Combining Serum Cystatin C and Urinary N-Acetyl-Beta-D-Glucosaminidase Improves the Precision for Acute Kidney Injury Diagnosis after Resection of Intracranial Space-Occupying Lesions
Open Access
- 10 January 2020
- journal article
- research article
- Published by S. Karger AG in Kidney and Blood Pressure Research
- Vol. 45 (1), 142-156
- https://doi.org/10.1159/000504599
Abstract
Background: Postoperative acute kidney injury (AKI) is frequent and associated with adverse outcomes. Unfortunately, the early diagnosis of AKI remains a challenge. Combining functional and tubular damage biomarkers may provide better precision for AKI detection. However, the diagnostic accuracy of this combination for AKI after neurosurgery is unclear. Serum cystatin C (sCysC) and urinary albumin/creatinine ratio (uACR) are considered functional biomarkers, while urinary N-acetyl-β-D-glucosaminidase (uNAG) represents tubular damage. We aimed to assess the performances of these clinical available biomarkers and their combinations for AKI prediction after resection of intracranial space-occupying lesions. Methods: A prospective study was conducted, enrolling adults undergoing resection of intracranial space-occupying lesions and admitted to the neurosurgical intensive care unit. The discriminative abilities of postoperative sCysC, uNAG, uACR, and their combinations in predicting AKI were compared using the area under the receiver operating characteristic curve (AUC-ROC), continuous net reclassification index (cNRI), and incremental discrimination improvement (IDI). Results: Of 605 enrolled patients, AKI occurred in 67 patients. The cutoff values of sCysC, uNAG, and uACR to predict postoperative AKI were 0.72 mg/L, 19.98 U/g creatinine, and 44.21 mg/g creatinine, respectively. For predicting AKI, the composite of sCysC and uNAG (AUC-ROC = 0.785) outperformed either individual biomarkers or the other two panels (uNAG plus uACR or sCysC plus uACR). Adding this panel to the predictive model improved the AUC-ROC to 0.808. Moreover, this combination significantly improved risk reclassification over the clinical model alone, with cNRI (0.633) and IDI (0.076). Superior performance of this panel was further confirmed with bootstrap internal validation. Conclusions: Combination of functional and tubular damage biomarkers improves the predictive accuracy for AKI after resection of intracranial space-occupying lesions.Keywords
This publication has 51 references indexed in Scilit:
- Cystatin C in Prediction of Acute Kidney Injury: A Systemic Review and Meta-analysisAmerican Journal of Kidney Diseases, 2011
- Neutrophil Gelatinase-associated Lipocalin at ICU Admission Predicts for Acute Kidney Injury in Adult PatientsAmerican Journal of Respiratory and Critical Care Medicine, 2011
- Renal cortical albumin gene induction and urinary albumin excretion in response to acute kidney injuryAmerican Journal of Physiology-Renal Physiology, 2011
- Serum and urine cystatin C are poor biomarkers for acute kidney injury and renal replacement therapyIntensive Care Medicine, 2010
- Assessing the Performance of Prediction ModelsEpidemiology, 2010
- Alkalinization of urine samples preserves albumin concentrations during prolonged frozen storage in patients with diabetes mellitusDiabetic Medicine, 2009
- Urinary Biomarkers in the Early Detection of Acute Kidney Injury after Cardiac SurgeryClinical Journal of the American Society of Nephrology, 2009
- Cystatin C is correlated with mortality in patients with and without acute kidney injuryNephrology Dialysis Transplantation, 2009
- Urinary biomarkers in the early diagnosis of acute kidney injuryKidney International, 2008
- Biomarkers of Acute Kidney InjuryAnnual Review of Pharmacology and Toxicology, 2008