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Annals of Intensive Care

, 6:6

First Online: 13 January 2016Received: 17 November 2015Accepted: 05 January 2016


BackgroundBreakdown of renal endothelial, tubular and glomerular matrix collagen plays a major role in acute kidney injury AKI development. Such collagen breakdown releases endostatin into the circulation. The aim of this study was to compare the AKI predictive value of plasma endostatin with two previously suggested biomarkers of AKI, cystatin C and neutrophil gelatinase-associated lipocalin NGAL.

MethodsWe studied 93 patients without kidney disease who had a first plasma sample obtained within 48 h of ICU admission. We identified risk factors for AKI within the population and designed a predictive model. The individual ability and net contribution of endostatin, cystatin C and NGAL to predict AKI were evaluated by the area under the receiver operating characteristics curve AUC, likelihood-ratio test, net reclassification improvement NRI and integrated discrimination improvement IDI.

ResultsIn total, 21 23 % patients experienced AKI within 72 h. A three-parameter model age, illness severity score and early oliguria predicted AKI with an AUC of 0.759 95 % CI 0.646–0.872. Adding endostatin to the predictive model significantly P = 0.04 improved the AUC to 0.839 95 % CI 0.752–0.925. In addition, endostatin significantly improved risk prediction using the likelihood-ratio test P = 0.005, NRI analysis 0.27; P = 0.04 and IDI analysis 0.07; P = 0.04. In contrast, adding cystatin C or NGAL to the three-parameter model did not improve risk prediction in any of the four analyses.

ConclusionsIn this cohort of critically ill patients, plasma endostatin improved AKI prediction based on clinical risk factors, while cystatin C and NGAL did not.

KeywordsEndostatin Cystatin C NGAL Acute kidney injury Sepsis AbbreviationsAKIacute kidney injury

APACHEacute physiology and chronic health evaluation

AUCarea under the receiver operating characteristics curve

CKDchronic kidney disease

ELISAenzyme-linked immunosorbent assay

ESRDend-stage renal disease

GFRglomerular filtration rate

ICUintensive care unit

IDIintegrated discrimination improvement

KDIGOKidney Disease: Improving Global Outcomes

MDRDmodification of diet in renal disease

NGALneutrophil gelatinase-associated lipocalin

NRInet reclassification improvement

SIRSsystemic inflammatory response syndrome

Electronic supplementary materialThe online version of this article doi:10.1186-s13613-016-0108-x contains supplementary material, which is available to authorized users.

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Autor: Johan Mårtensson - Niklas Jonsson - Neil J. Glassford - Max Bell - Claes-Roland Martling - Rinaldo Bellomo - Anders Larss


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