Journal Article

Predictive value of urine interleukin-18 in the evolution and outcome of acute kidney injury in critically ill adult patients

S. Nisula, R. Yang, M. Poukkanen, S. T. Vaara, K. M. Kaukonen, M. Tallgren, M. Haapio, J. Tenhunen, A. M. Korhonen and V. Pettilä

Edited by J. P. Thompson

in BJA: British Journal of Anaesthesia

Published on behalf of the British Journal of Anaesthesia

Volume 114, issue 3, pages 460-468
Published in print March 2015 | ISSN: 0007-0912
Published online December 2014 | e-ISSN: 1471-6771 | DOI: https://dx.doi.org/10.1093/bja/aeu382
Predictive value of urine interleukin-18 in the evolution and outcome of acute kidney injury in critically ill adult patients

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Background

Interleukin-18 (IL-18) is a pro-inflammatory protein, which mediates ischaemic tubular injury, and has been suggested to be a sensitive and specific biomarker for acute kidney injury (AKI). The predictive value of IL-18 in the diagnosis, evolution, and outcome of AKI in critically ill patients is still unclear.

Methods

We measured urine IL-18 from critically ill patients at intensive care unit (ICU) admission and 24 h. We evaluated the association of IL-18 with developing new AKI, renal replacement therapy (RRT), and 90-day mortality. We calculated areas under receiver operating characteristics curves (AUCs), best cut-off values, and positive likelihood ratios (LR+) for IL-18 concerning these endpoints. Additionally, we compared the predictive value of IL-18 at ICU admission to that of urine neutrophil gelatinase-associated lipocalin (NGAL).

Results

In this study population of 1439 patients the highest urine IL-18 during the first 24 h in the ICU associated with the development of AKI with an AUC [95% confidence interval (CI)] of 0.586 (0.546–0.627) and with the development of Stage 3 AKI with an AUC (95% CI) of 0.667 (0.591–0.774). IL-18 predicted the initiation of RRT with an AUC (95% CI) of 0.655 (0.572–0.739), and 90-day mortality with an AUC (95% CI) of 0.536 (0.497–0.574).

Conclusions

IL-18 had poor-to-moderate ability to predict AKI, RRT, or 90-day mortality in this large cohort of critically ill patients. Thus, it should be used with caution for diagnostic or predictive purposes in the critically ill.

Keywords: acute kidney injury; critical illness; interleukin-18; intensive care; long-term outcome; renal replacement therapy

Journal Article.  4439 words.  Illustrated.

Subjects: Anaesthetics

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