Background
Methods
Subjects
Serum biomarker measurement
Evaluation of AKI
Procedures and prognoses
Statistical analysis
Results
Patient characteristics
total (n = 494) | no AKI (n = 349) | AKI | ||||
---|---|---|---|---|---|---|
Class R (n = 83) | Class I (n = 36) | Class F (n = 26) | P value | |||
Age (years old) | 71 (62–79) | 71 (62–80) | 71 (64–79) | 67 (62–76) | 78 (69–81) | 0.092 |
Gender (male, %) | 336 (68.0 %) | 237 (67.9 %) | 56 (67.5 %) | 28 (77.8 %) | 15 (57.7 %) | |
Etiology | ||||||
Acute Heart Failure (yes) | 242 (49.0 %) | 186 (53.3 %) | 37 (44.6 %) | 12 (33.3 %) | 7 (26.9 %) | 0.008 |
Acute Aortic Dissection (yes) | 48 (9.7 %) | 34 (9.7 %) | 11 (13.3 %) | 3 (8.3 %) | 0 (0.0 %) | 0.255 |
Pulmonary Thromboembolism (yes) | 21 (4.3 %) | 17 (4.9 %) | 3 (3.6 %) | 1 (2.8 %) | 0 (0.0 %) | 0.624 |
Arrhythmia (yes) | 65 (13.2 %) | 38 (10.9 %) | 14 (16.9 %) | 7 (19.4 %) | 6 (23.1 %) | 0.109 |
Coronary Spasms (yes) | 22 (4.5 %) | 21 (6.0 %) | 1 (1.2 %) | 0 (0.0 %) | 0 (0.0 %) | 0.073 |
Takotsubo Cardiomyopathy (yes) | 13 (2.6 %) | 10 (2.9 %) | 1 (1.2 %) | 1 (2.8 %) | 1 (3.4 %) | 0.829 |
Infectious disease (yes) | 32 (6.5 %) | 9 (2.6 %) | 9 (10.8 %) | 7 (19.4 %) | 7 (26.9 %) | <0.001 |
Other Intensive Care disease (yes) | 36 (7.3 %) | 20 (5.7 %) | 6 (7.2 %) | 5 (13.9 %) | 5 (19.2 %) | 0.028 |
Past medical history | ||||||
Chronic Kidney Disease (yes) | 211 (42.7 %) | 159 (45.6 %) | 31 (37.3 %) | 12 (33.3 %) | 9 (34.6 %) | 0.249 |
Hypertension (yes) | 360 (72.9 %) | 260 (74.5 %) | 55 (66.3 %) | 25 (69.4 %) | 20 (76.9 %) | 0.435 |
Diabetes mellitus (yes) | 174 (35.2 %) | 115 (33.0 %) | 36 (43.4 %) | 9 (25.0 %) | 14 (53.8 %) | 0.032 |
Dyslipidemia (yes) | 234 (47.4 %) | 170 (48.7 %) | 40 (48.2 %) | 14 (38.9 %) | 10 (38.5 %) | 0.544 |
Vital signs and status | ||||||
Systolic blood pressure (mmHg) | 147 (116–174) | 156 (129–182) | 137 (101–164) | 115 (103–133) | 107 (87–128) | <0.001 |
Diastolic blood pressure (mmHg) | 80 (64–100) | 84 (70–101) | 74 (60–91) | 64 (52–74) | 55 (44–70) | <0.001 |
Pulse Rate (beats/min) | 98 (75–119) | 100 (78–120) | 92 (67–115) | 97 (66–110) | 83 (59–120) | 0.141 |
Respiratory Rate (beats/min) | 25 (20–32) | 25 (20–32) | 24 (17–34) | 21 (18–27) | 20 (15–26) | 0.050 |
Body Temperature (°C) | 36.3 (35.7–36.8) | 36.3 (35.8–36.7) | 36.3 (35.5–36.8) | 36.7 (36.2–37.3) | 36.6 (35.9–37.5) | 0.006 |
Body Mass Index (%) | 22.9 (20.3–25.4) | 23.1 (20.4–25.8) | 23.0 (21.0–25.2) | 21.7 (19.8–23.8) | 22.7 (19.0–25.1) | 0.094 |
LVEF (%) | 50 (32–65) | 50 (35–64) | 47 (29–65) | 45 (29–69) | 50 (45–65) | 0.466 |
Arterial blood gas | ||||||
pH | 7.40 (7.28–7.44) | 7.40 (7.29–7.44) | 7.37 (7.20–7.42) | 7.40 (7.31–7.46) | 7.35 (7.27–7.42) | 0.052 |
PCO2 (mmHg) | 38 (33–48) | 39 (34–48) | 36 (33–53) | 32 (27–40) | 34 (30–43) | <0.001 |
PO2 (mmHg) | 101 (73–156) | 100 (72–149) | 112 (73–181) | 116 (80–162) | 81 (68–128) | 0.249 |
HCO3 - (mmol/l) | 22.4 (19.2–24.9) | 23.1 (20.6–25.1) | 20.4 (17.8–24.3) | 20.2 (15.5–23.5) | 18.8 (14.7–23.0) | <0.001 |
SaO2 (%) | 97 (94–99) | 97 (94–99) | 97 (94–99) | 98 (96–99) | 96 (93–98) | 0.243 |
Lactate (mmol/l) | 1.7 (1.1–3.3) | 1.5 (1.1–2.6) | 2.7 (1.4–6.1) | 2.0 (1.1–8.4) | 2.4 (1.2–7.4) | <0.001 |
Laboratory data | ||||||
WBC (U/l) | 9,630 (7,000–12,590) | 9,245 (6,868–12,018) | 10,250 (7,915–13,630) | 10,800 (7,810–14,710) | 8,370 (6,678–13,405) | 0.018 |
Hemoglobin (g/dl) | 12.6 (10.7–14.3) | 12.7 (11.1–14.4) | 13.4 (10.8–14.7) | 11.3 (9.4–12.7) | 9.7 (8.5–11.9) | <0.001 |
BUN (mg/dl) | 22.4 (16.5–33.3) | 19.9 (15.9–28.2) | 24.9 (18.3–33.2) | 39.3 (23.8–51.1) | 55.6 (46.5–83.1) | <0.001 |
Creatinine (mg/dl) | 1.10 (0.82–1.69) | 0.99 (0.75–1.35) | 1.23 (1.00–1.53) | 1.74 (1.12–2.16) | 3.27 (2.20–4.84) | <0.001 |
Sodium (mmol/l) | 140 (137–142) | 140 (138–142) | 139 (136–142) | 137 (133–142) | 139 (136–142) | 0.007 |
Potassium (mmol/l) | 4.1 (3.8-4.7) | 4.0 (3.7-4.5) | 4.3 (3.9-4.9) | 4.5 (3.8-5.5) | 4.9 (3.9-6.5) | <0.001 |
BS (mg/dl) | 157 (122–235) | 154 (119–233) | 174 (144–303) | 143 (124–242) | 130 (97–174) | <0.001 |
CRP (mg/dl) | 0.61 (0.11–3.17) | 0.41 (0.09–1.27) | 0.99 (0.14–5.88) | 3.34 (0.83–9.08) | 3.51 (0.42–8.17) | <0.001 |
Uric Acid (mg/dl) | 6.8 (5.2–8.2) | 6.4 (5.1–7.6) | 8.2 (6.1–9.2) | 7.4 (6.7–9.9) | 8.4 (6.0–11.8) | <0.001 |
BNP (pg/ml) | 431 (95–951) | 426 (76–901) | 389 (157–750) | 691 (139–2007) | 437 (263–1231) | 0.090 |
hs-TropT (ng/ml) | 0.05 (0.02–0.12) | 0.04 (0.02–0.09) | 0.05 (0.02–0.18) | 0.07 (0.05–0.38) | 0.08 (0.05–0.14) | <0.001 |
Nt-proBNP (pg/ml) | 2,550 (633–8,653) | 2,333 (378–6,753) | 2,746 (924–7,958) | 6,975 (1,946–47,228) | 10,959 (2,686–23,400) | <0.001 |
H-FABP (ng/ml) | 11.7 (6.2–27.8) | 8.8 (5.4–17.7) | 21.1 (10.2–47.9) | 41.5 (16.7–71.6) | 79.2 (29.9–200.3) | <0.001 |
Mechanical Support (cases) during the ICU stay | ||||||
NPPV (yes, %) | 209 (42.3 %) | 161 (46.1 %) | 35 (42.2 %) | 10 (27.8 %) | 3 (11.5 %) | 0.002 |
ETI (yes, %) | 121 (24.5 %) | 53 (15.2 %) | 36 (43.4 %) | 18 (50.0 %) | 14 (53.8 %) | <0.001 |
Pacing (yes, %) | 37 (7.5 %) | 20 (5.7 %) | 8 (9.6 %) | 6 (16.7 %) | 3 (11.5 %) | 0.069 |
IABP (yes, %) | 26 (5.3 %) | 9 (2.6 %) | 10 (12.0 %) | 5 (13.9 %) | 2 (7.7 %) | <0.001 |
PCPS (yes, %) | 17 (3.4 %) | 5 (1.4 %) | 7 (8.4 %) | 3 (8.3 %) | 2 (7.7 %) | 0.002 |
CHDF (yes, %) | 60 (12.1 %) | 15 (4.3 %) | 11 (13.3 %) | 17 (47.2 %) | 17 (65.4 %) | <0.001 |
HFABP and AKI
Q1 | Q2 | Q3 | Q4 | ||
---|---|---|---|---|---|
H-FABP≦6.2 (n = 124) | 6.3≦H-FABP≦11.6 (n = 123) | 11.7≦H-FABP≦27.8 (n = 124) | 27.9≦H-FABP (n = 123) | p value | |
Acute kidney injury | |||||
no-AKI (yes, %) | 113 (91.1 %) | 102 (82.9 %) | 90 (72.6 %) | 44 (35.8 %) | <0.001 |
Class R (yes, %) | 9 (7.3 %) | 16 (13.0 %) | 23 (18.5 %) | 35 (28.5 %) | <0.001 |
Class I (yes, %) | 1 (0.8 %) | 5 (4.1 %) | 6 (4.8 %) | 24 (19.5 %) | <0.001 |
Class F (yes, %) | 1 (0.8 %) | 0 (0.0 %) | 5 (4.0 %) | 20 (16.3 %) | <0.001 |
Biomarkers | |||||
hs-TropT (ng/ml) | 0.02 (0.01–0.03) | 0.04 (0.02–0.06) | 0.06 (0.03–0.10) | 0.14 (0.06–0.54) | <0.001 |
Nt-proBNP (pg/ml) | 351 (68–1,748) | 2,401 (925–5,451) | 5,739 (1,991–13,267) | 7929 (2,164–23,269) | <0.001 |
In-hospital mortality | |||||
dead (yes, %) | 3 (2.4 %) | 5 (4.1 %) | 18 (14.5 %) | 38 (30.9 %) | <0.001 |
AKI | Class I/F | |||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Univariate analysis | Multivariate analysis | Univariate analysis | Multivariate analysis | |||||||||
OR | 95 % CI | p value | OR | 95 % CI | p value | OR | 95 % CI | p value | OR | 95 % CI | p value | |
Quartiles of H-FABP | ||||||||||||
Q1 (H-FABP≦6.2) | 1.000 | 1.000 | 1.000 | 1.000 | ||||||||
Q2 (6.3≦H-FABP≦11.6) | 2.453 | 1.095– 5.498 | 0.029 | 3.743 | 1.693–8.274 | 0.001 | 2.585 | 0.492–13.584 | 0.262 | 3.194 | 0.582–17.523 | 0.181 |
Q3 (11.7≦H-FABP≦27.8) | 5.030 | 2.311–10.947 | <0.001 | 9.427 | 4.124–21.548 | <0.001 | 5.938 | 1.288–27.374 | 0.022 | 5.155 | 1.030–25.790 | 0.046 |
Q4 (27.9≦H-FABP) | 12.778 | 5.774 –28.777 | <0.001 | 28.000 | 11.245–69.720 | <0.001 | 33.975 | 8.009–144.122 | <0.001 | 22.978 | 4.814 –109.668 | <0.001 |
Adjusting Factors | ||||||||||||
Chronic kidney disease | 1.196 | 0.786–1.819 | 0.404 | 0.652 | 0.373–1.141 | 0.134 | ||||||
Age (≧71 years old) | 0.921 | 0.626–1.356 | 0.677 | 0.887 | 0.520–1.512 | 0.659 | ||||||
MBP (≧102 mmHg) | 0.260 | 0.171–0.393 | <0.001 | 0.264 | 0.172–0.442 | <0.001 | 0.140 | 0.067–0.290 | <0.001 | 0.191 | 0.087–0.416 | <0.001 |
LVEF (≧51 %) | 0.757 | 0.493–1.163 | 0.204 | 0.533 | 0.486–1.453 | 0.840 | ||||||
Hemoglobin (≧12.7 g/dl) | 0.681 | 0.461–1.006 | 0.053 | 0.259 | 0.138–0.483 | <0.001 | 0.430 | 0.212–0.874 | 0.020 | |||
Hs-TropT (≧0.048 ng/ml) | 2.319 | 1.555–3.458 | <0.001 | 0.736 | 0.428–1.265 | 0.267 | 4.035 | 2.160–7.536 | <0.001 | 1.220 | 0.553–2.691 | 0.623 |
Nt-ProBNP (≧2553 pg/ml) | 1.665 | 1.126–2.462 | 0.011 | 0.824 | 0.497–1.366 | 0.452 | 2.325 | 1.322–4.091 | 0.003 | 1.023 | 0.500–2.094 | 0.950 |
Diagnostic value of the H-FABP level
Prognosis
Univariate analysis | Multivariate analysis | |||||
---|---|---|---|---|---|---|
180-days mortality | HR | 95 % CI | p value | HR | 95 % CI | p value |
H-FABP level and AKI status | ||||||
H-FABP≦15.6 and no-AKI | 1.000 | 1.000 | ||||
H-FABP≦15.6 and AKI | 4.128 | 1.432–11.898 | 0.009 | 2.676 | 0.920–7.783 | 0.071 |
H-FABP≧15.7 and no-AKI | 8.070 | 3.592–18.131 | <0.001 | 9.268 | 3.835–22.396 | <0.001 |
H-FABP≧15.7 and AKI | 14.037 | 6.556–30.054 | <0.001 | 11.593 | 5.154–26.078 | <0.001 |
Adjusting factors | ||||||
Chronic kiedney disease | 0.887 | 0.560–1.405 | 0.609 | |||
Age (≧69 years old) | 1.036 | 0.659–1.629 | 0.879 | |||
MBP (≧99 mmHg) | 0.205 | 0.114–0.366 | <0.001 | 0.239 | 0.130–0.441 | <0.001 |
LVEF (≧51 %) | 0.652 | 0.396–1.074 | 0.093 | |||
Hemoglobin (≧13.5 g/dl) | 0.567 | 0.352–0.912 | 0.019 | 0.990 | 0.603–1.624 | 0.968 |
Hs-TropT (≧0.064 ng/ml) | 2.429 | 1.478–3.994 | <0.001 | 0.818 | 0.469 –1.424 | 0.477 |
Nt-ProBNP (≧930 pg/ml) | 1.598 | 1.001–2.552 | 0.050 |