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Urinary biomarkers of kidney tubule injury, risk of acute kidney injury, and mortality in patients with acute ischaemic stroke treated at a stroke care unit
Author(s) -
Shimoyama T.,
Sato T.,
Sakamoto Y.,
Nagai K.,
Aoki J.,
Suda S.,
Nishiyama Y.,
Kimura K.
Publication year - 2020
Publication title -
european journal of neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.881
H-Index - 124
eISSN - 1468-1331
pISSN - 1351-5101
DOI - 10.1111/ene.14448
Subject(s) - medicine , acute kidney injury , renal function , stroke (engine) , creatinine , urinary system , kidney disease , hazard ratio , odds ratio , univariate analysis , albuminuria , confidence interval , multivariate analysis , mechanical engineering , engineering
Background and purpose Urinary liver‐type fatty‐acid binding protein (L‐FABP), which is a biomarker of kidney tubule injury, has been studied extensively and established as a risk marker of acute kidney injury (AKI). The aim of this study was to investigate whether kidney tubule injury is associated with the development of AKI and mortality in patients with acute ischaemic stroke. Methods Acute ischaemic stroke patients hospitalized in the stroke care unit (SCU) within 24 h after symptom onset were prospectively investigated. AKI was defined on the basis of Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Baseline urinary L‐FABP was measured on admission. We evaluated the associations among urinary L‐FABP, incidence of AKI, and 90‐day mortality adjusted for renal function, albuminuria and other potentially predictive variables, using multivariable analysis. Results In total, 527 acute ischaemic stroke patients (342 men, median age 74 years) were enrolled in the study. Twenty‐seven patients (5.1%) experienced AKI within 7 days of admission. In the univariate analysis, high urinary L‐FABP level had positive associations with AKI [53.8 μg/g creatinine (Cr) vs. 3.9 μg/g Cr; P < 0.001] and 90‐day mortality (15.5 μg/g Cr vs. 4.0 μg/g Cr; P < 0.001). In the multivariate analysis, elevated urinary L‐FABP level (per 10‐μg/g Cr increase) was independently associated with AKI (odds ratio 1.225, 95% confidence interval (CI) 1.083–1.454; P = 0.003) and 90‐day mortality (hazard ratio 1.091, 95% CI 1.045–1.138; P < 0.001). Conclusion Urinary biomarkers of kidney tubule injury are independently associated with the development of AKI and 90‐day mortality in patients with acute ischaemic stroke treated at the SCU.