Biomarkers for Diagnosis and Prediction of Outcomes in Contrast-Induced Nephropathy. (24th January 2020)

• Record Type: Journal Article
• Authors: Banda, Justor; Duarte, Raquel; Dix-Peek, Therese; Dickens, Caroline; Manga, Pravin; Naicker, Saraladevi
• Other Names: Uribarri Jaime Academic Editor.
• Is Part Of: International journal of nephrology. Volume 2020(2020)
• Publication Date: 2020-01-24
• Subjects: Nephrology -- Periodicals; Nephrology; Kidney Diseases; Nephrology; Periodicals; Periodicals; Fulltext; Internet Resources; Electronic journals; 616.61
• DOI: 10.1155/2020/8568139
• Languages: English
• ISSNs: 2090-214X

Abstract

Abstract : Background . Serum creatinine is suboptimal as a biomarker in the early diagnosis of contrast-induced nephropathy (CIN). In this study, we investigated a panel of novel biomarkers in the early diagnosis of CIN and in assessing patient outcomes. Methods . This single-centre, nested, prospective case-controlled study included 30 patients with CIN and 60 matched controls. Serum and urine samples were collected before contrast administration and at 24 hours, 48 hours, and ≥5 days after contrast administration. Concentrations of NGAL, cystatin C, β 2 M, IL18, IL10, KIM1, and TNF α were determined using Luminex and ELISA assays. Outcomes were biomarker diagnostic discrimination performance for CIN and mortality after generation of area under receiver operating characteristic curves (AUROCs). Results . Median serum levels for 24 h cystatin C (p < 0.01 ) and 48 h β 2 M levels (p < 0.001 ) and baseline urine NGAL (p = 0.02 ) were higher in CIN patients compared to controls with AUROCs of 0.75, 0.78, and 0.74, respectively, for the early diagnosis of CIN. Serum β 2 M levels were higher in CIN patients at all time points. Elevated baseline serum concentrations of IL18 (p < 0.001 ), β 2 M (p = 0.04 ), TNF α (p < 0.001 ), and baseline urine KIM (p = 0.01 ) and 24 h urine NGAL (p = 0.02 ) were significantly associated with mortality. Baseline serum concentrations of IL18, β 2 M, and TNF α showed the best discrimination performance for mortality with AUROCs, all >0.80. Baseline NGAL was superior for excluding patients at risk for CIN, with positive and negative predictive ranges of 0.50–0.55 and 0.81–0.88, respectively. Cystatin C (p = 0.003 ) and β 2 M (p = 0.03 ) at 24 h independently predicted CIN risk. β 2 M predicted increased mortality of 40% at baseline and 50% at 24 hours. Conclusion . Serum cystatin C at 24 h was the best biomarker for CIN diagnosis, while baseline levels of serum IL18, β 2 M, and TNF α were best for predicting prognosis.