Combination of Urinary Biomarkers for Early Detection of Patients With Acute Kidney Injury After Transcatheter Aortic...

To investigate whether urinary biomarker paneling improves the accuracy of diagnosis of acute kidney injury (AKI) after transcatheter aortic valve implantation (TAVI).

Post-hoc analysis of a prospective, single-center study.

University hospital.

This post-hoc analysis utilized data from a prospective, single-center study of 173 patients who underwent TAVI between December 2016 and April 2020.

None.

The combination of three urinary biomarkers, including preoperative urinary liver-type fatty acid-binding protein (L-FABP), immediately postoperative urinary albumin, and 4-hour postoperative urinary clusterin, was evaluated. The diagnostic performance of the combinations was assessed using receiver operating characteristic analysis, likelihood ratios, and predictive values. Post-TAVI AKI occurred in 22 patients (12.7%). The combination of preoperative L-FABP and immediately postoperative albumin demonstrated superior diagnostic accuracy (area under the curve = 0.80) compared with preoperative L-FABP alone (area under the curve = 0.68, p = 0.031). Additionally, the combination of preoperative L-FABP and 4-hour postoperative clusterin exhibited diagnostic efficacy with high specificity (0.99), positive predictive value (90%), and a positive likelihood ratio (64.8). These associations remained significant after adjusting for potential confounders.

Biomarker paneling, particularly the combination of preoperative L-FABP with immediately postoperative albumin or 4-hour postoperative clusterin, significantly enhanced the diagnostic accuracy for post-TAVI AKI. This approach may facilitate earlier detection and more precise diagnosis of AKI.