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Quantitative and qualitative analyses of urinary L-FABP for predicting acute kidney injury after emergency laparotomy

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Abstract

Purpose

The aim of this study was to explore the clinical utility of urinary L-FABP for earlier prediction of acute kidney injury (AKI) after emergency laparotomy, and to assess the clinical utility of a point-of-care (POC) kit for urinary L-FABP.

Methods

Forty-eight patients undergoing emergency laparotomy were divided into AKI and non-AKI groups by the kidney diseases: improving global outcome (KDIGO) criteria. Ten patients were included in the AKI group. Urinary L-FABP, albumin, N-acetyl-β-d-glucosaminidase (NAG), TIMP-2, IGFBP7, serum creatinine (SCr), and blood presepsin were measured perioperatively and compared between groups. Perioperative urinary L-FABP was also evaluated qualitatively using a POC kit.

Results

L-FABP and albumin levels were significantly higher in the AKI group at all measurement points. NAG was significantly higher only postoperatively in the AKI group. There were no inter-group differences in [TIMP-2] × [IGFBP7] at any measuring point. The area under the receiver operating characteristic curve of urinary L-FABP was greater than 0.8 perioperatively, which was larger than that of other biomarkers throughout the study period. The correlation coefficient at 2 h after entering the operating room between quantitative and qualitative tests for urinary L-FABP was 0.714, which was the maximum. The sensitivity, specificity, and negative predictive value of the urinary L-FABP POC kit at 2 h after entry were 55.6%, 91.9%, and 89.5%, respectively.

Conclusion

Quantitative L-FABP analyses is suitable for predicting postoperative AKI earlier in the perioperative period of emergency laparotomy. Conversely, the higher specificity of qualitative L-FABP analysis suggests that it may be useful for excluding the risk of AKI but its overall clinical validity should be further investigated.

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Acknowledgements

We would like to thank Editage (www.editage.com) for English language editing. We thank Ms. Sachi Shinmi for her technical assistance. In addition, we thank Dr. Miki Sakamoto, Dr. Makito Yokozuka, Dr. Yu Sato, Dr. Yuki Abukawa, Dr. Eriko Amano, Dr. Yu Somemura, Dr. Miyuna Sato, and Dr. Ayako Yamaura for sample collection.

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Authors and Affiliations

  1. Department of Anesthesiology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, 216-8511, Japan

    Hirotaka Okuda, Yumi Obata & Soichiro Inoue

  2. Department of Anatomy, St. Marianna University School of Medicine, Kanagawa, Japan

    Atsuko Kamijo-Ikemori

Authors
  1. Hirotaka Okuda
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  2. Yumi Obata
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  3. Atsuko Kamijo-Ikemori
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  4. Soichiro Inoue
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Contributions

HO, YO, AKI, and SI contributed to the study design, execution of the study, and manuscript preparation. All authors have approved the final manuscript and attest to the integrity of the original data and the analyses described in the paper.

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Correspondence to Soichiro Inoue.

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Okuda, H., Obata, Y., Kamijo-Ikemori, A. et al. Quantitative and qualitative analyses of urinary L-FABP for predicting acute kidney injury after emergency laparotomy. J Anesth 36, 38–45 (2022). https://doi.org/10.1007/s00540-021-03003-w

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  • DOI: https://doi.org/10.1007/s00540-021-03003-w

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