Christian Albert1,2,3, Annemarie Albert1,2,3, Rinaldo Bellomo4, Siegfried Kropf5, Prasad Devarajan6, Sabine Westphal7, Hassina Baraki8, Ingo Kutschka8, Christian Butter2,9, Michael Haase1,2,3, Anja Haase-Fielitz2,9,10. 1. Medical Faculty, Otto-von-Guericke University, Magdeburg, ST, Germany. 2. Brandenburg Medical School (MHB), Brandenburg an der Havel, BB, Germany. 3. Diaverum Deutschland, Potsdam, BB, Germany. 4. School of Medicine, Intensive Care Unit, Austin Hospital, Heidelberg, VIC, 3084 Australia. 5. Institute for Biometrics & Medical Informatics, Otto-von-Guericke University, Magdeburg, ST, Germany. 6. Division of Nephrology & Hypertension, Cincinnati Children's Hospital, Cincinnati, OH 45229, USA. 7. Institute of Laboratory Medicine, Hospital Dessau, Dessau, ST, Germany. 8. Department of Thoracic, Cardiac & Vascular Surgery, University of Göttingen, Göttingen, NI, Germany. 9. Department of Cardiology, Immanuel Diakonie Bernau, Heart Center Brandenburg, BB, Germany. 10. Institute of Social Medicine & Health Economics, Otto-von-Guericke University, Magdeburg, ST, Germany.
Abstract
AIM: To assess weather doctors' clinical risk-assessment for major adverse kidney events (MAKE) and acute kidney injury (AKI) after open-heart surgery would improve when being informed about neutrophil gelatinase-associated lipocalin (NGAL) test result at ICU admission. PATIENTS & METHODS: Clinical risk-assessment for MAKE and AKI were performed with and without providing NGAL test result and compared in an exploratory- and a validation-cohort using reclassification metrics, exemplary category-free net reclassification improvement (cfNRI). RESULTS:Exploratory cohort: doctors' prediction of MAKE (cfNRI = 0.750 [0.130-1.370]; p = 0.018) and AKI (cfNRI = 0.565 [0.001-1.129]; p = 0.049) improved being provided with NGAL test information. This finding was confirmed in the validation-cohort (MAKE cfNRI = 0.930 [0.188-1.672]; p = 0.014) and the combined-cohort (MAKE: cfNRI = 0.847 [0.371-1.323], p < 0.001); AKI: cfNRI = 0.468 [0.099-0.836; p = 0.013]). Improvements mostly generated from correctly reclassifying patients who not developed events (p < 0.001). CONCLUSION: Biomarker informed risk-assessment is superior in predicting MAKE and AKI after open-heart surgery.
RCT Entities:
AIM: To assess weather doctors' clinical risk-assessment for major adverse kidney events (MAKE) and acute kidney injury (AKI) after open-heart surgery would improve when being informed about neutrophil gelatinase-associated lipocalin (NGAL) test result at ICU admission. PATIENTS & METHODS: Clinical risk-assessment for MAKE and AKI were performed with and without providing NGAL test result and compared in an exploratory- and a validation-cohort using reclassification metrics, exemplary category-free net reclassification improvement (cfNRI). RESULTS: Exploratory cohort: doctors' prediction of MAKE (cfNRI = 0.750 [0.130-1.370]; p = 0.018) and AKI (cfNRI = 0.565 [0.001-1.129]; p = 0.049) improved being provided with NGAL test information. This finding was confirmed in the validation-cohort (MAKE cfNRI = 0.930 [0.188-1.672]; p = 0.014) and the combined-cohort (MAKE: cfNRI = 0.847 [0.371-1.323], p < 0.001); AKI: cfNRI = 0.468 [0.099-0.836; p = 0.013]). Improvements mostly generated from correctly reclassifying patients who not developed events (p < 0.001). CONCLUSION: Biomarker informed risk-assessment is superior in predicting MAKE and AKI after open-heart surgery.
Authors: Wai H Lim; Joshua R Lewis; Germaine Wong; Rachel Teo; Ee M Lim; Elizabeth Byrnes; Richard L Prince Journal: Am J Nephrol Date: 2015-03-25 Impact factor: 3.754
Authors: Lu Renhua; Che Miaolin; Wang Junlin; Wu Qingwei; Xu Xiaoping; Dai Huili; Zhang Weiming; Ni Zhaohui; Qian Jiaqi; Yucheng Yan Journal: Blood Purif Date: 2014-10-17 Impact factor: 2.614
Authors: Rajit K Basu; Hector R Wong; Catherine D Krawczeski; Derek S Wheeler; Peter B Manning; Lakhmir S Chawla; Prasad Devarajan; Stuart L Goldstein Journal: J Am Coll Cardiol Date: 2014-12-30 Impact factor: 24.094
Authors: Peter A McCullough; Andrew D Shaw; Michael Haase; Josee Bouchard; Sushrut S Waikar; Edward D Siew; Patrick T Murray; Ravindra L Mehta; Claudio Ronco Journal: Contrib Nephrol Date: 2013-05-13 Impact factor: 1.580
Authors: Lars Englberger; Rakesh M Suri; Zhuo Li; Edward T Casey; Richard C Daly; Joseph A Dearani; Hartzell V Schaff Journal: Crit Care Date: 2011-01-13 Impact factor: 9.097
Authors: Kianoush Kashani; Ali Al-Khafaji; Thomas Ardiles; Antonio Artigas; Sean M Bagshaw; Max Bell; Azra Bihorac; Robert Birkhahn; Cynthia M Cely; Lakhmir S Chawla; Danielle L Davison; Thorsten Feldkamp; Lui G Forni; Michelle Ng Gong; Kyle J Gunnerson; Michael Haase; James Hackett; Patrick M Honore; Eric A J Hoste; Olivier Joannes-Boyau; Michael Joannidis; Patrick Kim; Jay L Koyner; Daniel T Laskowitz; Matthew E Lissauer; Gernot Marx; Peter A McCullough; Scott Mullaney; Marlies Ostermann; Thomas Rimmelé; Nathan I Shapiro; Andrew D Shaw; Jing Shi; Amy M Sprague; Jean-Louis Vincent; Christophe Vinsonneau; Ludwig Wagner; Michael G Walker; R Gentry Wilkerson; Kai Zacharowski; John A Kellum Journal: Crit Care Date: 2013-02-06 Impact factor: 9.097
Authors: Valeria Rudman-Melnick; Mike Adam; Andrew Potter; Saagar M Chokshi; Qing Ma; Keri A Drake; Meredith P Schuh; J Matthew Kofron; Prasad Devarajan; S Steven Potter Journal: J Am Soc Nephrol Date: 2020-10-28 Impact factor: 10.121
Authors: Christian Albert; Michael Haase; Annemarie Albert; Antonia Zapf; Rüdiger Christian Braun-Dullaeus; Anja Haase-Fielitz Journal: Ann Lab Med Date: 2020-08-25 Impact factor: 3.464
Authors: Christian Albert; Michael Haase; Annemarie Albert; Siegfried Kropf; Rinaldo Bellomo; Sabine Westphal; Mark Westerman; Rüdiger Christian Braun-Dullaeus; Anja Haase-Fielitz Journal: Ann Lab Med Date: 2020-03 Impact factor: 3.464