Abstract:

Objective To evaluate the value of new biological indicators of acute kidney injury (AKI) for early diagnosis of acute decompensated heart failure (ADHF) combined with AKI, i.e. cardiorenal syndrome type 1 (CRS1). Methods A total of 200 patients with ADHF were enrolled. Levels of baseline serum creatinine (SCr), serum combination [neutrophil gelatinase associated lipocalin (NAGL) and Cystatin C (CysC)], and urine combination [NAGL and kidney injury molecule-1(KIM-1)] were detected. Levels of serum combination and urine combination were redetected after 6 h and 18 h and the level of SCr was redetected after 48 h. According to the criteria, CRS1 patients were selected. The correlations of serum and urine NAGL, serum CysC, urine KIM-1, and Scr were analyzed. According to receiver operating characteristic (ROC) curve, the cut-off value, sensitivity, specificity, and the area under the ROC curve (AUC) of NAGL, Cys C and KIM-1 at 6 h and 18 h for diagnosing AKI were obtained. The AUC of serum combination (NAGL,Cys C) and urine combination (NAGL，KIM-1) at 6 h and 18 h for diagnosing AKI was calculated. Results According to the diagnostic criteria of CRS1, 48 of 200 ADHF patients were diagnosed with AKI and the incidence was 24%. Serum NAGL at 6 h and serum Cys C at 18 h positively correlated with Scr (r＝0.857, P<0.05; r＝0.869, P<0.05). Urine NAGL and KIM-1 at 6 h positively correlated with Scr (r＝0.756, P<0.05； r＝0.742, P<0.05). The AUCs of serum combination at 6 h and 18 h were 0.87 and 0.89, while the AUCs of urine combination at 6 h and 18 h were 0.92 and 0.93. Conclusion Serum and urine NAGL, serum Cys C, and urine KIM-1 can be used as early diagnostic indicators for CRS1 patients. Combined detection of urine NAGL and KIM-1 may improve the sensitivity and specificity of early diagnosis of CRS1.

Key words: acute decompensated heart failure, acute renal injury, serum creatinine, neutrophil gelatinase associated lipocalin, Cystatin C, kidney injury molecule-1