Monitoring of plasma creatinine and urinary ?-glutamyl transpeptidase improves detection of acute kidney injury by more than 20%
Crit Care Med. 2011 Jan;39(1):52-56
Authors: Blasco V, Wiramus S, Textoris J, Antonini F, Bechis C, Albanèse J, Martin C, Leone M
OBJECTIVES:: We sought to determine how early we can detect acute kidney injury inpatients at intensive care unit admission by combining the use of plasma creatinine and urinary ?-glutamyl transpeptidase. DESIGN:: Prospective study including development (n = 100) and validation (n = 56) cohorts. SETTINGS:: Intensive care unit of a university hospital. INTERVENTIONS:: None. MEASUREMENTS AND MAIN RESULTS:: To determine acute kidney injury, we subtracted measured creatinine clearance from theoretical creatinine clearance with a 25% reduction signifying acute kidney injury. Its incidence in 100 consecutive patients was 36%. An indexed urinary ?-glutamyl transpeptidase-to-urinary creatinine ratio was significantly increased in the patients with acute kidney injury and did not correlate with plasma creatinine (p = .3). Using a predefined threshold of indexed urinary ?-glutamyl transpeptidase-to-urinary creatinine ratio (>12.4 units/mmol) and plasma creatinine (>89 ?mol/L), acute kidney injury detection was significantly improved, making it possible to detect 22 (22%) additional patients with acute kidney injury. This finding was confirmed in the validation group. The rates of false-positive results were 30% and 19% in the data development and internal validation cohorts, respectively. CONCLUSIONS:: The use of low-cost, widely available markers (creatinine and urinary ?-glutamyl transpeptidase) increases the detection of acute kidney injury. Further studies are needed to determine the impact on outcome with the use of these biomarkers.
PMID: 21178528 [PubMed - as supplied by publisher]