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Submitted: 07 May 2019
Accepted: 09 Aug 2018
ePublished: 14 Sep 2019
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J Renal Inj Prev. 2019;8(4): 292-300.
doi: 10.15171/jrip.2019.54
  Abstract View: 376
  PDF Download: 205

Original Article

Role of interleukin-18 and plasma B-type natriuretic peptide in predicting requirement of kidney replacement therapy and/or mortality in individuals with acute heart disorders

Aida Hamzić-Mehmedbašić 1,2 * ORCID logo, Damir Rebić 1, Amina Valjevac 3, Hajrunisa Čubro 4, Azra Durak Nalbantić 5, Vedad Herenda 1,2, Aida Kulo Ćesić 6

1 Nephrology Clinic, Clinical Center University of Sarajevo, Bolnička 25, 71000, Sarajevo, Bosnia and Herzegovina
2 Sarajevo Medical School, University Sarajevo School of Science and Technology, Hrasnička cesta 3a, 71000, Sarajevo, Bosnia and Herzegovina
3 Department of Physiology, Faculty of Medicine, University of Sarajevo, Čekaluša 90, 71000, Sarajevo, Bosnia and Herzegovina
4 Department of Obstetrics and Gynecology, University of Louisville, 550 S Jackson St, Louisville, KY 40202, USA
5 Heart Disease Clinic, Clinical Center University of Sarajevo, Bolnička 25, 71000, Sarajevo, Bosnia and Herzegovina
6 Department of Pharmacology, Faculty of Medicine, University of Sarajevo, Čekaluša 90, 71000, Sarajevo, Bosnia and Herzegovina

Abstract

Introduction: Although many predictive tools have already been developed, efforts are still proceeding to identify a reliable biomarker to predict the prognosis of the patients with acute heart disorders.

Objectives: The aim was to evaluate the role of renal injury biomarkers (serum cystatin C, serum and urine interleukin-18, IL-18) and heart failure biomarkers (plasma B-type natriuretic peptide, BNP) in the prediction of the postdischarge requirement of renal replacement therapy (RRT) and/or 6-month mortality in patients with acute heart disorders.

Patients and Methods: In patients diagnosed with acute heart disorders (acute heart failure [AHF] and/or acute coronary syndrome [ACS]) and admitted to the intensive care units, baseline clinical parameters, renal and cardiac biomarkers were determined. Patients were followed up for 6 months. The composite outcome was the postdischarge requirement of RRT and/or 6-month mortality.

Results: Of 120 patients, 5.8% continued RRT after discharge. The 6-month mortality was 20%. Cox logistic regression analysis showed that urine IL-18 (P=0.021), plasma BNP (P=0.046), Acute Physiology and Chronic Health Evaluation (APACHE) II score (P=0.002), and left ventricular diastolic dysfunction (P=0.045) were independent predictors of the postdischarge requirement of RRT and/or 6-month mortality. For predicting RRT and/or 6-month mortality, using urine IL-18 cutoff value of 29.1 pg/mL showed 66.7% sensitivity and 67.7% specificity (area under the curve, AUC 0.70, P=0.003), while using plasma BNP cutoff value of 881.6 pg/mL showed 66.7% sensitivity and 70.8% specificity (AUC 0.76, P<0.001).

Conclusion: Urine IL-18 and plasma BNP are independently predictive for the postdischarge requirement of RRT and/or 6-month mortality in patients with acute heart disorders.

Keywords: Acute heart disorders, Interleukin-18, B-type natriuretic peptide, Dialysis, Mortality

Implication for health policy/practice/research/medical education:

Prognostic value of renal and cardiac biomarkers is ascertained in recognizing high risk patients with acute heart disorders. Thoughtful use of cardiorenal biomarkers allows not only diagnostic assessment of acute cardiac patients with potential worsening of renal function but also monitoring of renal disease progression in this patient population. As these patients with acute heart disorders may need more strategic and tailored treatment in order to prevent future risk of an adverse event, novel cardiac and renal biomarkers can be helpful on this matter.

Please cite this paper as: Hamzić-Mehmedbašić A, Rebić D, Valjevac A, Čubro H, Durak Nalbantić A, Herenda V, et al. Role of interleukin-18 and plasma B-type natriuretic peptide in predicting requirement of kidney replacement therapy and/or mortality in individuals with acute heart disorders. J Renal Inj Prev. 2019;8(4):292-300. DOI: 10.15171/jrip.2019.54.

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