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Urinary chitinase 3-like protein 1 for early diagnosis of acute kidney injury : a prospective cohort study in adult critically ill patients

Jorien De Loor (UGent) , Johan Decruyenaere (UGent) , Kristel Demeyere (UGent) , Lieve Nuytinck (UGent) , Eric Hoste (UGent) and Evelyne Meyer (UGent)
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Abstract
Background: Acute kidney injury (AKI) occurs frequently and adversely affects patient and kidney outcomes, especially when its severity increases from stage 1 to stages 2 or 3. Early interventions may counteract such deterioration, but this requires early detection. Our aim was to evaluate whether the novel renal damage biomarker urinary chitinase 3-like protein 1 (UCHI3L1) can detect AKI stage >= 2 more early than serum creatinine and urine output, using the respective Kidney Disease vertical bar Improving Global Outcomes (KDIGO) criteria for definition and classification of AKI, and compare this to urinary neutrophil gelatinase-associated lipocalin (UNGAL). Methods: This was a translational single-center, prospective cohort study at the 22-bed surgical and 14-bed medical intensive care units (ICU) of Ghent University Hospital. We enrolled 181 severely ill adult patients who did not yet have AKI stage >= 2 based on the KDIGO criteria at time of enrollment. The concentration of creatinine (serum, urine) and CHI3L1 (serum, urine) was measured at least daily, and urine output hourly, in the period from enrollment till ICU discharge with a maximum of 7 ICU-days. The concentration of UNGAL was measured at enrollment. The primary endpoint was the development of AKI stage >= 2 within 12 h after enrollment. Results: After enrollment, 21 (12 %) patients developed AKI stage >= 2 within the next 7 days, with 6 (3 %) of them reaching this condition within the first 12 h. The enrollment concentration of UCHI3L1 predicted the occurrence of AKI stage >= 2 within the next 12 h with a good AUC-ROC of 0.792 (95 % CI: 0.726-0.849). This performance was similar to that of UNGAL (AUC-ROC of 0.748 (95 % CI: 0.678-0.810)). Also, the samples collected in the 24-h time frame preceding diagnosis of the 1st episode of AKI stage >= 2 had a 2.0 times higher (95 % CI: 1.3-3.1) estimated marginal mean of UCHI3L1 than controls. We further found that increasing UCHI3L1 concentrations were associated with increasing AKI severity. Conclusions: In this pilot study we found that UCHI3L1 was a good biomarker for prediction of AKI stage >= 2 in adult ICU patients.
Keywords
Intensive care, Lipocalins, Chitinase, Biological markers, Acute kidney injury, HUMAN NEUTROPHILS, CYCLE ARREST BIOMARKERS, INTENSIVE-CARE UNITS, MATRIX PROTEIN, RIFLE CRITERIA, HOSPITALIZED-PATIENTS, GELATINASE-ASSOCIATED LIPOCALIN, CARDIAC-SURGERY, REAL-TIME, AKI

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Chicago
De Loor, Jorien, Johan Decruyenaere, Kristel Demeyere, Lieve Nuytinck, Eric Hoste, and Evelyne Meyer. 2016. “Urinary Chitinase 3-like Protein 1 for Early Diagnosis of Acute Kidney Injury : a Prospective Cohort Study in Adult Critically Ill Patients.” Critical Care 20.
APA
De Loor, J., Decruyenaere, J., Demeyere, K., Nuytinck, L., Hoste, E., & Meyer, E. (2016). Urinary chitinase 3-like protein 1 for early diagnosis of acute kidney injury : a prospective cohort study in adult critically ill patients. CRITICAL CARE, 20.
Vancouver
1.
De Loor J, Decruyenaere J, Demeyere K, Nuytinck L, Hoste E, Meyer E. Urinary chitinase 3-like protein 1 for early diagnosis of acute kidney injury : a prospective cohort study in adult critically ill patients. CRITICAL CARE. 2016;20.
MLA
De Loor, Jorien, Johan Decruyenaere, Kristel Demeyere, et al. “Urinary Chitinase 3-like Protein 1 for Early Diagnosis of Acute Kidney Injury : a Prospective Cohort Study in Adult Critically Ill Patients.” CRITICAL CARE 20 (2016): n. pag. Print.
@article{7192111,
  abstract     = {Background: Acute kidney injury (AKI) occurs frequently and adversely affects patient and kidney outcomes, especially when its severity increases from stage 1 to stages 2 or 3. Early interventions may counteract such deterioration, but this requires early detection. Our aim was to evaluate whether the novel renal damage biomarker urinary chitinase 3-like protein 1 (UCHI3L1) can detect AKI stage {\textrangle}= 2 more early than serum creatinine and urine output, using the respective Kidney Disease vertical bar Improving Global Outcomes (KDIGO) criteria for definition and classification of AKI, and compare this to urinary neutrophil gelatinase-associated lipocalin (UNGAL). 
Methods: This was a translational single-center, prospective cohort study at the 22-bed surgical and 14-bed medical intensive care units (ICU) of Ghent University Hospital. We enrolled 181 severely ill adult patients who did not yet have AKI stage {\textrangle}= 2 based on the KDIGO criteria at time of enrollment. The concentration of creatinine (serum, urine) and CHI3L1 (serum, urine) was measured at least daily, and urine output hourly, in the period from enrollment till ICU discharge with a maximum of 7 ICU-days. The concentration of UNGAL was measured at enrollment. The primary endpoint was the development of AKI stage {\textrangle}= 2 within 12 h after enrollment. 
Results: After enrollment, 21 (12 \%) patients developed AKI stage {\textrangle}= 2 within the next 7 days, with 6 (3 \%) of them reaching this condition within the first 12 h. The enrollment concentration of UCHI3L1 predicted the occurrence of AKI stage {\textrangle}= 2 within the next 12 h with a good AUC-ROC of 0.792 (95 \% CI: 0.726-0.849). This performance was similar to that of UNGAL (AUC-ROC of 0.748 (95 \% CI: 0.678-0.810)). Also, the samples collected in the 24-h time frame preceding diagnosis of the 1st episode of AKI stage {\textrangle}= 2 had a 2.0 times higher (95 \% CI: 1.3-3.1) estimated marginal mean of UCHI3L1 than controls. We further found that increasing UCHI3L1 concentrations were associated with increasing AKI severity. 
Conclusions: In this pilot study we found that UCHI3L1 was a good biomarker for prediction of AKI stage {\textrangle}= 2 in adult ICU patients.},
  articleno    = {38},
  author       = {De Loor, Jorien and Decruyenaere, Johan and Demeyere, Kristel and Nuytinck, Lieve and Hoste, Eric and Meyer, Evelyne},
  issn         = {1466-609X},
  journal      = {CRITICAL CARE},
  keyword      = {Intensive care,Lipocalins,Chitinase,Biological markers,Acute kidney injury,HUMAN NEUTROPHILS,CYCLE ARREST BIOMARKERS,INTENSIVE-CARE UNITS,MATRIX PROTEIN,RIFLE CRITERIA,HOSPITALIZED-PATIENTS,GELATINASE-ASSOCIATED LIPOCALIN,CARDIAC-SURGERY,REAL-TIME,AKI},
  language     = {eng},
  pages        = {14},
  title        = {Urinary chitinase 3-like protein 1 for early diagnosis of acute kidney injury : a prospective cohort study in adult critically ill patients},
  url          = {http://dx.doi.org/10.1186/s13054-016-1192-x},
  volume       = {20},
  year         = {2016},
}

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