Assessment of urinary KIM-1 and serum Cystain C in acute kidney injury of critical patients in emergency department

Wang Jun-yu; Zhang Da; Mei Xue

doi:10.3969/j.issn.1002-1949.2018.02.006

Abstract：Objective To investigate the predictive performance of kidney injury molecule-1 (KIM-1) and CystainC (Cys-C) for acute kidney injury (AKI), critical patients were hospitalized for seven days in Emergence Department (ED). Methods From October 2015 to October 2016,232 critical patients who have normal serum creatinine (SCr) and urine were admitted to the Emergency Department of Beijing Chaoyang Hospital. SCr,Cys-C,KIM-1 and APACHEⅡscore were measured when the patients arrived at hospital. A continuous measurement of 7 days was focused on the levels of urine and SCr. In terms of guideline,the patients were classified into two groups:AKI group (n=99)and none AKI group (n=133). The levels of Cys-C, KIM-1 and APACHEⅡ score were compared between AKI group and non-AKI group. The level of Cys-C, KIM-1 was compared in AKI group based upon different grades of KDIGO guideline. The predictive performances of KIM-1 and Cys-C for AKI were analyzed by area under the receiver operating characteristic curve(AUC). Results APACHEⅡ scores were significantly higher in AKI group than the ones in the non-AKI group(ng/mL:23 ± 4 vs.18 ± 4,P<0.05). KIM-1 and Cys-C were significantly higher in AKI group than the ones in the non-AKI group (ng/mL:26.6 ± 9.7 vs. 15.9 ± 5.8,P<0.001;969.3 ± 333.3 vs. 632.2 ± 270.4, P<0.001,respectively). In AKI group,a significant difference among grade 1,grade 2 and grade 3 of KIM-1 was indicated,which was ng/mL:19.3 ± 9.3,25.3 ± 9.1,31.0 ± 7.7,respectively. The level of Cys-C in grade 1,grade 2 and grade 3 were ng/mL:857.7 ± 341.8,956.7 ± 382.6,1031.7 ± 295. 5,respectively. The level of grade 3 was significant higher than grade 1 but was close to garde 2. The AUC of KIM - 1 and Cys - C were 0. 823 and 0. 781, and no significant difference was shown. Conclusion Monitoring of KIM-1and Cys-C concentrations could effectively predict the occurrence of AKI in critical patients. Compared with Cys-C,KIM-1 is increased with the severity of AKI.