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Failure of renal biomarkers to predict worsening renal function in high-risk patients presenting with oliguria

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An Erratum to this article was published on 17 January 2015

Abstract

Purpose

Oliguria is a common symptom in critically ill patients and puts patients in a high risk category for further worsening renal function (WRF). We performed this study to explore the predictive value of biomarkers to predict WRF in oliguric intensive care unit (ICU) patients.

Patients and methods

Single-center prospective observational study. ICU patients were included when they presented a first episode of oliguria. Plasma and urine biomarkers were measured: plasma and urine neutrophil gelatinase-associated lipocalin (pNGAL and uNGAL), urine α1-microglobulin, urine γ-glutamyl transferase, urine indices of tubular function, cystatin C, C terminal fragment of pro-arginine vasopressin (CT-ProAVP), and proadrenomedullin (MR-ProADM).

Results

One hundred eleven patients formed the cohort, of whom 43 had worsening renal function. Simplified Acute Physiology Score (SAPS) II was 41 (31–51). WRF was associated with increased mortality (hazard ratio 8.65 [95 % confidence interval (CI) 3.0–24.9], p = 0.0002). pNGAL, MR-ProADM, and cystatin C had the best odds ratio and area under the receiver-operating characteristic curve (AUC-ROC: 0.83 [0.75–0.9], 0.82 [0.71–0.91], and 0.83 [0.74–0.90]), but not different from serum creatinine (Screat, 0.80 [0.70–0.88]). A clinical model that included age, sepsis, SAPS II, and Screat had AUC-ROC of 0.79 [0.69–0.87]; inclusion of pNGAL increased the AUC-ROC to 0.86 (p = 0.03). The category-free net reclassification index improved with pNGAL (total net reclassification index for events to higher risk 61 % and nonevents to lower 82 %).

Conclusions

All episodes of oliguria do not carry the same risk. No biomarker further improved prediction of WRF compared with Screat in this selected cohort of patients at increased risk defined by oliguria.

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Acknowledgments

We acknowledge funding from institutional grants from Université Paris VII and from the Ministère de la Recherche plan quadriennal EA 3509. Assays for Ct-ProAVP and MR-ProADM were provided by Thermo Fisher.

Author contributions

All co-authors contributed to the manuscript and approved the submission.

Prior publication or overlapping content

Neither this manuscript nor any significant part of it is under consideration for publication elsewhere or published or available elsewhere in a manner that could be construed as a prior or duplicate publication of the same or substantially overlapping content.

Conflicts of interest

Matthieu Legrand received lectures fees from Alere. All other authors have no conflict of interest related to this article.

Author information

Authors and Affiliations

  1. Department of Anesthesiology and Critical Care and SMUR and Burn Unit, Assistance Publique-Hopitaux de Paris, AP-HP, GH St-Louis-Lariboisière, University of Paris 7 Denis Diderot, 1 rue Claude Vellefaux, 75010, Paris, France

    Matthieu Legrand, Aurélien Jacquemod, Etienne Gayat & Didier Payen

  2. UMR INSERM 942, Institut National de la Santé et de la Recherche Médicale (INSERM), Lariboisière hospital, Paris, France

    Matthieu Legrand, Etienne Gayat, Corinne Collet & Jean-Marie Launay

  3. University Paris Diderot, 75475, Paris, France

    Matthieu Legrand, Etienne Gayat, Jean-Marie Launay & Didier Payen

  4. Laboratory of Biochemistry, Lariboisière Hospital, Assistance Publique-Hopitaux de Paris, University of Paris 7 Denis Diderot, Paris, France

    Corinne Collet, Veronique Giraudeaux & Jean-Marie Launay

  5. UMR INSERM 1160, Saint Louis Hospital, University Paris Diderot, 75475, Paris, France

    Didier Payen

Authors
  1. Matthieu Legrand
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  2. Aurélien Jacquemod
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  3. Etienne Gayat
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  4. Corinne Collet
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  5. Veronique Giraudeaux
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  6. Jean-Marie Launay
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  7. Didier Payen
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Corresponding author

Correspondence to Matthieu Legrand.

Additional information

Take-home message: Although oliguria is used to detect acute kidney injury, only a small proportion of oliguric patients subsequently show a sustained decrease of glomerular filtration rate. In this study, biomarkers of renal function injury and systemic stress could substantially improve our ability to detect oliguric patients at risk of poor renal outcome when compared with clinical presentation.

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Legrand, M., Jacquemod, A., Gayat, E. et al. Failure of renal biomarkers to predict worsening renal function in high-risk patients presenting with oliguria. Intensive Care Med 41, 68–76 (2015). https://doi.org/10.1007/s00134-014-3566-3

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  • DOI: https://doi.org/10.1007/s00134-014-3566-3

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