • Lipocalin-2
  • Lipocalins
  • Peptide Fragments
  • Proto-Oncogene Proteins
  • pro-brain natriuretic peptide (1-76)
  • Natriuretic Peptide, Brain