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Spot urine albumin to creatinine ratio outperforms novel acute kidney injury biomarkers in patients with acute myocardial infarction



Spot urine albumin to creatinine ratio outperforms novel acute kidney injury biomarkers in patients with acute myocardial infarction



International Journal of Cardiology 197: 48-55



Acute kidney injury (AKI) is a frequent complication in patients hospitalized for acute myocardial infarction (AMI), and is associated with in-hospital and long-term morbidity and mortality. We prospectively assessed the diagnostic performance of spot urine albumin to creatinine ratio (uACR) in an adequately sized multicenter cohort of patients admitted to hospital with AMI. We further compared uACR to novel renal injury associated biomarkers regarding their diagnostic ability. We enrolled 805 consecutive patients presenting with acute ST-elevation and non-ST elevation AMI. Patients were assessed for presence of AKI at 48h post-admission and at hospital discharge using the Acute Kidney Injury Network (AKIN), the Acute Dialysis Quality Initiative [Risk, Injury and Failure (RIFLE)] criteria and the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Blood and urine sampling for neutrophil gelatinase-associated lipocalin (NGAL), interleukin-18 (IL-18), cystatin-C, and uACR assessment was performed during admission. The predictive accuracy of uACR was good (Area Under the Curve (AUC), 0.725; 95% CI 0.676-0.774) and was better compared to urine NGAL (P=0.007), urine (P<0.001) and plasma Cystatin-C (P=0.001). ROC analysis identified concentrations of ≥66.7μg/mg as having the best diagnostic accuracy. The use of uACR exhibited good discriminating ability independent to possible cofounders and additive regarding the use of novel biomarkers. The use of uACR can easily be applied in the clinical setting, allows for robust risk assessment and offers the potential to improve the management of AMI patients at risk for acute kidney injury.

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Accession: 058893588

Download citation: RISBibTeXText

PMID: 26113474

DOI: 10.1016/j.ijcard.2015.06.019


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