The Urinary Liver-Type Fatty Acid Binding Protein (L-FABP) in Early Detection and Outcome Prediction of Sepsis-Associated Acute Kidney Injury
Archives of Academic Emergency Medicine,
Vol. 13 No. 1 (2025),
3 Shahrivar 2024
,
Page e26
https://doi.org/10.22037/aaemj.v13i1.2525
Abstract
Introduction: Acute kidney injury (AKI) is one of the most frequent complications in septic shock cases, and has a high mortality rate. The aim of this study was to determine the value of urinary liver-type fatty acid binding protein (L-FABP) in early detection and outcome prediction of AKI in patients with sepsis and septic shock.
Methods: This prospective cohort study was conducted on patients who presented to the emergency department (ED) with sepsis or septic shock. Urinary L-FABP levels were measured at the time of admission and patients were classified into AKI and non-AKI groups within 7 days according to the KIDGO Criteria. The screening performance characteristics of urinary L-FABP in early detection of AKI within seven days of admission and need for renal replacement therapy (RRT) were calculated and reported.
Results: 212 patients with the mean age of 66.5 ± 16.2 (range 18-99) years were included (60.4% male). 54 (25.5%) patients had sepsis, and septic shock was developed in 158 (74.53%) cases. 143 (67.5%) patients were complicated with AKI. The area under the receiver operating characteristic (ROC) curve (AUC) of urinary L-FABP in early detection of sepsis-associated AKI was 0.94 (95% confidence interval (CI): 0.90 - 0.97), compared to the AUC of 0.64 (95% CI: 0.54-0.74) for serum creatinine. The sensitivity and specificity of urinary L_FABP at its best cutoff point (13.90 μg L-FABP/g Cr) were 89.9% and 86.3%, respectively. The area under the ROC curve of urinary L-FABP in predicting the need for RRT in sepsis-associated AKI patients was 0.74 (95% CI: 0.64-0.85), compared to the AUC of 0.53 (95% CI: 0.41-0.64) for serum creatinine. The sensitivity and specificity of urinary L-FABP at its best cutoff point (22.05 μg L-FABP/g Cr) were 63.6% and 71.4%, respectively.
Conclusions: It seems that, L-FABP could be considered as a valuable biomarker for early detection and predicting the severity of AKI in septic patients.
- Acute kidney injury
- Fatty acid binding proteins
- Sepsis
- Shock, Septic
How to Cite
References
Ma S, Evans RG, Iguchi N, Tare M, Parkington HC, Bellomo R, et al. Sepsis-induced acute kidney injury: A disease of the microcirculation. 2019;26(2):e12483.
Coca SG, Singanamala S, Parikh CR. Chronic kidney disease after acute kidney injury: a systematic review and meta-analysis. Kidney Int. 2012;81(5):442-8.
Nguyen MT, Devarajan P. Biomarkers for the early detection of acute kidney injury. Pediatr Nephrol. 2008;23(12):2151-7.
Ockner RK. Historic overview of studies on fatty acid-binding proteins. Mol Cell Biochem. 1990;98(1-2):3-9.
Schrezenmeier EV, Barasch J, Budde K, Westhoff T, Schmidt-Ott KM. Biomarkers in acute kidney injury - pathophysiological basis and clinical performance. Acta Physiol (Oxf). 2017;219(3):554-72.
Xu Y, Xie Y, Shao X, Ni Z, Mou S. L-FABP: A novel biomarker of kidney disease. Clin Chim Acta. 2015;445:85-90.
Atay E, Guzel M, Amanvermez R, Demir MT, Erenler AK, Ozgen E, et al. Role of Gal-3 and H-FABP in the early diagnosis of acute coronary syndrome. Bratisl Lek Listy. 2019;120(2):124-30.
Voth M, Duchene M, Auner B, Lustenberger T, Relja B, Marzi I. I-FABP is a Novel Marker for the Detection of Intestinal Injury in Severely Injured Trauma Patients. World J Surg. 2017;41(12):3120-7.
Kamijo-Ikemori A, Kimura K. Clinical utility of tubular markers in kidney disease: a narrative review. Journal of Laboratory and Precision Medicine. 2022;7.
Kosaki K, Kamijo-Ikemori A, Sugaya T, Tanahashi K, Sawano Y, Akazawa N, et al. Effect of habitual exercise on urinary liver-type fatty acid-binding protein levels in middle-aged and older adults. Scand J Med Sci Sports. 2018;28(1):152-60.
A R. Surviving sepsis campaign: International guidelines for management of
sepsis and septic shock: 2016. Crit Care Med 2017; 45:486-552. 2016.
Khwaja A. KDIGO clinical practice guidelines for acute kidney injury. Nephron Clin Pract. 2012;120(4):c179-84.
Jadoon A, Cunningham P, McDermott LC. Regulation of fatty acid binding proteins by hypoxia inducible factors 1α and 2α in the placenta: relevance to pre-eclampsia. Prostaglandins Leukot Essent Fatty Acids. 2015;93:25-9.
Okazaki M, Oikawa T, Sugaya T. [The biomarker for CKD: urinary L-FABP - from molecular function to clinical significance]. Nihon Yakurigaku Zasshi. 2015;146(1):27-32.
Yamamoto T, Noiri E, Ono Y, Doi K, Negishi K, Kamijo A, et al. Renal L-type fatty acid–binding protein in acute ischemic injury. Journal of the American Society of Nephrology. 2007;18(11):2894-902.
Rajaraman G, Wang G, Yan J, Jiang P, Gong Y, Burczynski F. Role of cytosolic liver fatty acid binding protein in hepatocellular oxidative stress: effect of dexamethasone and clofibrate treatment. Molecular and cellular biochemistry. 2007;295:27-34.
Wang G, Gong Y, Anderson J, Sun D, Minuk G, Roberts MS, et al. Antioxidative function of L‐FABP in L‐FABP stably transfected Chang liver cells. Hepatology. 2005;42(4):871-9.
Sato E, Kamijo-Ikemori A, Oikawa T, Okuda A, Sugaya T, Kimura K, et al. Urinary excretion of liver-type fatty acid-binding protein reflects the severity of sepsis. Renal Replacement Therapy. 2017;3(1):26.
Kalakeche R, Hato T, Rhodes G, Dunn KW, El-Achkar TM, Plotkin Z, et al. Endotoxin uptake by S1 proximal tubular segment causes oxidative stress in the downstream S2 segment. J Am Soc Nephrol. 2011;22(8):1505-16.
Doi K, Noiri E, Sugaya T. Urinary L-type fatty acid-binding protein as a new renal biomarker in critical care. Curr Opin Crit Care. 2010;16(6):545-9.
Shemesh O, Golbetz H, Kriss JP, Myers BD. Limitations of creatinine as a filtration marker in glomerulopathic patients. Kidney Int. 1985;28(5):830-8.
Goldberg TH, Finkelstein MS. Difficulties in estimating glomerular filtration rate in the elderly. Arch Intern Med. 1987;147(8):1430-3.
Vanmassenhove J, Kielstein J, Jörres A, Van Biesen W. Management of patients at risk of acute kidney injury. The lancet. 2017;389(10084):2139-51.
Kellen M, Aronson S, Roizen MF, Barnard J, Thisted RA. Predictive and diagnostic tests of renal failure: a review. Anesthesia & Analgesia. 1994;78(1):134-42.
Xu Y, Xie Y, Shao X, Ni Z, Mou S. L-FABP: A novel biomarker of kidney disease. Clinica chimica acta. 2015;445:85-90.
Nakamura T, Sugaya T, Koide H. Urinary liver-type fatty acid-binding protein in septic shock: effect of polymyxin B-immobilized fiber hemoperfusion. Shock. 2009;31(5):454-9.
Fayad AII, Buamscha DG, Ciapponi A. Timing of renal replacement therapy initiation for acute kidney injury. Cochrane Database Syst Rev. 2018;12(12):Cd010612.
Uhel F, Peters-Sengers H, van der Poll T. Initiation of renal replacement therapy in patients with sepsis: more to it than meets the eye. Ann Transl Med. 2018;6(Suppl 2):S130.
- Abstract Viewed: 64 times
- pdf Downloaded: 33 times