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.