• Yohei Komaru, Rei Isshiki, Ryo Matsuura, Yoshifumi Hamasaki, Masaomi Nangaku, and Kent Doi.
• Division of Nephrology and Endocrinology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo, Tokyo, Japan; Department of Hemodialysis and Apheresis, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo, Tokyo, Japan.
• J Crit Care. 2023 Oct 1; 77: 154312154312.

PurposeEstimating the baseline renal function of patients without prior creatinine measurement is crucial for diagnosing acute kidney injury (AKI). This study aimed to incorporate AKI biomarkers into a new AKI diagnosis rule when no premorbid baseline is available.MethodsThis prospective observational study was conducted in an adult intensive care unit (ICU). Urinary neutrophil gelatinase-associated lipocalin (NGAL) and L-type fatty acid-binding protein (L-FABP) were measured at ICU admission. An AKI diagnostic rule was composed by classification and regression tree (CART) analysis.ResultsA total of 243 patients were enrolled. In the development cohort, CART analysis composed a decision tree for AKI diagnosis selecting serum creatinine and urinary NGAL at ICU admission as predictors. In the validation cohort, the novel decision rule was superior to the imputation strategy based on Modification of Diet in Renal Disease (MDRD) equation regarding misclassification rate (13.0% vs. 29.6%, p = 0.002). Decision curve analysis demonstrated that the net benefit of the decision rule exceeded the MDRD approach in a threshold probability range of 25% and higher.ConclusionsThe novel diagnostic rule incorporating serum creatinine and urinary NGAL at ICU admission showed superiority to the MDRD approach in AKI diagnosis without baseline renal function data.Copyright © 2023. Published by Elsevier Inc.

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