Clinical usefulness of urinary liver-type fatty-acid-binding protein as a perioperative marker of acute kidney injury in patients undergoing endovascular or open-abdominal aortic aneurysm repair

• Published in: Journal of anesthesia 2016-02, Vol.30 (1), p.89-99
• Main Authors: Obata, Yumi, Kamijo-Ikemori, Atsuko, Ichikawa, Daisuke, Sugaya, Takeshi, Kimura, Kenjiro, Shibagaki, Yugo, Tateda, Takeshi
• Format: Article
• Language: English
• Subjects: Abdominal aneurysm; Acute Kidney Injury - etiology; Aged; Aged, 80 and over; Anesthesiology; Aortic Aneurysm, Abdominal - surgery; Biomarkers - urine; Care and treatment; Complications and side effects; Critical Care Medicine; Diagnosis; Emergency Medicine; Endovascular Procedures - methods; Fatty Acid-Binding Proteins - urine; Female; Humans; Intensive; Male; Medicine; Medicine & Public Health; Original; Original Article; Pain Medicine; Patient outcomes; Postoperative Period; Prospective Studies; Protein binding; ROC Curve
• ISSN: 0913-8668; 1438-8359
• DOI: 10.1007/s00540-015-2095-8

Purpose Acute kidney injury (AKI) is common after cardiovascular surgery and is usually diagnosed on the basis of the serum creatinine (SCr) level and urinary output. However, SCr is of low sensitivity in patients with poor renal function. Because urinary liver-type fatty-acid-binding protein (L-FABP) reflects renal tubular injury, we evaluated whether perioperative changes in urinary L-FABP predict AKI in the context of abdominal aortic repair. Methods Study participants were 95 patients who underwent endovascular abdominal aortic aneurysm repair (EVAR) and 42 who underwent open repair. We obtained urine samples before surgery, after anesthesia induction, upon stent placement, before aortic cross-clamping (AXC), 1 and 2 h after AXC, at the end of surgery, 4 h after surgery, and on postoperative days (PODs) 1, 2, and 3, for measurement of L-FABP. We obtained serum samples before surgery, immediately after surgery, and on PODs 1, 2, and 3, for measurement of SCr. We also plotted receiver-operating characteristic (ROC) curves to identify cutoff laboratory values for predicting the onset of AKI. Results With EVAR, urinary L-FABP was significantly increased 4 h after the procedure ( P  = 0.014). With open repair, urinary L-FABP increased significantly to its maximum by 2 h after AXC ( P  = 0.007). With AKI, SCr significantly increased ( P