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The urinary levels of prostanoid metabolites predict acute kidney injury in heterogeneous adult Japanese ICU patients: a prospective observational study

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Abstract

Background

Acute kidney injury (AKI) is frequently observed in critically ill patients in the intensive care unit (ICU) and is associated with increased mortality. Prostanoids regulate numerous biological functions, including hemodynamics and renal tubular transport. We herein investigated the ability of urinary prostanoid metabolites to predict the onset of AKI in critically ill adult patients.

Methods

The current study was conducted as a prospective observational study. Urine of patients admitted to the ICU at Okayama University Hospital was collected and the urinary levels of prostaglandin E2 (PGE2), PGI2 metabolite (2,3-dinor-6-OXO-PGF1α), thromboxane A2 (TXA2) metabolite (11-dehydro-TXB2) were determined.

Results

Of the 93 patients, 24 developed AKI (AKIN criteria). Surgical intervention (93, 75 %) was the leading cause of ICU admission. Overall, the ratio of the level of serum Cr on Day 1 after ICU admission to that observed at baseline positively correlated with the urinary 2,3-dinor-6-OXO-PGF1α/Cr (r = 0.57, p < 0.0001) and 11-dehydro-TXB2/Cr (r = 0.47, p < 0.0001) ratios. In 16 cases of de novo AKI, the urinary 2,3-dinor-6-OXO-PGF1α/Cr and 11-dehydro-TXB2/Cr values were significantly elevated compared with that observed in the non-AKI group, whereas the urinary PGE2/Cr values were not. The urinary 2,3-dinor-6-OXO-PGF1α/Cr ratio exhibited the best diagnostic and predictive performance among the prostanoid metabolites according to the receiver operating characteristic (ROC) analysis [ROC–area under the curve (AUC): 0.75].

Conclusions

Taken together, these results demonstrate that the urinary 2,3-dinor-6-OXO-PGF1α/Cr and 11-dehydro-TXB2/Cr ratios are associated with the subsequent onset of AKI and poor outcomes in adult heterogeneous ICU patients.

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Acknowledgments

We thank Drs. Makiko Tani, Junya Matsumi, Yuichiro Toda and Kentaro Sugimoto (Dept. of Anesthesiology, Okayama Univ. Hospital) for collecting the clinical samples and Drs. Takashi Yorifuji, Kenei Sada and Hiroyuki Doi for their assistance in performing the statistical analysis.

Conflict of interests

Financial competing interests Prof. Yohei Maeshima belonged to endowed department by Chugai pharmaceutical, MSD, Boehringer ingelheim and Kawanishi Holdings. Prof. Hitoshi Sugiyama belongs to endowed department by Baxter. Prof. Hirofumi Makino is a consultant for AbbVie, Astellas and Teijin, receives speaker honoraria from Astellas, Boehringer-ingelheim, Chugai, Daiichi Sankyo, Dainippon Sumitomo, Kyowa Hakko Kirin, MSD, Novartis, Pfizer, Takeda, and Tanabe Mitsubishi, and receives grant support from Astellas, Boehringer-ingelheim, Daiichi Sankyo, Dainippon Sumitomo, Kyowa Hakko Kirin, Mochida, MSD, Novartis, Novo Nordisk, Pfizer, Takeda, and Tanabe Mitsubishi.

Non-financial competing interest None.

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Authors and Affiliations

  1. Department of Medicine and Clinical Science, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan

    Haruyo Ujike-Omori, Yohei Maeshima, Masaru Kinomura, Katsuyuki Tanabe, Hiroyuki Watatani, Norikazu Hinamoto & Hirofumi Makino

  2. Medical Innovation Center, Kyoto University Graduate School of Medicine, Kyoto, Japan

    Kiyoshi Mori

  3. Center for chronic kidney disease and peritoneal dialysis, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan

    Hitoshi Sugiyama

  4. Ono Pharmaceutical Co., Ltd, Osaka, Japan

    Yoshiki Sakai

  5. Department of Anesthesiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan

    Hiroshi Morimatsu

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  1. Haruyo Ujike-Omori
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Correspondence to Yohei Maeshima.

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Ujike-Omori, H., Maeshima, Y., Kinomura, M. et al. The urinary levels of prostanoid metabolites predict acute kidney injury in heterogeneous adult Japanese ICU patients: a prospective observational study. Clin Exp Nephrol 19, 1024–1036 (2015). https://doi.org/10.1007/s10157-015-1092-4

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  • DOI: https://doi.org/10.1007/s10157-015-1092-4

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