U.S. patent application number 17/494773 was filed with the patent office on 2022-05-19 for methods and compositions for diagnosis and prognosis of renal injury and renal failure.
This patent application is currently assigned to ASTUTE MEDICAL, INC.. The applicant listed for this patent is ASTUTE MEDICAL, INC.. Invention is credited to JOSEPH ANDERBERG, JEFF GRAY, JAMES PATRICK KAMPF, THOMAS KWAN, PAUL MCPHERSON, KEVIN NAKAMURA.
Application Number | 20220155324 17/494773 |
Document ID | / |
Family ID | |
Filed Date | 2022-05-19 |
United States Patent
Application |
20220155324 |
Kind Code |
A1 |
ANDERBERG; JOSEPH ; et
al. |
May 19, 2022 |
METHODS AND COMPOSITIONS FOR DIAGNOSIS AND PROGNOSIS OF RENAL
INJURY AND RENAL FAILURE
Abstract
The present invention relates to methods and compositions for
monitoring, diagnosis, prognosis, and determination of treatment
regimens in subjects suffering from or suspected of having a renal
injury. In particular, the invention relates to using assays that
detect one or more of Insulin-like growth factor-binding protein 2,
Insulin-like growth factor-binding protein 3, Insulin-like growth
factor-binding protein 4, and Insulin like growth factor-binding
protein 6 as diagnostic and prognostic biomarker assays in renal
injuries.
Inventors: |
ANDERBERG; JOSEPH;
(ENCINITAS, CA) ; MCPHERSON; PAUL; (ENCINITAS,
CA) ; GRAY; JEFF; (SOLANA BEACH, CA) ;
NAKAMURA; KEVIN; (CARDIFF BY THE SEA, CA) ; KAMPF;
JAMES PATRICK; (SAN DIEGO, CA) ; KWAN; THOMAS;
(SAN DIEGO, CA) |
|
Applicant: |
Name |
City |
State |
Country |
Type |
ASTUTE MEDICAL, INC. |
SAN DIEGO |
CA |
US |
|
|
Assignee: |
ASTUTE MEDICAL, INC.
SAN DIEGO
CA
|
Appl. No.: |
17/494773 |
Filed: |
October 5, 2021 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
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15573441 |
Nov 10, 2017 |
11143658 |
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PCT/US2016/032209 |
May 12, 2016 |
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17494773 |
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62160531 |
May 12, 2015 |
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62160519 |
May 12, 2015 |
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62160526 |
May 12, 2015 |
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62160523 |
May 12, 2015 |
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International
Class: |
G01N 33/68 20060101
G01N033/68 |
Claims
1-111. (canceled)
112. A method of treating acute kidney injury comprising: (a)
detecting a level of one or more of insulin-like growth
factor-binding protein 2, insulin-like growth factor-binding
protein 3, insulin-like growth factor-binding protein 4, and
insulin-like growth factor-binding protein 6 in a body fluid sample
obtained from a subject; (b) determining that the subject is at
increased risk of persistence of a RIFLE I acute kidney injury or
persistence of a RIFLE F acute kidney injury based on the level of
one or more of insulin-like growth factor-binding protein 2,
insulin-like growth factor-binding protein 3, insulin-like growth
factor-binding protein 4, and insulin-like growth factor-binding
protein 6 in the body fluid sample; and (c) administering to the
subject at the increased risk of persistence of a RIFLE I acute
kidney injury or persistence of a RIFLE F acute kidney injury a
treatment regimen comprising one or more of renal replacement
therapy, withdrawing delivery of compounds that are known to be
damaging to the kidney, delaying or avoiding procedures that are
known to be damaging to the kidney, modifying diuretic
administration, monitoring and optimizing hemodynamics and fluid
administration, and adjusting dosing of renally excreted
substances.
113. The method of claim 112, wherein the determining comprises
determining that the subject has an increased likelihood of the
persistence of a RIFLE I acute kidney injury or the persistence of
a RIFLE F acute kidney injury for a period of 24 hours or more
after the time the sample is obtained from the subject.
114. The method of claim 112, wherein the determining comprises
determining that the subject has an increased likelihood of the
persistence of a RIFLE I acute kidney injury or the persistence of
a RIFLE F acute kidney injury for a period of 48 hours or more
after the time the sample is obtained from the subject.
115. The method of claim 112, wherein the determining comprises
determining that the subject has an increased likelihood of the
persistence of a RIFLE I acute kidney injury or the persistence of
a RIFLE F acute kidney injury for a period of 72 hours or more
after the time the sample is obtained from the subject.
116. The method of claim 112, wherein the determining comprises
determining that the subject has an increased likelihood of the
persistence of a RIFLE I acute kidney injury or the persistence of
a RIFLE F acute kidney injury for a period of 24, 48, or 72 hours
after the time the sample is obtained from the subject.
117. The method of claim 112, wherein the persistence of a RIFLE I
acute kidney injury or the persistence of a RIFLE F acute kidney
injury is future persistence of a RIFLE I acute kidney injury or
future persistence of a RIFLE F acute kidney injury.
118. The method of claim 112, wherein the persistence of a RIFLE I
acute kidney injury or the persistence of a RIFLE F acute kidney
injury is future persistence of a RIFLE F acute kidney injury.
119. The method of claim 112, wherein the persistence of a RIFLE I
acute kidney injury or the persistence of a RIFLE F acute kidney
injury is future persistence of a RIFLE I acute kidney injury.
120. The method of claim 117, wherein the future persistence
comprises a persistence period that starts within 24 hours after
the sample is obtained.
121. The method of claim 117, wherein the future persistence
comprises a persistence period that starts within 48 hours after
the sample is obtained.
122. The method of claim 117, wherein the future persistence
comprises a persistence period that starts within 72 hours after
the sample is obtained.
123. The method of claim 112, wherein the persistence comprises a
persistence period that starts at the time the sample is
obtained.
124. The method of claim 112, wherein the detecting comprises
detecting an elevated level of the one or more of insulin-like
growth factor-binding protein 2, insulin-like growth factor-binding
protein 3, insulin-like growth factor-binding protein 4, and
insulin-like growth factor-binding protein 6 in the sample as
compared to a predetermined threshold level.
125. The method of claim 112, wherein the detecting comprises:
contacting all or a portion of the sample with a binding reagent
which binds to the one or more of insulin-like growth
factor-binding protein 2, insulin-like growth factor-binding
protein 3, insulin-like growth factor-binding protein 4, and
insulin-like growth factor-binding protein 6; and generating an
assay result indicative of binding of the one or more of
insulin-like growth factor-binding protein 2, insulin-like growth
factor-binding protein 3, insulin-like growth factor-binding
protein 4, and insulin-like growth factor-binding protein 6.
126. The method of claim 125, wherein the assay result is a
measured concentration of the one or more of insulin-like growth
factor-binding protein 2, insulin-like growth factor-binding
protein 3, insulin-like growth factor-binding protein 4, and
insulin-like growth factor-binding protein 6.
127. The method of claim 125, wherein the assay result is a
composite of a plurality of assay results.
128. The method of claim 125, wherein the binding reagent is an
antibody.
129. The method of claim 112, wherein the body fluid sample is a
urine sample.
130. A method of treating acute kidney injury comprising: (a)
detecting a level of one or more of insulin-like growth
factor-binding protein 2, insulin-like growth factor-binding
protein 3, insulin-like growth factor-binding protein 4, and
insulin-like growth factor-binding protein 6 in a urine sample
obtained from a subject; (b) determining that the subject is at
increased risk of persistence of a RIFLE F acute kidney injury
based on the level of one or more of insulin-like growth
factor-binding protein 2, insulin-like growth factor-binding
protein 3, insulin-like growth factor-binding protein 4, and
insulin-like growth factor-binding protein 6 in the sample, wherein
the persistence comprises a persistence period that starts at or
after the time the sample is obtained and at or before 48 hours
after the sample is obtained, and lasts for a period of 72 hours or
more; and (c) administering to the subject at the increased risk of
persistence of a RIFLE F acute kidney injury a treatment regimen
comprising one or more of renal replacement therapy, withdrawing
delivery of compounds that are known to be damaging to the kidney,
delaying or avoiding procedures that are known to be damaging to
the kidney, modifying diuretic administration, monitoring and
optimizing hemodynamics and fluid administration, and adjusting
dosing of renally excreted substances.
131. A method of treating acute kidney injury comprising: (a)
detecting a level of one or more of insulin-like growth
factor-binding protein 2, insulin-like growth factor-binding
protein 3, insulin-like growth factor-binding protein 4, and
insulin-like growth factor-binding protein 6 in a urine sample
obtained from a subject; (b) determining that the subject is at
increased risk of persistence of a RIFLE I acute kidney injury
based on the level of one or more of insulin-like growth
factor-binding protein 2, insulin-like growth factor-binding
protein 3, insulin-like growth factor-binding protein 4, and
insulin-like growth factor-binding protein 6 in the sample, wherein
the persistence comprises a persistence period that starts at or
after the time the sample is obtained and at or before 48 hours
after the sample is obtained, and lasts for a period of 72 hours or
more; and (c) administering to the subject at the increased risk of
persistence of a RIFLE I acute kidney injury a treatment regimen
comprising one or more of renal replacement therapy, withdrawing
delivery of compounds that are known to be damaging to the kidney,
delaying or avoiding procedures that are known to be damaging to
the kidney, modifying diuretic administration, monitoring and
optimizing hemodynamics and fluid administration, and adjusting
dosing of renally excreted substances.
Description
[0001] The present invention claims priority from U.S. Provisional
Patent Application No. 62/160,519 filed May 12, 2015; from U.S.
Provisional Patent Application No. 62/160,523 filed May 12, 2015;
from U.S. Provisional Patent Application No. 62/160,526 filed May
12, 2015; and from U.S. Provisional Patent Application No.
62/160,531 filed May 12, 2015, each of which is hereby incorporated
in its entirety including all tables, figures, and claims.
BACKGROUND OF THE INVENTION
[0002] The following discussion of the background of the invention
is merely provided to aid the reader in understanding the invention
and is not admitted to describe or constitute prior art to the
present invention.
[0003] The kidney is responsible for water and solute excretion
from the body. Its functions include maintenance of acid-base
balance, regulation of electrolyte concentrations, control of blood
volume, and regulation of blood pressure. As such, loss of kidney
function through injury and/or disease results in substantial
morbidity and mortality. A detailed discussion of renal injuries is
provided in Harrison's Principles of Internal Medicine, 17.sup.th
Ed., McGraw Hill, N.Y., pages 1741-1830, which are hereby
incorporated by reference in their entirety. Renal disease and/or
injury may be acute or chronic. Acute and chronic kidney disease
are described as follows (from Current Medical Diagnosis &
Treatment 2008, 47.sup.th Ed, McGraw Hill, N.Y., pages 785-815,
which are hereby incorporated by reference in their entirety):
"Acute renal failure is worsening of renal function over hours to
days, resulting in the retention of nitrogenous wastes (such as
urea nitrogen) and creatinine in the blood. Retention of these
substances is called azotemia. Chronic renal failure (chronic
kidney disease) results from an abnormal loss of renal function
over months to years".
[0004] Acute renal failure (ARF, also known as acute kidney injury,
or AKI) is an abrupt (typically detected within about 48 hours to 1
week) reduction in glomerular filtration. This loss of filtration
capacity results in retention of nitrogenous (urea and creatinine)
and non-nitrogenous waste products that are normally excreted by
the kidney, a reduction in urine output, or both. It is reported
that ARF complicates about 5% of hospital admissions, 4-15% of
cardiopulmonary bypass surgeries, and up to 30% of intensive care
admissions. ARF may be categorized as prerenal, intrinsic renal, or
postrenal in causation. Intrinsic renal disease can be further
divided into glomerular, tubular, interstitial, and vascular
abnormalities. Major causes of ARF are described in the following
table, which is adapted from the Merck Manual, 17.sup.th ed.,
Chapter 222, and which is hereby incorporated by reference in their
entirety:
TABLE-US-00001 Type Risk Factors Prerenal ECF volume depletion
Excessive diuresis, hemorrhage, GI losses, loss of intravascular
fluid into the extravascular space (due to ascites, peritonitis,
pancreatitis, or burns), loss of skin and mucus membranes, renal
salt- and water-wasting states Low cardiac output Cardiomyopathy,
MI, cardiac tamponade, pulmonary embolism, pulmonary hypertension,
positive-pressure mechanical ventilation Low systemic vascular
Septic shock, liver failure, antihypertensive drugs resistance
Increased renal vascular NSAIDs, cyclosporines, tacrolimus,
hypercalcemia, resistance anaphylaxis, anesthetics, renal artery
obstruction, renal vein thrombosis, sepsis, hepatorenal syndrome
Decreased efferent ACE inhibitors or angiotensin II receptor
blockers arteriolar tone (leading to decreased GFR from reduced
glomerular transcapillary pressure, especially in patients with
bilateral renal artery stenosis) Intrinsic Renal Acute tubular
injury Ischemia (prolonged or severe prerenal state): surgery,
hemorrhage, arterial or venous obstruction; Toxins: NSAIDs,
cyclosporines, tacrolimus, aminoglycosides, foscarnet, ethylene
glycol, hemoglobin, myoglobin, ifosfamide, heavy metals,
methotrexate, radiopaque contrast agents, streptozotocin Acute
glomerulonephritis ANCA-associated: Crescentic glomerulonephritis,
polyarteritis nodosa, Wegener's granulomatosis; Anti- GBM
glomerulonephritis: Goodpasture's syndrome; Immune-complex: Lupus
glomerulonephritis, postinfectious glomerulonephritis,
cryoglobulinemic glomerulonephritis Acute tubulointerstitial Drug
reaction (eg, .beta.-lactams, NSAIDs, sulfonamides, nephritis
ciprofloxacin, thiazide diuretics, furosemide, phenytoin,
allopurinol, pyelonephritis, papillary necrosis Acute vascular
Vasculitis, malignant hypertension, thrombotic nephropathy
microangiopathies, scleroderma, atheroembolism Infiltrative
diseases Lymphoma, sarcoidosis, leukemia Postrenal Tubular
precipitation Uric acid (tumor lysis), sulfonamides, triamterene,
acyclovir, indinavir, methotrexate, ethylene glycol ingestion,
myeloma protein, myoglobin Ureteral obstruction Intrinsic: Calculi,
clots, sloughed renal tissue, fungus ball, edema, malignancy,
congenital defects; Extrinsic: Malignancy, retroperitoneal
fibrosis, ureteral trauma during surgery or high impact injury
Bladder obstruction Mechanical: Benign prostatic hyperplasia,
prostate cancer, bladder cancer, urethral strictures, phimosis,
paraphimosis, urethral valves, obstructed indwelling urinary
catheter; Neurogenic: Anticholinergic drugs, upper or lower motor
neuron lesion
[0005] In the case of ischemic ARF, the course of the disease may
be divided into four phases. During an initiation phase, which
lasts hours to days, reduced perfusion of the kidney is evolving
into injury. Glomerular ultrafiltration reduces, the flow of
filtrate is reduced due to debris within the tubules, and back
leakage of filtrate through injured epithelium occurs. Renal injury
can be mediated during this phase by reperfusion of the kidney.
Initiation is followed by an extension phase which is characterized
by continued ischemic injury and inflammation and may involve
endothelial damage and vascular congestion. During the maintenance
phase, lasting from 1 to 2 weeks, renal cell injury occurs, and
glomerular filtration and urine output reaches a minimum. A
recovery phase can follow in which the renal epithelium is repaired
and GFR gradually recovers. Despite this, the survival rate of
subjects with ARF may be as low as about 60%.
[0006] Acute kidney injury caused by radiocontrast agents (also
called contrast media) and other nephrotoxins such as cyclosporine,
antibiotics including aminoglycosides and anticancer drugs such as
cisplatin manifests over a period of days to about a week. Contrast
induced nephropathy (CIN, which is AKI caused by radiocontrast
agents) is thought to be caused by intrarenal vasoconstriction
(leading to ischemic injury) and from the generation of reactive
oxygen species that are directly toxic to renal tubular epithelial
cells. CIN classically presents as an acute (onset within 24-48 h)
but reversible (peak 3-5 days, resolution within 1 week) rise in
blood urea nitrogen and serum creatinine.
[0007] A commonly reported criteria for defining and detecting AKI
is an abrupt (typically within about 2-7 days or within a period of
hospitalization) elevation of serum creatinine. Although the use of
serum creatinine elevation to define and detect AKI is well
established, the magnitude of the serum creatinine elevation and
the time over which it is measured to define AKI varies
considerably among publications. Traditionally, relatively large
increases in serum creatinine such as 100%, 200%, an increase of at
least 100% to a value over 2 mg/dL and other definitions were used
to define AKI. However, the recent trend has been towards using
smaller serum creatinine rises to define AKI. The relationship
between serum creatinine rise, AKI and the associated health risks
are reviewed in Praught and Shlipak, Curr Opin Nephrol Hypertens
14:265-270, 2005 and Chertow et al, J Am Soc Nephrol 16: 3365-3370,
2005, which, with the references listed therein, are hereby
incorporated by reference in their entirety. As described in these
publications, acute worsening renal function (AKI) and increased
risk of death and other detrimental outcomes are now known to be
associated with very small increases in serum creatinine. These
increases may be determined as a relative (percent) value or a
nominal value. Relative increases in serum creatinine as small as
20% from the pre-injury value have been reported to indicate
acutely worsening renal function (AKI) and increased health risk,
but the more commonly reported value to define AKI and increased
health risk is a relative increase of at least 25%. Nominal
increases as small as 0.3 mg/dL, 0.2 mg/dL or even 0.1 mg/dL have
been reported to indicate worsening renal function and increased
risk of death. Various time periods for the serum creatinine to
rise to these threshold values have been used to define AKI, for
example, ranging from 2 days, 3 days, 7 days, or a variable period
defined as the time the patient is in the hospital or intensive
care unit. These studies indicate there is not a particular
threshold serum creatinine rise (or time period for the rise) for
worsening renal function or AKI, but rather a continuous increase
in risk with increasing magnitude of serum creatinine rise.
[0008] One study (Lassnigg et all, J Am Soc Nephrol 15:1597-1605,
2004, hereby incorporated by reference in its entirety)
investigated both increases and decreases in serum creatinine.
Patients with a mild fall in serum creatinine of -0.1 to -0.3 mg/dL
following heart surgery had the lowest mortality rate. Patients
with a larger fall in serum creatinine (more than or equal to -0.4
mg/dL) or any increase in serum creatinine had a larger mortality
rate. These findings caused the authors to conclude that even very
subtle changes in renal function (as detected by small creatinine
changes within 48 hours of surgery) seriously effect patient's
outcomes. In an effort to reach consensus on a unified
classification system for using serum creatinine to define AKI in
clinical trials and in clinical practice, Bellomo et al., Crit
Care. 8(4):R204-12, 2004, which is hereby incorporated by reference
in its entirety, proposes the following classifications for
stratifying AKI patients:
"Risk": serum creatinine increased 1.5 fold from baseline OR urine
production of <0.5 ml/kg body weight/hr for 6 hours; "Injury":
serum creatinine increased 2.0 fold from baseline OR urine
production <0.5 ml/kg/hr for 12 h; "Failure": serum creatinine
increased 3.0 fold from baseline OR creatinine >355 .mu.mol/l
(with a rise of >44) or urine output below 0.3 ml/kg/hr for 24 h
or anuria for at least 12 hours; And included two clinical
outcomes: "Loss": persistent need for renal replacement therapy for
more than four weeks. "ESRD": end stage renal disease--the need for
dialysis for more than 3 months. These criteria are called the
RIFLE criteria, which provide a useful clinical tool to classify
renal status. As discussed in Kellum, Crit. Care Med. 36: S141-45,
2008 and Ricci et al., Kidney Int. 73, 538-546, 2008, each hereby
incorporated by reference in its entirety, the RIFLE criteria
provide a uniform definition of AKI which has been validated in
numerous studies.
[0009] More recently, Mehta et al., Crit. Care 11:R31
(doi:10.1186.cc5713), 2007, hereby incorporated by reference in its
entirety, proposes the following similar classifications for
stratifying AKI patients, which have been modified from RIFLE:
"Stage I": increase in serum creatinine of more than or equal to
0.3 mg/dL (>26.4 .mu.mol/L) or increase to more than or equal to
150% (1.5-fold) from baseline OR urine output less than 0.5 mL/kg
per hour for more than 6 hours; "Stage II": increase in serum
creatinine to more than 200% (>2-fold) from baseline OR urine
output less than 0.5 mL/kg per hour for more than 12 hours; "Stage
III": increase in serum creatinine to more than 300% (>3-fold)
from baseline OR serum creatinine .gtoreq.354 .mu.mol/L accompanied
by an acute increase of at least 44 .mu.mol/L OR urine output less
than 0.3 mL/kg per hour for 24 hours or anuria for 12 hours.
[0010] The CIN Consensus Working Panel (McCollough et al, Rev
Cardiovasc Med. 2006; 7(4):177-197, hereby incorporated by
reference in its entirety) uses a serum creatinine rise of 25% to
define Contrast induced nephropathy (which is a type of AKI).
Although various groups propose slightly different criteria for
using serum creatinine to detect AKI, the consensus is that small
changes in serum creatinine, such as 0.3 mg/dL or 25%, are
sufficient to detect AKI (worsening renal function) and that the
magnitude of the serum creatinine change is an indicator of the
severity of the AKI and mortality risk.
[0011] Although serial measurement of serum creatinine over a
period of days is an accepted method of detecting and diagnosing
AKI and is considered one of the most important tools to evaluate
AKI patients, serum creatinine is generally regarded to have
several limitations in the diagnosis, assessment and monitoring of
AKI patients. The time period for serum creatinine to rise to
values (e.g., a 0.3 mg/dL or 25% rise) considered diagnostic for
AKI can be 48 hours or longer depending on the definition used.
Since cellular injury in AKI can occur over a period of hours,
serum creatinine elevations detected at 48 hours or longer can be a
late indicator of injury, and relying on serum creatinine can thus
delay diagnosis of AKI. Furthermore, serum creatinine is not a good
indicator of the exact kidney status and treatment needs during the
most acute phases of AKI when kidney function is changing rapidly.
Some patients with AKI will recover fully, some will need dialysis
(either short term or long term) and some will have other
detrimental outcomes including death, major adverse cardiac events
and chronic kidney disease. Because serum creatinine is a marker of
filtration rate, it does not differentiate between the causes of
AKI (pre-renal, intrinsic renal, post-renal obstruction,
atheroembolic, etc) or the category or location of injury in
intrinsic renal disease (for example, tubular, glomerular or
interstitial in origin). Urine output is similarly limited, Knowing
these things can be of vital importance in managing and treating
patients with AKI.
[0012] These limitations underscore the need for better methods to
detect and assess AKI, particularly in the early and subclinical
stages, but also in later stages when recovery and repair of the
kidney can occur. Furthermore, there is a need to better identify
patients who arc at risk of having an AKI.
BRIEF SUMMARY OF THE INVENTION
[0013] It is an object of the invention to provide methods and
compositions for evaluating renal function in a subject. As
described herein, measurement of one or more markers selected from
the group consisting of Insulin-like growth factor-binding protein
2, Insulin-like growth factor-binding protein 3, Insulin-like
growth factor-binding protein 4, and Insulin-like growth
factor-binding protein 6 (collectively referred to herein as
"kidney injury markers, and individually as a "kidney injury
marker") can be used for diagnosis, prognosis, risk stratification,
staging, monitoring, categorizing and determination of further
diagnosis and treatment regimens in subjects suffering or at risk
of suffering from an injury to renal function, reduced renal
function, and/or acute renal failure (also called acute kidney
injury).
[0014] These kidney injury markers may be used, individually or in
panels comprising a plurality of kidney injury markers, for risk
stratification (that is, to identify subjects at risk for a future
injury to renal function, for future progression to reduced renal
function, for future progression to ARF, for future improvement in
renal function, etc.); for diagnosis of existing disease (that is,
to identify subjects who have suffered an injury to renal function,
who have progressed to reduced renal function, who have progressed
to ARF, etc.); for monitoring for deterioration or improvement of
renal function; and for predicting a future medical outcome, such
as improved or worsening renal function, a decreased or increased
mortality risk, a decreased or increased risk that a subject will
require renal replacement therapy (i.e., hemodialysis, peritoneal
dialysis, hemofiltration, and/or renal transplantation, a decreased
or increased risk that a subject will recover from an injury to
renal function, a decreased or increased risk that a subject will
recover from ARF, a decreased or increased risk that a subject will
progress to end stage renal disease, a decreased or increased risk
that a subject will progress to chronic renal failure, a decreased
or increased risk that a subject will suffer rejection of a
transplanted kidney, etc.
[0015] In a first aspect, the present invention relates to methods
for evaluating renal status in a subject. These methods comprise
performing an assay method that is configured to detect one or more
kidney injury markers of the present invention in a body fluid
sample obtained from the subject. The assay result(s), for example
a measured concentration of one or more markers selected from the
group consisting of Insulin-like growth factor-binding protein 2,
Insulin-like growth factor-binding protein 3, Insulin-like growth
factor-binding protein 4, and/or Insulin-like growth factor-binding
protein 6, is/are then correlated to the renal status of the
subject. This correlation to renal status may include correlating
the assay result(s) to one or more of risk stratification,
diagnosis, prognosis, staging, classifying and monitoring of the
subject as described herein. Thus, the present invention utilizes
one or more kidney injury markers of the present invention for the
evaluation of renal injury.
[0016] In certain embodiments, the methods for evaluating renal
status described herein are methods for risk stratification of the
subject; that is, assigning a likelihood of one or more future
changes in renal status to the subject. In these embodiments, the
assay result(s) is/are correlated to one or more such future
changes. The following are preferred risk stratification
embodiments.
[0017] In preferred risk stratification embodiments, these methods
comprise determining a subject's risk for a future injury to renal
function, and the assay result(s), for example a measured
concentration of one or more markers selected from the group
consisting of Insulin-like growth factor-binding protein 2,
Insulin-like growth factor-binding protein 3, Insulin-like growth
factor-binding protein 4, and/or Insulin-like growth factor-binding
protein 6, is/are correlated to a likelihood of such a future
injury to renal function. For example, the measured
concentration(s) may each be compared to a threshold value. For a
"positive going" kidney injury marker, an increased likelihood of
suffering a future injury to renal function is assigned to the
subject when the measured concentration is above the threshold,
relative to a likelihood assigned when the measured concentration
is below the threshold. For a "negative going" kidney injury
marker, an increased likelihood of suffering a future injury to
renal function is assigned to the subject when the measured
concentration is below the threshold, relative to a likelihood
assigned when the measured concentration is above the
threshold.
[0018] In other preferred risk stratification embodiments, these
methods comprise determining a subject's risk for future reduced
renal function, and the assay result(s), for example a measured
concentration of one or more markers selected from the group
consisting of Insulin-like growth factor-binding protein 2,
Insulin-like growth factor-binding protein 3, Insulin-like growth
factor-binding protein 4, and/or Insulin-like growth factor-binding
protein 6, is/are correlated to a likelihood of such reduced renal
function. For example, the measured concentrations may each be
compared to a threshold value. For a "positive going" kidney injury
marker, an increased likelihood of suffering a future reduced renal
function is assigned to the subject when the measured concentration
is above the threshold, relative to a likelihood assigned when the
measured concentration is below the threshold. For a "negative
going" kidney injury marker, an increased likelihood of future
reduced renal function is assigned to the subject when the measured
concentration is below the threshold, relative to a likelihood
assigned when the measured concentration is above the
threshold.
[0019] In still other preferred risk stratification embodiments,
these methods comprise determining a subject's likelihood for a
future improvement in renal function, and the assay result(s), for
example a measured concentration of one or more markers selected
from the group consisting of Insulin-like growth factor-binding
protein 2, Insulin-like growth factor-binding protein 3,
Insulin-like growth factor-binding protein 4, and/or Insulin-like
growth factor-binding protein 6, is/are correlated to a likelihood
of such a future improvement in renal function. For example, the
measured concentration(s) may each be compared to a threshold
value. For a "positive going" kidney injury marker, an increased
likelihood of a future improvement in renal function is assigned to
the subject when the measured concentration is below the threshold,
relative to a likelihood assigned when the measured concentration
is above the threshold. For a "negative going" kidney injury
marker, an increased likelihood of a future improvement in renal
function is assigned to the subject when the measured concentration
is above the threshold, relative to a likelihood assigned when the
measured concentration is below the threshold.
[0020] In yet other preferred risk stratification embodiments,
these methods comprise determining a subject's risk for progression
to ARF, and the result(s), for example a measured concentration of
one or more markers selected from the group consisting of
Insulin-like growth factor-binding protein 2, Insulin-like growth
factor-binding protein 3, Insulin-like growth factor-binding
protein 4, and/or Insulin-like growth factor-binding protein 6,
is/are correlated to a likelihood of such progression to ARF. For
example, the measured concentration(s) may each be compared to a
threshold value. For a "positive going" kidney injury marker, an
increased likelihood of progression to ARF is assigned to the
subject when the measured concentration is above the threshold,
relative to a likelihood assigned when the measured concentration
is below the threshold. For a "negative going" kidney injury
marker, an increased likelihood of progression to ARF is assigned
to the subject when the measured concentration is below the
threshold, relative to a likelihood assigned when the measured
concentration is above the threshold.
[0021] And in other preferred risk stratification embodiments,
these methods comprise determining a subject's outcome risk, and
the assay result(s), for example a measured concentration of one or
more markers selected from the group consisting of Insulin-like
growth factor-binding protein 2, Insulin-like growth factor-binding
protein 3, Insulin-like growth factor-binding protein 4, and/or
Insulin-like growth factor-binding protein 6, is/are correlated to
a likelihood of the occurrence of a clinical outcome related to a
renal injury suffered by the subject. For example, the measured
concentration(s) may each be compared to a threshold value. For a
"positive going" kidney injury marker, an increased likelihood of
one or more of: acute kidney injury, progression to a worsening
stage of AKI, mortality, a requirement for renal replacement
therapy, a requirement for withdrawal of renal toxins, end stage
renal disease, heart failure, stroke, myocardial infarction,
progression to chronic kidney disease, etc., is assigned to the
subject when the measured concentration is above the threshold,
relative to a likelihood assigned when the measured concentration
is below the threshold. For a "negative going" kidney injury
marker, an increased likelihood of one or more of: acute kidney
injury, progression to a worsening stage of AKI, mortality, a
requirement for renal replacement therapy, a requirement for
withdrawal of renal toxins, end stage renal disease, heart failure,
stroke, myocardial infarction, progression to chronic kidney
disease, etc., is assigned to the subject when the measured
concentration is below the threshold, relative to a likelihood
assigned when the measured concentration is above the
threshold.
[0022] In such risk stratification embodiments, preferably the
likelihood or risk assigned is that an event of interest is more or
less likely to occur within 180 days of the time at which the body
fluid sample is obtained from the subject. In particularly
preferred embodiments, the likelihood or risk assigned relates to
an event of interest occurring within a shorter time period such as
18 months, 120 days, 90 days, 60 days, 45 days, 30 days, 21 days,
14 days, 7 days, 5 days, 96 hours, 72 hours, 48 hours, 36 hours, 24
hours, 12 hours, or less. A risk at 0 hours of the time at which
the body fluid sample is obtained from the subject is equivalent to
diagnosis of a current condition.
[0023] In preferred risk stratification embodiments, the subject is
selected for risk stratification based on the pre-existence in the
subject of one or more known risk factors for prerenal, intrinsic
renal, or postrenal ARF. For example, a subject undergoing or
having undergone major vascular surgery, coronary artery bypass, or
other cardiac surgery; a subject having pre-existing congestive
heart failure, preeclampsia, eclampsia, diabetes mellitus,
hypertension, coronary artery disease, proteinuria, renal
insufficiency, glomerular filtration below the normal range,
cirrhosis, serum creatinine above the normal range, or sepsis; or a
subject exposed to NSAIDs, cyclosporines, tacrolimus,
aminoglycosides, foscarnet, ethylene glycol, hemoglobin, myoglobin,
ifosfamide, heavy metals, methotrexate, radiopaque contrast agents,
or streptozotocin are all preferred subjects for monitoring risks
according to the methods described herein. This list is not meant
to be limiting. By "pre-existence" in this context is meant that
the risk factor exists at the time the body fluid sample is
obtained from the subject. In particularly preferred embodiments, a
subject is chosen for risk stratification based on an existing
diagnosis of injury to renal function, reduced renal function, or
ARF.
[0024] In other embodiments, the methods for evaluating renal
status described herein are methods for diagnosing a renal injury
in the subject; that is, assessing whether or not a subject has
suffered from an injury to renal function, reduced renal function,
or ARF. In these embodiments, the assay result(s) is/are correlated
to the occurrence or nonoccurrence of a change in renal status. The
following are preferred diagnostic embodiments.
[0025] In preferred diagnostic embodiments, these methods comprise
diagnosing the occurrence or nonoccurrence of an injury to renal
function, and the assay result(s), for example a measured
concentration of one or more markers selected from the group
consisting of Insulin-like growth factor-binding protein 2,
Insulin-like growth factor-binding protein 3, Insulin-like growth
factor-binding protein 4, and/or Insulin-like growth factor-binding
protein 6, is/are correlated to the occurrence or nonoccurrence of
such an injury. For example, each of the measured concentration(s)
may be compared to a threshold value. For a positive going marker,
an increased likelihood of the occurrence of an injury to renal
function is assigned to the subject when the measured concentration
is above the threshold (relative to the likelihood assigned when
the measured concentration is below the threshold); alternatively,
when the measured concentration is below the threshold, an
increased likelihood of the nonoccurrence of an injury to renal
function may be assigned to the subject (relative to the likelihood
assigned when the measured concentration is above the threshold).
For a negative going marker, an increased likelihood of the
occurrence of an injury to renal function is assigned to the
subject when the measured concentration is below the threshold
(relative to the likelihood assigned when the measured
concentration is above the threshold); alternatively, when the
measured concentration is above the threshold, an increased
likelihood of the nonoccurrence of an injury to renal function may
he assigned to the subject (relative to the likelihood assigned
when the measured concentration is below the threshold).
[0026] In other preferred diagnostic embodiments, these methods
comprise diagnosing the occurrence or nonoccurrence of reduced
renal function, and the assay result(s), for example a measured
concentration of one or more markers selected from the group
consisting of Insulin-like growth factor-binding protein 2,
Insulin-like growth factor-binding protein 3, Insulin-like growth
factor-binding protein 4, and/or Insulin-like growth factor-binding
protein 6, is/are correlated to the occurrence or nonoccurrence of
an injury causing reduced renal function. For example, each of the
measured concentration(s) may be compared to a threshold value. For
a positive going marker, an increased likelihood of the occurrence
of an injury causing reduced renal function is assigned to the
subject when the measured concentration is above the threshold
(relative to the likelihood assigned when the measured
concentration is below the threshold); alternatively, when the
measured concentration is below the threshold, an increased
likelihood of the nonoccurrence of an injury causing reduced renal
function may be assigned to the subject (relative to the likelihood
assigned when the measured concentration is above the threshold).
For a negative going marker, an increased likelihood of the
occurrence of an injury causing reduced renal function is assigned
to the subject when the measured concentration is below the
threshold (relative to the likelihood assigned when the measured
concentration is above the threshold); alternatively, when the
measured concentration is above the threshold, an increased
likelihood of the nonoccurrence of an injury causing reduced renal
function may be assigned to the subject (relative to the likelihood
assigned when the measured concentration is below the
threshold).
[0027] In yet other preferred diagnostic embodiments, these methods
comprise diagnosing the occurrence or nonoccurrence of ARF, and the
assay result(s), for example a measured concentration of one or
more markers selected from the group consisting of Insulin-like
growth factor-binding protein 2, Insulin-like growth factor-binding
protein 3, Insulin-like growth factor-binding protein 4, and/or
Insulin-like growth factor-binding protein 6, is/are correlated to
the occurrence or nonoccurrence of an injury causing ARF. For
example, each of the measured concentration(s) may be compared to a
threshold value. For a positive going marker, an increased
likelihood of the occurrence of ARF is assigned to the subject when
the measured concentration is above the threshold (relative to the
likelihood assigned when the measured concentration is below the
threshold); alternatively, when the measured concentration is below
the threshold, an increased likelihood of the nonoccurrence of ARF
may be assigned to the subject (relative to the likelihood assigned
when the measured concentration is above the threshold). For a
negative going marker, an increased likelihood of the occurrence of
ARF is assigned to the subject when the measured concentration is
below the threshold (relative to the likelihood assigned when the
measured concentration is above the threshold); alternatively, when
the measured concentration is above the threshold, an increased
likelihood of the nonoccurrence of ARF may be assigned to the
subject (relative to the likelihood assigned when the measured
concentration is below the threshold).
[0028] In still other preferred diagnostic embodiments, these
methods comprise diagnosing a subject as being in need of renal
replacement therapy, and the assay result(s), for example a
measured concentration of one or more markers selected from the
group consisting of Insulin-like growth factor-binding protein 2,
Insulin-like growth factor-binding protein 3, Insulin-like growth
factor-binding protein 4, and/or Insulin-like growth factor-binding
protein 6, is/are correlated to a need for renal replacement
therapy. For example, each of the measured concentration(s) may be
compared to a threshold value. For a positive going marker, an
increased likelihood of the occurrence of an injury creating a need
for renal replacement therapy is assigned to the subject when the
measured concentration is above the threshold (relative to the
likelihood assigned when the measured concentration is below the
threshold); alternatively, when the measured concentration is below
the threshold, an increased likelihood of the nonoccurrence of an
injury creating a need for renal replacement therapy may be
assigned to the subject (relative to the likelihood assigned when
the measured concentration is above the threshold). For a negative
going marker, an increased likelihood of the occurrence of an
injury creating a need for renal replacement therapy is assigned to
the subject when the measured concentration is below the threshold
(relative to the likelihood assigned when the measured
concentration is above the threshold); alternatively, when the
measured concentration is above the threshold, an increased
likelihood of the nonoccurrence of an injury creating a need for
renal replacement therapy may be assigned to the subject (relative
to the likelihood assigned when the measured concentration is below
the threshold).
[0029] In still other preferred diagnostic embodiments, these
methods comprise diagnosing a subject as being in need of renal
transplantation, and the assay result(s), for example a measured
concentration of one or more markers selected from the group
consisting of Insulin-like growth factor-binding protein 2,
Insulin-like growth factor-binding protein 3, Insulin-like growth
factor-binding protein 4, and/or Insulin-like growth factor-binding
protein 6, is/are correlated to a need for renal transplantation.
For example, each of the measured concentration(s) may be compared
to a threshold value. For a positive going marker, an increased
likelihood of the occurrence of an injury creating a need for renal
transplantation is assigned to the subject when the measured
concentration is above the threshold (relative to the likelihood
assigned when the measured concentration is below the threshold);
alternatively, when the measured concentration is below the
threshold, an increased likelihood of the nonoccurrence of an
injury creating a need for renal transplantation may be assigned to
the subject (relative to the likelihood assigned when the measured
concentration is above the threshold). For a negative going marker,
an increased likelihood of the occurrence of an injury creating a
need for renal transplantation is assigned to the subject when the
measured concentration is below the threshold (relative to the
likelihood assigned when the measured concentration is above the
threshold); alternatively, when the measured concentration is above
the threshold, an increased likelihood of the nonoccurrence of an
injury creating a need for renal transplantation may be assigned to
the subject (relative to the likelihood assigned when the measured
concentration is below the threshold).
[0030] In still other embodiments, the methods for evaluating renal
status described herein are methods for monitoring a renal injury
in the subject; that is, assessing whether or not renal function is
improving or worsening in a subject who has suffered from an injury
to renal function, reduced renal function, or ARF. In these
embodiments, the assay result(s), for example a measured
concentration of one or more markers selected from the group
consisting of Insulin-like growth factor-binding protein 2,
Insulin-like growth factor-binding protein 3, Insulin-like growth
factor-binding protein 4, and/or Insulin-like growth factor-binding
protein 6, is/arc correlated to the occurrence or nonoccurrence of
a change in renal status. The following arc preferred monitoring
embodiments.
[0031] In preferred monitoring embodiments, these methods comprise
monitoring renal status in a subject suffering from an injury to
renal function, and the assay result(s), for example a measured
concentration of one or more markers selected from the group
consisting of Insulin-like growth factor-binding protein 2,
Insulin-like growth factor-binding protein 3, Insulin-like growth
factor-binding protein 4, and/or Insulin-like growth factor-binding
protein 6, is/are correlated to the occurrence or nonoccurrence of
a change in renal status in the subject. For example, the measured
concentration(s) may be compared to a threshold value. For a
positive going marker, when the measured concentration is above the
threshold, a worsening of renal function may be assigned to the
subject; alternatively, when the measured concentration is below
the threshold, an improvement of renal function may be assigned to
the subject. For a negative going marker, when the measured
concentration is below the threshold, a worsening of renal function
may be assigned to the subject; alternatively, when the measured
concentration is above the threshold, an improvement of renal
function may be assigned to the subject.
[0032] In other preferred monitoring embodiments, these methods
comprise monitoring renal status in a subject suffering from
reduced renal function, and the assay result(s), for example a
measured concentration of one or more markers selected from the
group consisting of Insulin-like growth factor-binding protein 2,
Insulin-like growth factor-binding protein 3, Insulin-like growth
factor-binding protein 4, and/or Insulin-like growth factor-binding
protein 6, is/are correlated to the occurrence or nonoccurrence of
a change in renal status in the subject. For example, the measured
concentration(s) may be compared to a threshold value. For a
positive going marker, when the measured concentration is above the
threshold, a worsening of renal function may be assigned to the
subject; alternatively, when the measured concentration is below
the threshold, an improvement of renal function may be assigned to
the subject. For a negative going marker, when the measured
concentration is below the threshold, a worsening of renal function
may be assigned to the subject; alternatively, when the measured
concentration is above the threshold, an improvement of renal
function may be assigned to the subject.
[0033] In yet other preferred monitoring embodiments, these methods
comprise monitoring renal status in a subject suffering from acute
renal failure, and the assay result(s), for example a measured
concentration of one or more markers selected from the group
consisting of Insulin-like growth factor-binding protein 2,
Insulin-like growth factor-binding protein 3, Insulin-like growth
factor-binding protein 4, and/or Insulin-like growth factor-binding
protein 6, is/are correlated to the occurrence or nonoccurrence of
a change in renal status in the subject. For example, the measured
concentration(s) may be compared to a threshold value. For a
positive going marker, when the measured concentration is above the
threshold, a worsening of renal function may be assigned to the
subject; alternatively, when the measured concentration is below
the threshold, an improvement of renal function may be assigned to
the subject. For a negative going marker, when the measured
concentration is below the threshold, a worsening of renal function
may be assigned to the subject; alternatively, when the measured
concentration is above the threshold, an improvement of renal
function may be assigned to the subject.
[0034] In other additional preferred monitoring embodiments, these
methods comprise monitoring renal status in a subject at risk of an
injury to renal function due to the pre-existence of one or more
known risk factors for prerenal, intrinsic renal, or postrenal ARF,
and the assay result(s), for example a measured concentration of
one or more markers selected from the group consisting of
Insulin-like growth factor-binding protein 2, Insulin-like growth
factor-binding protein 3, Insulin-like growth factor-binding
protein 4, and/or Insulin-like growth factor-binding protein 6,
is/are correlated to the occurrence or nonoccurrence of a change in
renal status in the subject. For example, the measured
concentration(s) may be compared to a threshold value. For a
positive going marker, when the measured concentration is above the
threshold, a worsening of renal function may be assigned to the
subject; alternatively, when the measured concentration is below
the threshold, an improvement of renal function may be assigned to
the subject. For a negative going marker, when the measured
concentration is below the threshold, a worsening of renal function
may be assigned to the subject; alternatively, when the measured
concentration is above the threshold, an improvement of renal
function may be assigned to the subject.
[0035] In yet other preferred monitoring embodiments, these methods
comprise monitoring renal status in a subject having, or at risk
of, an injury to renal function for future persistence of acute
kidney injury. "Future persistence" as used herein refers to an
existing acute renal injury that will continue for a period
selected from the group consisting of 21 days, 14 days, 7 days, 5
days, 96 hours, 72 hours, 48 hours, 36 hours, 24 hours, and 12
hours. In certain embodiments the subject has an acute kidney
injury at the time the sample is obtained. This is not meant to
imply that the subject must have an acute kidney injury at the time
the sample is obtained, but rather that the subject, upon onset of
an acute kidney injury, suffers from an acute kidney injury that
will persist. In various embodiments, the assay result(s), for
example a measured concentration of one or more markers selected
from the group consisting of Insulin-like growth factor-binding
protein 2, Insulin-like growth factor-binding protein 3,
Insulin-like growth factor-binding protein 4, and/or Insulin-like
growth factor-binding protein 6, is/are correlated to the future
persistence of the acute kidney injury in the subject. For example,
the measured concentration(s) may be compared to a threshold value.
For a positive going marker, when the measured concentration is
above the threshold, a future persistence of acute kidney injury
may be assigned to the subject; alternatively, when the measured
concentration is below the threshold, a future improvement of renal
function may be assigned to the subject. For a negative going
marker, when the measured concentration is below the threshold, a
future persistence of acute kidney injury may be assigned to the
subject; alternatively, when the measured concentration is above
the threshold, a future improvement of renal function may be
assigned to the subject.
[0036] In still other embodiments, the methods for evaluating renal
status described herein are methods for classifying a renal injury
in the subject; that is, determining whether a renal injury in a
subject is prerenal, intrinsic renal, or postrenal; and/or further
subdividing these classes into subclasses such as acute tubular
injury, acute glomerulonephritis acute tubulointerstitial
nephritis, acute vascular nephropathy, or infiltrative disease;
and/or assigning a likelihood that a subject will progress to a
particular RIFLE stage. In these embodiments, the assay result(s),
for example a measured concentration of one or more markers
selected from the group consisting of Insulin-like growth
factor-binding protein 2, Insulin-like growth factor-binding
protein 3, Insulin-like growth factor-binding protein 4, and/or
Insulin-like growth factor-binding protein 6, is/arc correlated to
a particular class and/or subclass. The following arc preferred
classification embodiments.
[0037] In preferred classification embodiments, these methods
comprise determining whether a renal injury in a subject is
prerenal, intrinsic renal, or postrenal; and/or further subdividing
these classes into subclasses such as acute tubular injury, acute
glomerulonephritis acute tubulointerstitial nephritis, acute
vascular nephropathy, or infiltrative disease; and/or assigning a
likelihood that a subject will progress to a particular RIFLE
stage, and the assay result(s), for example a measured
concentration of one or more markers selected from the group
consisting of Insulin-like growth factor-binding protein 2,
Insulin-like growth factor-binding protein 3, Insulin-like growth
factor-binding protein 4, and/or Insulin-like growth factor-binding
protein 6, is/arc correlated to the injury classification for the
subject. For example, the measured concentration may be compared to
a threshold value, and when the measured concentration is above the
threshold, a particular classification is assigned; alternatively,
when the measured concentration is below the threshold, a different
classification may be assigned to the subject.
[0038] A variety of methods may be used by the skilled artisan to
arrive at a desired threshold value for use in these methods. For
example, the threshold value may be determined from a population of
normal subjects by selecting a concentration representing the
75.sup.th, 85.sup.th, 90.sup.th, 95.sup.th, or 99.sup.th percentile
of a kidney injury marker measured in such normal subjects.
Alternatively, the threshold value may be determined from a
"diseased" population of subjects, e.g., those suffering from an
injury or having a predisposition for an injury (e.g., progression
to ARF or some other clinical outcome such as death, dialysis,
renal transplantation, etc.), by selecting a concentration
representing the 75.sup.th, 85.sup.th, 90.sup.th, 95.sup.th, or
99.sup.th percentile of a kidney injury marker measured in such
subjects. In another alternative, the threshold value may be
determined from a prior measurement of a kidney injury marker in
the same subject; that is, a temporal change in the level of a
kidney injury marker in the subject may be used to assign risk to
the subject.
[0039] The foregoing discussion is not meant to imply, however,
that the kidney injury markers of the present invention must be
compared to corresponding individual thresholds. Methods for
combining assay results can comprise the use of multivariate
logistical regression, loglinear modeling, neural network analysis,
n-of-m analysis, decision tree analysis, calculating ratios of
markers, etc. This list is not meant to be limiting. In these
methods, a composite result which is determined by combining
individual markers may be treated as if it is itself a marker; that
is, a threshold may be determined for the composite result as
described herein for individual markers, and the composite result
for an individual patient compared to this threshold.
[0040] The ability of a particular test to distinguish two
populations can be established using ROC analysis. For example, ROC
curves established from a "first" subpopulation which is
predisposed to one or more future changes in renal status, and a
"second" subpopulation which is not so predisposed can be used to
calculate a ROC curve, and the area under the curve provides a
measure of the quality of the test. Preferably, the tests described
herein provide a ROC curve area greater than 0.5, preferably at
least 0.6, more preferably 0.7, still more preferably at least 0.8,
even more preferably at least 0.9, and most preferably at least
0.95.
[0041] In certain aspects, the measured concentration of one or
more kidney injury markers, or a composite of such markers, may be
treated as continuous variables. For example, any particular
concentration can be converted into a corresponding probability of
a future reduction in renal function for the subject, the
occurrence of an injury, a classification, etc. In yet another
alternative, a threshold that can provide an acceptable level of
specificity and sensitivity in separating a population of subjects
into "bins" such as a "first" subpopulation (e.g., which is
predisposed to one or more future changes in renal status, the
occurrence of an injury, a classification, etc.) and a "second"
subpopulation which is not so predisposed. A threshold value is
selected to separate this first and second population by one or
more of the following measures of test accuracy:
an odds ratio greater than 1, preferably at least about 2 or more
or about 0.5 or less, more preferably at least about 3 or more or
about 0.33 or less, still more preferably at least about 4 or more
or about 0.25 or less, even more preferably at least about 5 or
more or about 0.2 or less, and most preferably at least about 10 or
more or about 0.1 or less; a specificity of greater than 0.5,
preferably at least about 0.6, more preferably at least about 0.7,
still more preferably at least about 0.8, even more preferably at
least about 0.9 and most preferably at least about 0.95, with a
corresponding sensitivity greater than 0.2, preferably greater than
about 0.3, more preferably greater than about 0.4, still more
preferably at least about 0.5, even more preferably about 0.6, yet
more preferably greater than about 0.7, still more preferably
greater than about 0.8, more preferably greater than about 0.9, and
most preferably greater than about 0.95; a sensitivity of greater
than 0.5, preferably at least about 0.6, more preferably at least
about 0.7, still more preferably at least about 0.8, even more
preferably at least about 0.9 and most preferably at least about
0.95, with a corresponding specificity greater than 0.2, preferably
greater than about 0.3, more preferably greater than about 0.4,
still more preferably at least about 0.5, even more preferably
about 0.6, yet more preferably greater than about 0.7, still more
preferably greater than about 0.8, more preferably greater than
about 0.9, and most preferably greater than about 0.95; at least
about 75% sensitivity, combined with at least about 75%
specificity; a positive likelihood ratio (calculated as
sensitivity/(1-specificity)) of greater than 1, at least about 2,
more preferably at least about 3, still more preferably at least
about 5, and most preferably at least about 10; or a negative
likelihood ratio (calculated as (1-sensitivity)/specificity) of
less than 1, less than or equal to about 0.5, more preferably less
than or equal to about 0.3, and most preferably less than or equal
to about 0.1. The term "about" in the context of any of the above
measurements refers to +/-5% of a given measurement.
[0042] Multiple thresholds may also be used to assess renal status
in a subject. For example, a "first" subpopulation which is
predisposed to one or more future changes in renal status, the
occurrence of an injury, a classification, etc., and a "second"
subpopulation which is not so predisposed can be combined into a
single group. This group is then subdivided into three or more
equal parts (known as tertiles, quartiles, quintiles, etc.,
depending on the number of subdivisions). An odds ratio is assigned
to subjects based on which subdivision they fall into. If one
considers a tertile, the lowest or highest tertile can be used as a
reference for comparison of the other subdivisions. This reference
subdivision is assigned an odds ratio of 1. The second tertile is
assigned an odds ratio that is relative to that first tertile. That
is, someone in the second tertile might be 3 times more likely to
suffer one or more future changes in renal status in comparison to
someone in the first tertile. The third tertile is also assigned an
odds ratio that is relative to that first tertile.
[0043] In certain embodiments, the assay method is an immunoassay.
Antibodies for use in such assays will specifically bind a full
length kidney injury marker of interest, and may also bind one or
more polypeptides that are "related" thereto, as that term is
defined hereinafter. Numerous immunoassay formats are known to
those of skill in the art. Preferred body fluid samples are
selected from the group consisting of urine, blood, serum, saliva,
tears, and plasma.
[0044] The foregoing method steps should not be interpreted to mean
that the kidney injury marker assay result(s) is/are used in
isolation in the methods described herein. Rather, additional
variables or other clinical indicia may be included in the methods
described herein. For example, a risk stratification, diagnostic,
classification, monitoring, etc. method may combine the assay
result(s) with one or more variables measured for the subject
selected from the group consisting of demographic information
(e.g., weight, sex, age, race), medical history (e.g., family
history, type of surgery, pre-existing disease such as aneurism,
congestive heart failure, preeclampsia, eclampsia, diabetes
mellitus, hypertension, coronary artery disease, proteinuria, renal
insufficiency, or sepsis, type of toxin exposure such as NSAIDs,
cyclosporines, tacrolimus, aminoglycosides, foscarnet, ethylene
glycol, hemoglobin, myoglobin, ifosfamide, heavy metals,
methotrexate, radiopaque contrast agents, or streptozotocin),
clinical variables (e.g., blood pressure, temperature, respiration
rate), risk scores (APACHE score, PREDICT score, TIMI Risk Score
for UA/NSTEMI, Framingham Risk Score), a glomerular filtration
rate, an estimated glomerular filtration rate, a urine production
rate, a serum or plasma creatinine concentration, a urine
creatinine concentration, a fractional excretion of sodium, a urine
sodium concentration, a urine creatinine to serum or plasma
creatinine ratio, a urine specific gravity, a urine osmolality, a
urine urea nitrogen to plasma urea nitrogen ratio, a plasma BUN to
creatnine ratio, a renal failure index calculated as urine
sodium/(urine creatinine/plasma creatinine), a serum or plasma
neutrophil gelatinase (NGAL) concentration, a urine NGAL
concentration, a serum or plasma cystatin C concentration, a serum
or plasma cardiac troponin concentration, a serum or plasma BNP
concentration, a serum or plasma NTproBNP concentration, and a
serum or plasma proBNP concentration. Other measures of renal
function which may be combined with one or more kidney injury
marker assay result(s) are described hereinafter and in Harrison's
Principles of Internal Medicine, 17.sup.th Ed., McGraw Hill, N.Y.,
pages 1741-1830, and Current Medical Diagnosis & Treatment
2008, 47.sup.th Ed, McGraw Hill, N.Y., pages 785-815, each of which
are hereby incorporated by reference in their entirety.
[0045] When more than one marker is measured, the individual
markers may be measured in samples obtained at the same time, or
may be determined from samples obtained at different (e.g., an
earlier or later) times. The individual markers may also be
measured on the same or different body fluid samples. For example,
one kidney injury marker may be measured in a serum or plasma
sample and another kidney injury marker may be measured in a urine
sample. In addition, assignment of a likelihood may combine an
individual kidney injury marker assay result with temporal changes
in one or more additional variables.
[0046] In various related aspects, the present invention also
relates to devices and kits for performing the methods described
herein. Suitable kits comprise reagents sufficient for performing
an assay for at least one of the described kidney injury markers,
together with instructions for performing the described threshold
comparisons.
[0047] In certain embodiments, reagents for performing such assays
are provided in an assay device, and such assay devices may be
included in such a kit. Preferred reagents can comprise one or more
solid phase antibodies, the solid phase antibody comprising
antibody that detects the intended biomarker target(s) bound to a
solid support. In the case of sandwich immunoassays, such reagents
can also include one or more detectably labeled antibodies, the
detectably labeled antibody comprising antibody that detects the
intended biomarker target(s) bound to a detectable label.
Additional optional elements that may be provided as part of an
assay device arc described hereinafter.
[0048] Detectable labels may include molecules that are themselves
detectable (e.g., fluorescent moieties, electrochemical labels, ecl
(electrochemical luminescence) labels, metal chelates, colloidal
metal particles, etc.) as well as molecules that may be indirectly
detected by production of a detectable reaction product (e.g.,
enzymes such as horseradish peroxidase, alkaline phosphatase, etc.)
or through the use of a specific binding molecule which itself may
be detectable (e.g., a labeled antibody that binds to the second
antibody, biotin, digoxigenin, maltose, oligohistidine,
2,4-dintrobenzene, phenylarsenate, ssDNA, dsDNA, etc.).
[0049] Generation of a signal from the signal development element
can be performed using various optical, acoustical, and
electrochemical methods well known in the art. Examples of
detection modes include fluorescence, radiochemical detection,
reflectance, absorbance, amperometry, conductance, impedance,
interferometry, ellipsometry, etc. In certain of these methods, the
solid phase antibody is coupled to a transducer (e.g., a
diffraction grating, electrochemical sensor, etc) for generation of
a signal, while in others, a signal is generated by a transducer
that is spatially separate from the solid phase antibody (e.g., a
fluorometer that employs an excitation light source and an optical
detector). This list is not meant to be limiting. Antibody-based
biosensors may also be employed to determine the presence or amount
of analytes that optionally eliminate the need for a labeled
molecule.
DETAILED DESCRIPTION OF THE INVENTION
[0050] The present invention relates to methods and compositions
for diagnosis, differential diagnosis, risk stratification,
monitoring, classifying and determination of treatment regimens in
subjects suffering or at risk of suffering from injury to renal
function, reduced renal function and/or acute renal failure through
measurement of one or more kidney injury markers. In various
embodiments, a measured concentration of one or more markers
selected from the group consisting of Insulin-like growth
factor-binding protein 2, Insulin-like growth factor-binding
protein 3, Insulin-like growth factor-binding protein 4, and
Insulin-like growth factor-binding protein 6 or one or more markers
related thereto, and optionally one or more additional kidney
injury markers known in the art, are correlated to the renal status
of the subject.
[0051] For purposes of this document, the following definitions
apply:
As used herein, an "injury to renal function" is an abrupt (within
14 days, preferably within 7 days, more preferably within 72 hours,
and still more preferably within 48 hours) measurable reduction in
a measure of renal function. Such an injury may be identified, for
example, by a decrease in glomerular filtration rate or estimated
GFR, a reduction in urine output, an increase in serum creatinine,
an increase in serum cystatin C, a requirement for renal
replacement therapy, etc. "Improvement in Renal Function" is an
abrupt (within 14 days, preferably within 7 days, more preferably
within 72 hours, and still more preferably within 48 hours)
measurable increase in a measure of renal function. Preferred
methods for measuring and/or estimating GFR arc described
hereinafter. As used herein, "reduced renal function" is an abrupt
(within 14 days, preferably within 7 days, more preferably within
72 hours, and still more preferably within 48 hours) reduction in
kidney function identified by an absolute increase in serum
creatinine of greater than or equal to 0.1 mg/dL (.gtoreq.8.8
.mu.mol/L), a percentage increase in serum creatinine of greater
than or equal to 20% (1.2-fold from baseline), or a reduction in
urine output (documented oliguria of less than 0.5 ml/kg per
hour).
[0052] As used herein, "acute renal failure" or "ARF" is an abrupt
(within 14 days, preferably within 7 days, more preferably within
72 hours, and still more preferably within 48 hours) reduction in
kidney function identified by an absolute increase in serum
creatinine of greater than or equal to 0.3 mg/dl (.gtoreq.26.4
.mu.mol/l), a percentage increase in serum creatinine of greater
than or equal to 50% (1.5-fold from baseline), or a reduction in
urine output (documented oliguria of less than 0.5 ml/kg per hour
for at least 6 hours). This term is synonymous with "acute kidney
injury" or "AKI."
[0053] In this regard, the skilled artisan will understand that the
signals obtained from an immunoassay arc a direct result of
complexes formed between one or more antibodies and the target
biomolecule (i.e., the analyte) and polypeptides containing the
necessary epitope(s) to which the antibodies bind. While such
assays may detect the full length biomarker and the assay result he
expressed as a concentration of a biomarker of interest, the signal
from the assay is actually a result of all such "immunoreactive"
polypeptides present in the sample. Expression of biomarkers may
also be determined by means other than immunoassays, including
protein measurements (such as dot blots, western blots,
chromatographic methods, mass spectrometry, etc.) and nucleic acid
measurements (mRNA quatitation). This list is not meant to be
limiting.
[0054] As used herein, the term "Insulin-like growth factor-binding
protein 3" refers to one or more polypeptides present in a
biological sample that are derived from a Insulin-like growth
factor-binding protein 3 precursor (human precursor Swiss-Prot
entry P17936 (SEQ ID NO: 1)):
TABLE-US-00002 10 20 30 40 MQRARPTLWA AALTLLVLLR GPPVARAGAS
SAGLGPVVRC 50 60 70 80 EPCDARALAQ CAPPPAVCAE LVREPGCGCC LTCALSEGQP
90 100 110 120 CGIYTERCGS GLRCQPSPDE ARPLQALLDG RGLCVNASAV 130 140
150 160 SRLRAYLLPA PPAPGNASES EEDRSAGSVE SPSVSSTHRV 170 180 190 200
SDPKFHPLHS KIIIIKKGHA KDSQRYKVDY ESQSTDTQNF 210 220 230 240
SSESKRETEY GPCRREMEDT LNHLKFLNVL SPRGVHIPNC 250 260 270 280
DKKGFYKKKQ CRPSKGRKRG FCWCVDKYGQ PLPGYTTKGK 290 EDVHCYSMQS K
[0055] The following domains have been identified in Insulin-like
growth factor-binding protein 3:
TABLE-US-00003 Residues Length Domain ID 1-27 27 signal sequence
28-291 264 Insulin-like growth factor-binding protein 3
135-135 G.fwdarw.GEPPAPG (SEQ ID NO: 2) in isoform 2
[0056] As used herein, the term "Insulin-like growth factor-binding
protein 2" refers to one or more polypeptides present in a
biological sample that are derived from a Insulin-like growth
factor-binding protein 2 precursor (human precursor Swiss-Prot
entry P18065) (SEQ ID NO: 3)):
TABLE-US-00004 10 20 30 40 MLPRVGCPAL PLPPPPLLPL LLLLLGASGG
GGGARAEVLF 50 60 70 80 RCPPCTPERL AACGPPPVAP PAAVAAVAGG ARMPCAELVR
90 100 110 120 EPGCGCCSVC ARLEGEACGV YTPRCGQGLR CYPHPGSELP 130 140
150 160 LQALVMGEGT CEKRRDAEYG ASPEQVADNG DDHSEGGLVE 170 180 190 200
NHVDSTMNML GGGGSAGRKP LKSGMKELAV FREKVTEQHR 210 220 230 240
QMGKGGKHHL GLEEPKKLRP PPARTPCQQE LDQVLERIST 250 260 270 280
MRLPDERGPL EHLYSLHIPN CDKHGLYNLK QCKMSLNGQR 290 300 310 320
GECWCVNPNT GKLIQGAPTI RGDPECHLFY NEQQEARGVH TQRMQ
[0057] The following domains have been identified in Insulin-like
growth factor-binding protein 2:
TABLE-US-00005 Residues Length Domain ID 1-35 35 signal sequence
36-325 290 Insulin-like growth factor-binding protein 2
[0058] As used herein, the term "Insulin-like growth factor-binding
protein 4" refers to one or more polypeptides present in a
biological sample that are derived from a Insulin-like growth
factor-binding protein 4 precursor (human precursor Swiss-Prot
entry P22692(SEQ ID NO: 4)):
TABLE-US-00006 10 20 30 40 MLPLCLVAAL LLAAGPGPSL GDEAIHCPPC
SEEKLARCRP 50 60 70 80 PVGCEELVRE PGCGCCATCA LGLGMPCGVY TPRCGSGLRC
90 100 110 120 YPPRGVEKPL HTLMHGQGVC MELAEIEAIQ ESLQPSDKDE 130 140
150 160 GDHPNNSFSP CSAHDRRCLQ KHFAKIRDRS TSGGKMKVNG 170 180 190 200
APREDARPVP QGSCQSELHR ALERLAASQS RTHEDLYIIP 210 220 230 240
IPNCDRNGNF HPKQCHPALD GQRGKCWCVD RKTGVKLPGG 250 LEPKGELDCH
QLADSFRE
[0059] The following domains have been identified in Insulin-like
growth factor-binding protein 4:
TABLE-US-00007 Residues Length Domain ID 1-21 21 signal sequence
22-258 237 Insulin-like growth factor-binding protein 4 1-100
missing in isoform 2
[0060] As used herein, the term "Insulin-like growth factor-binding
protein 6" refers to one or more polypeptides present in a
biological sample that are derived from a Insulin-like growth
factor-binding protein 6 precursor (human precursor Swiss-Prot
entry P24592 (SEQ ID NO: 5)):
TABLE-US-00008 10 20 30 40 MTPHRLLPPL LLLLALLLAA SPGGALARCP
GCGQGVQAGC 50 60 70 80 PGGCVEEEDG GSPAEGCAEA EGCLRREGQE CGVYTPNCAP
90 100 110 120 GLQCHPPKDD EAPLRALLLG RGRCLPARAP AVAEENPKES 130 140
150 160 KPQAGTARPQ DVNRRDQQRN PGTSTTPSQP NSAGVQDTEM 170 180 190 200
GPCRRHLDSV LQQLQTEVYR GAQTLYVPNC DHRGFYRKRQ 210 220 230 240
CRSSQGQRRG PCWCVDRMGK SLPGSPDGNG SSSCPTGSSG
[0061] The following domains have been identified in Insulin-like
growth factor-binding protein 6:
TABLE-US-00009 Residues Length Domain ID 1-27 27 signal sequence
28-240 213 Insulin-like growth factor-binding protein 6
[0062] As used herein, the term "relating a signal to the presence
or amount" of an analyte reflects this understanding. Assay signals
are typically related to the presence or amount of an analyte
through the use of a standard curve calculated using known
concentrations of the analyte of interest. As the term is used
herein, an assay is "configured to detect" an analyte if an assay
can generate a detectable signal indicative of the presence or
amount of a physiologically relevant concentration of the analyte.
Because an antibody epitope is on the order of 8 amino acids, an
immunoassay configured to detect a marker of interest will also
detect polypeptides related to the marker sequence, so long as
those polypeptides contain the epitope(s) necessary to bind to the
antibody or antibodies used in the assay.
[0063] The term "related marker" as used herein with regard to a
biomarker such as one of the kidney injury markers described herein
refers to one or more fragments, variants, etc., of a particular
marker or its biosynthetic parent that may be detected as a
surrogate for the marker itself or as independent biomarkers. The
term also refers to one or more polypeptides present in a
biological sample that are derived from the biomarker precursor
complexed to additional species, such as binding proteins,
receptors, heparin, lipids, sugars, etc.
[0064] The term "positive going" marker as that term is used herein
refer to a marker that is determined to be elevated in subjects
suffering from a disease or condition, relative to subjects not
suffering from that disease or condition. The term "negative going"
marker as that term is used herein refer to a marker that is
determined to be reduced in subjects suffering from a disease or
condition, relative to subjects not suffering from that disease or
condition.
[0065] The term "subject" as used herein refers to a human or
non-human organism. Thus, the methods and compositions described
herein are applicable to both human and veterinary disease.
Further, while a subject is preferably a living organism, the
invention described herein may be used in post-mortem analysis as
well. Preferred subjects are humans, and most preferably
"patients," which as used herein refers to living humans that are
receiving medical care for a disease or condition. This includes
persons with no defined illness who are being investigated for
signs of pathology.
[0066] Preferably, an analyte is measured in a sample. Such a
sample may be obtained from a subject, or may be obtained from
biological materials intended to be provided to the subject. For
example, a sample may be obtained from a kidney being evaluated for
possible transplantation into a subject, and an analyte measurement
used to evaluate the kidney for preexisting damage. Preferred
samples are body fluid samples.
[0067] The term "body fluid sample" as used herein refers to a
sample of bodily fluid obtained for the purpose of diagnosis,
prognosis, classification or evaluation of a subject of interest,
such as a patient or transplant donor. In certain embodiments, such
a sample may be obtained for the purpose of determining the outcome
of an ongoing condition or the effect of a treatment regimen on a
condition. Preferred body fluid samples include blood, serum,
plasma, cerebrospinal fluid, urine, saliva, sputum, and pleural
effusions. In addition, one of skill in the art would realize that
certain body fluid samples would be more readily analyzed following
a fractionation or purification procedure, for example, separation
of whole blood into serum or plasma components.
[0068] The term "diagnosis" as used herein refers to methods by
which the skilled artisan can estimate and/or determine the
probability ("a likelihood") of whether or not a patient is
suffering from a given disease or condition. In the case of the
present invention, "diagnosis" includes using the results of an
assay, most preferably an immunoassay, for a kidney injury marker
of the present invention, optionally together with other clinical
characteristics, to arrive at a diagnosis (that is, the occurrence
or nonoccurrence) of an acute renal injury or ARF for the subject
from which a sample was obtained and assayed. That such a diagnosis
is "determined" is not meant to imply that the diagnosis is 100%
accurate. Many biomarkers are indicative of multiple conditions.
The skilled clinician does not use biomarker results in an
informational vacuum, but rather test results are used together
with other clinical indicia to arrive at a diagnosis. Thus, a
measured biomarker level on one side of a predetermined diagnostic
threshold indicates a greater likelihood of the occurrence of
disease in the subject relative to a measured level on the other
side of the predetermined diagnostic threshold.
[0069] Similarly, a prognostic risk signals a probability ("a
likelihood") that a given course or outcome will occur. A level or
a change in level of a prognostic indicator, which in turn is
associated with an increased probability of morbidity (e.g.,
worsening renal function, future ARF, or death) is referred to as
being "indicative of an increased likelihood" of an adverse outcome
in a patient.
[0070] Marker Assays
[0071] In general, immunoassays involve contacting a sample
containing or suspected of containing a biomarker of interest with
at least one antibody that specifically binds to the biomarker. A
signal is then generated indicative of the presence or amount of
complexes formed by the binding of polypeptides in the sample to
the antibody. The signal is then related to the presence or amount
of the biomarker in the sample. Numerous methods and devices are
well known to the skilled artisan for the detection and analysis of
biomarkers. See, e.g., U.S. Pat. Nos. 6,143,576; 6,113,855;
6,019,944; 5,985,579; 5,947,124; 5,939,272; 5,922,615; 5,885,527;
5,851,776; 5,824,799; 5,679,526; 5,525,524; and 5,480,792, and The
Immunoassay Handbook, David Wild, ed. Stockton Press, New York,
1994, each of which is hereby incorporated by reference in its
entirety, including all tables, figures and claims.
[0072] The assay devices and methods known in the art can utilize
labeled molecules in various sandwich, competitive, or
non-competitive assay formats, to generate a signal that is related
to the presence or amount of the biomarker of interest. Suitable
assay formats also include chromatographic, mass spectrographic,
and protein "blotting" methods. Additionally, certain methods and
devices, such as biosensors and optical immunoassays, may be
employed to determine the presence or amount of analytes without
the need for a labeled molecule. See, e.g., U.S. Pat. Nos.
5,631,171; and 5,955,377, each of which is hereby incorporated by
reference in its entirety, including all tables, figures and
claims. One skilled in the art also recognizes that robotic
instrumentation including but not limited to Beckman ACCESS.RTM.,
Abbott AXSYM.RTM., Roche ELECSYS.RTM., Dade Behring STRATUS.RTM.
systems are among the immunoassay analyzers that are capable of
performing immunoassays. But any suitable immunoassay may be
utilized, for example, enzyme-linked immunoassays (ELISA),
radioimmunoassays (RIAs), competitive binding assays, and the
like.
[0073] Antibodies or other polypeptides may be immobilized onto a
variety of solid supports for use in assays. Solid phases that may
be used to immobilize specific binding members include include
those developed and/or used as solid phases in solid phase binding
assays. Examples of suitable solid phases include membrane filters,
cellulose-based papers, beads (including polymeric, latex and
paramagnetic particles), glass, silicon wafers, microparticles,
nanoparticles, TentaGels, AgroGels, PEGA gels, SPOCC gels, and
multiple-well plates. An assay strip could be prepared by coating
the antibody or a plurality of antibodies in an array on solid
support. This strip could then be dipped into the test sample and
then processed quickly through washes and detection steps to
generate a measurable signal, such as a colored spot. Antibodies or
other polypeptides may be bound to specific zones of assay devices
either by conjugating directly to an assay device surface, or by
indirect binding. In an example of the later case, antibodies or
other polypeptides may be immobilized on particles or other solid
supports, and that solid support immobilized to the device
surface.
[0074] Biological assays require methods for detection, and one of
the most common methods for quantitation of results is to conjugate
a detectable label to a protein or nucleic acid that has affinity
for one of the components in the biological system being studied.
Detectable labels may include molecules that are themselves
detectable (e.g., fluorescent moieties, electrochemical labels,
metal chelates, etc.) as well as molecules that may be indirectly
detected by production of a detectable reaction product (e.g.,
enzymes such as horseradish peroxidase, alkaline phosphatase, etc.)
or by a specific binding molecule which itself may be detectable
(e.g., biotin, digoxigenin, maltose, oligohistidine,
2,4-dintrobenzene, phenylarsenate, ssDNA, dsDNA, etc.).
[0075] Preparation of solid phases and detectable label conjugates
often comprise the use of chemical cross-linkers. Cross-linking
reagents contain at least two reactive groups, and are divided
generally into homofunctional cross-linkers (containing identical
reactive groups) and heterofunctional cross-linkers (containing
non-identical reactive groups). Homobifunctional cross-linkers that
couple through amines, sulfhydryls or react non-specifically are
available from many commercial sources. Maleimides, alkyl and aryl
halides, alpha-haloacyls and pyridyl disulfides are thiol reactive
groups. Maleimides, alkyl and aryl halides, and alpha-haloacyls
react with sulfhydryls to form thiol ether bonds, while pyridyl
disulfides react with sulfhydryls to produce mixed disulfides. The
pyridyl disulfide product is cleavable. Tmidoesters are also very
useful for protein-protein cross-links. A variety of
heterobifunctional cross-linkers, each combining different
attributes for successful conjugation, are commercially
available.
[0076] In certain aspects, the present invention provides kits for
the analysis of the described kidney injury markers. The kit
comprises reagents for the analysis of at least one test sample
which comprise at least one antibody that a kidney injury marker.
The kit can also include devices and instructions for performing
one or more of the diagnostic and/or prognostic correlations
described herein. Preferred kits will comprise an antibody pair for
performing a sandwich assay, or a labeled species for performing a
competitive assay, for the analyte. Preferably, an antibody pair
comprises a first antibody conjugated to a solid phase and a second
antibody conjugated to a detectable label, wherein each of the
first and second antibodies that bind a kidney injury marker. Most
preferably each of the antibodies are monoclonal antibodies. The
instructions for use of the kit and performing the correlations can
be in the form of labeling, which refers to any written or recorded
material that is attached to, or otherwise accompanies a kit at any
time during its manufacture, transport, sale or use. For example,
the term labeling encompasses advertising leaflets and brochures,
packaging materials, instructions, audio or video cassettes,
computer discs, as well as writing imprinted directly on kits.
[0077] Antibodies
[0078] The term "antibody" as used herein refers to a peptide or
polypeptide derived from, modeled after or substantially encoded by
an immunoglobulin gene or immunoglobulin genes, or fragments
thereof, capable of specifically binding an antigen or epitope.
See, e.g. Fundamental Immunology, 3rd Edition, W. E. Paul, cd.,
Raven Press, N.Y. (1993); Wilson (1994; J. Immunol. Methods
175:267-273; Yarmush (1992) J. Biochem. Biophys. Methods 25:85-97.
The term antibody includes antigen-binding portions, i.e., "antigen
binding sites," (e.g., fragments, subsequences, complementarity
determining regions (CDRs)) that retain capacity to bind antigen,
including (i) a Fab fragment, a monovalent fragment consisting of
the VL, VH, CL and CH1 domains; (ii) a F(ab')2 fragment, a bivalent
fragment comprising two Fab fragments linked by a disulfide bridge
at the hinge region; (iii) a Fd fragment consisting of the VH and
CH1 domains; (iv) a Fv fragment consisting of the VL and VH domains
of a single arm of an antibody, (v) a dAb fragment (Ward et al.,
(1989) Nature 341:544-546), which consists of a VH domain; and (vi)
an isolated complementarity determining region (CDR). Single chain
antibodies are also included by reference in the term
"antibody."
[0079] Antibodies used in the immunoassays described herein
preferably specifically bind to a kidney injury marker of the
present invention. The term "specifically binds" is not intended to
indicate that an antibody binds exclusively to its intended target
since, as noted above, an antibody binds to any polypeptide
displaying the epitope(s) to which the antibody binds. Rather, an
antibody "specifically binds" if its affinity for its intended
target is about 5-fold greater when compared to its affinity for a
non-target molecule which does not display the appropriate
epitope(s). Preferably the affinity of the antibody will be at
least about 5 fold, preferably 10 fold, more preferably 25-fold,
even more preferably 50-fold, and most preferably 100-fold or more,
greater for a target molecule than its affinity for a non-target
molecule. In preferred embodiments, Preferred antibodies bind with
affinities of at least about 10.sup.7 M.sup.-1, and preferably
between about 10.sup.8 M.sup.-1 to about 10.sup.9 M.sup.-1, about
10.sup.9 M.sup.-1 to about 10.sup.10 M.sup.-1, or about 10.sup.10
M.sup.-1 to about 10.sup.12 M.sup.-1.
[0080] Affinity is calculated as K.sub.d=k.sub.off/k.sub.on
(k.sub.off is the dissociation rate constant, K.sub.on, is the
association rate constant and K.sub.d is the equilibrium constant).
Affinity can be determined at equilibrium by measuring the fraction
bound (r) of labeled ligand at various concentrations (c). The data
are graphed using the Scatchard equation: r/c=K(n-r): where r=moles
of bound ligand/mole of receptor at equilibrium; c=free ligand
concentration at equilibrium; K=equilibrium association constant;
and n=number of ligand binding sites per receptor molecule. By
graphical analysis, r/c is plotted on the Y-axis versus r on the
X-axis, thus producing a Scatchard plot. Antibody affinity
measurement by Scatchard analysis is well known in the art. See,
e.g., van Erp et al., J. Immunoassay 12: 425-43, 1991; Nelson and
Griswold, Comput. Methods Programs Biomed. 27: 65-8, 1988.
[0081] The term "epitope" refers to an antigenic determinant
capable of specific binding to an antibody. Epitopes usually
consist of chemically active surface groupings of molecules such as
amino acids or sugar side chains and usually have specific three
dimensional structural characteristics, as well as specific charge
characteristics. Conformational and nonconformational epitopes are
distinguished in that the binding to the former but not the latter
is lost in the presence of denaturing solvents.
[0082] Numerous publications discuss the use of phage display
technology to produce and screen libraries of polypeptides for
binding to a selected analyte. See, e.g, Cwirla et al., Proc. Natl.
Acad. Sci. USA 87, 6378-82, 1990; Devlin et al., Science 249,
404-6, 1990, Scott and Smith, Science 249, 386-88, 1990; and Ladner
et al., U.S. Pat. No. 5,571,698. A basic concept of phage display
methods is the establishment of a physical association between DNA
encoding a polypeptide to be screened and the polypeptide. This
physical association is provided by the phage particle, which
displays a polypeptide as part of a capsid enclosing the phage
genome which encodes the polypeptide. The establishment of a
physical association between polypeptides and their genetic
material allows simultaneous mass screening of very large numbers
of phage bearing different polypeptides. Phage displaying a
polypeptide with affinity to a target bind to the target and these
phage are enriched by affinity screening to the target. The
identity of polypeptides displayed from these phage can be
determined from their respective genomes. Using these methods a
polypeptide identified as having a binding affinity for a desired
target can then be synthesized in bulk by conventional means. See,
e.g., U.S. Pat. No. 6,057,098, which is hereby incorporated in its
entirety, including all tables, figures, and claims.
[0083] The antibodies that arc generated by these methods may then
be selected by first screening for affinity and specificity with
the purified polypeptide of interest and, if required, comparing
the results to the affinity and specificity of the antibodies with
polypeptides that are desired to be excluded from binding. The
screening procedure can involve immobilization of the purified
polypeptides in separate wells of microtiter plates. The solution
containing a potential antibody or groups of antibodies is then
placed into the respective microtiter wells and incubated for about
30 min to 2 h. The microtiter wells are then washed and a labeled
secondary antibody (for example, an anti-mouse antibody conjugated
to alkaline phosphatase if the raised antibodies are mouse
antibodies) is added to the wells and incubated for about 30 min
and then washed. Substrate is added to the wells and a color
reaction will appear where antibody to the immobilized
polypeptide(s) are present.
[0084] The antibodies so identified may then be further analyzed
for affinity and specificity in the assay design selected. In the
development of immunoassays for a target protein, the purified
target protein acts as a standard with which to judge the
sensitivity and specificity of the immunoassay using the antibodies
that have been selected. Because the binding affinity of various
antibodies may differ; certain antibody pairs (e.g., in sandwich
assays) may interfere with one another sterically, etc., assay
performance of an antibody may be a more important measure than
absolute affinity and specificity of an antibody.
[0085] Assay Correlations
[0086] The term "correlating" as used herein in reference to the
use of biomarkers refers to comparing the presence or amount of the
biomarker(s) in a patient to its presence or amount in persons
known to suffer from, or known to be at risk of, a given condition;
or in persons known to be free of a given condition. Often, this
takes the form of comparing an assay result in the form of a
biomarker concentration to a predetermined threshold selected to be
indicative of the occurrence or nonoccurrence of a disease or the
likelihood of some future outcome.
[0087] Selecting a diagnostic threshold involves, among other
things, consideration of the probability of disease, distribution
of true and false diagnoses at different test thresholds, and
estimates of the consequences of treatment (or a failure to treat)
based on the diagnosis. For example, when considering administering
a specific therapy which is highly efficacious and has a low level
of risk, few tests are needed because clinicians can accept
substantial diagnostic uncertainty. On the other hand, in
situations where treatment options are less effective and more
risky, clinicians often need a higher degree of diagnostic
certainty. Thus, cost/benefit analysis is involved in selecting a
diagnostic threshold.
[0088] Suitable thresholds may be determined in a variety of ways.
For example, one recommended diagnostic threshold for the diagnosis
of acute myocardial infarction using cardiac troponin is the
97.5.sup.th percentile of the concentration seen in a normal
population. Another method may be to look at serial samples from
the same patient, where a prior "baseline" result is used to
monitor for temporal changes in a biomarker level.
[0089] Population studies may also be used to select a decision
threshold. Reciever Operating Characteristic ("ROC") arose from the
field of signal detection theory developed during World War II for
the analysis of radar images, and ROC analysis is often used to
select a threshold able to best distinguish a "diseased"
subpopulation from a "nondiseased" subpopulation. A false positive
in this case occurs when the person tests positive, but actually
does not have the disease. A false negative, on the other hand,
occurs when the person tests negative, suggesting they are healthy,
when they actually do have the disease. To draw a ROC curve, the
true positive rate (TPR) and false positive rate (FPR) are
determined as the decision threshold is varied continuously. Since
TPR is equivalent with sensitivity and FPR is equal to
1--specificity, the ROC graph is sometimes called the sensitivity
vs (1--specificity) plot. A perfect test will have an area under
the ROC curve of 1.0; a random test will have an area of 0.5. A
threshold is selected to provide an acceptable level of specificity
and sensitivity.
[0090] In this context, "diseased" is meant to refer to a
population having one characteristic (the presence of a disease or
condition or the occurrence of some outcome) and "nondiseased" is
meant to refer to a population lacking the characteristic. While a
single decision threshold is the simplest application of such a
method, multiple decision thresholds may be used. For example,
below a first threshold, the absence of disease may be assigned
with relatively high confidence, and above a second threshold the
presence of disease may also be assigned with relatively high
confidence. Between the two thresholds may be considered
indeterminate. This is meant to be exemplary in nature only.
[0091] In addition to threshold comparisons, other methods for
correlating assay results to a patient classification (occurrence
or nonoccurrence of disease, likelihood of an outcome, etc.)
include decision trees, rule sets, Bayesian methods, and neural
network methods. These methods can produce probability values
representing the degree to which a subject belongs to one
classification out of a plurality of classifications.
[0092] Measures of test accuracy may be obtained as described in
Fischer et al., Intensive Care Med. 29: 1043-51, 2003, and used to
determine the effectiveness of a given biomarker. These measures
include sensitivity and specificity, predictive values, likelihood
ratios, diagnostic odds ratios, and ROC curve areas. The area under
the curve ("AUC") of a ROC plot is equal to the probability that a
classifier will rank a randomly chosen positive instance higher
than a randomly chosen negative one. The area under the ROC curve
may be thought of as equivalent to the Mann-Whitney U test, which
tests for the median difference between scores obtained in the two
groups considered if the groups are of continuous data, or to the
Wilcoxon test of ranks.
[0093] As discussed above, suitable tests may exhibit one or more
of the following results on these various measures: a specificity
of greater than 0.5, preferably at least 0.6, more preferably at
least 0.7, still more preferably at least 0.8, even more preferably
at least 0.9 and most preferably at least 0.95, with a
corresponding sensitivity greater than 0.2, preferably greater than
0.3, more preferably greater than 0.4, still more preferably at
least 0.5, even more preferably 0.6, yet more preferably greater
than 0.7, still more preferably greater than 0.8, more preferably
greater than 0.9, and most preferably greater than 0.95; a
sensitivity of greater than 0.5, preferably at least 0.6, more
preferably at least 0.7, still more preferably at least 0.8, even
more preferably at least 0.9 and most preferably at least 0.95,
with a corresponding specificity greater than 0.2, preferably
greater than 0.3, more preferably greater than 0.4, still more
preferably at least 0.5, even more preferably 0.6, yet more
preferably greater than 0.7, still more preferably greater than
0.8, more preferably greater than 0.9, and most preferably greater
than 0.95; at least 75% sensitivity, combined with at least 75%
specificity; a ROC curve area of greater than 0.5, preferably at
least 0.6, more preferably 0.7, still more preferably at least 0.8,
even more preferably at least 0.9, and most preferably at least
0.95; an odds ratio different from 1, preferably at least about 2
or more or about 0.5 or less, more preferably at least about 3 or
more or about 0.33 or less, still more preferably at least about 4
or more or about 0.25 or less, even more preferably at least about
5 or more or about 0.2 or less, and most preferably at least about
10 or more or about 0.1 or less; a positive likelihood ratio
(calculated as sensitivity/(1-specificity)) of greater than 1, at
least 2, more preferably at least 3, still more preferably at least
5, and most preferably at least 10; and or a negative likelihood
ratio (calculated as (1-sensitivity)/specificity) of less than 1,
less than or equal to 0.5, more preferably less than or equal to
0.3, and most preferably less than or equal to 0.1
[0094] Additional clinical indicia may be combined with the kidney
injury marker assay result(s) of the present invention. These
include other biomarkers related to renal status. Examples include
the following, which recite the common biomarker name, followed by
the Swiss-Prot entry number for that biomarker or its parent: Actin
(P68133); Adenosine deaminase binding protein (DPP4, P27487);
Alpha-1-acid glycoprotein 1 (P02763); Alpha-1-microglobulin
(P02760); Albumin (P02768); Angiotensinogenase (Renin, P00797);
Nidogen-1 (P07355); Beta-glucuronidase (P08236); B-2-microglobulin
(P61769); Beta-galactosidase (P16278); BMP-7 (P18075); Brain
natriuretic peptide (proBNP, BNP-32, NTproBNP; P16860);
Calcium-binding protein Beta (S100-beta, P04271); Carbonic
anhydrase 9 (Q16790); Casein Kinase 2 (P68400); Clusterin (P10909);
Complement C3 (P01024); Cysteine-rich protein (CYR61, 000622);
Cytochrome C (P99999); Epidermal growth factor (EGF, P01133);
Endothelin-1 (P05305); Exosomal Fetuin-A (P02765); Fatty
acid-binding protein, heart (FABP3, P05413); Fatty acid-binding
protein, liver (P07148); Ferritin (light chain, P02792; heavy chain
P02794); Fructose-1,6-biphosphatase (P09467); GRO-alpha (CXCL1,
(P09341); Growth Hormone (P01241); Hepatocyte growth factor
(P14210); Insulin-like growth factor I (P05019); Immunoglobulin G;
Immunoglobulin Light Chains (Kappa and Lambda); Interferon gamma
(P01308); Lysozyme (P61626); Interleukin-1alpha (P01583);
Interleukin-2 (P60568); Interleukin-4 (P05112); Interleukin-9
(P15248); Interleukin-12p40 (P29460); Interleukin-13 (P35225);
Interleukin-16 (Q14005); L1 cell adhesion molecule (P32004);
Lactate dehydrogenase (P00338); Leucine Aminopeptidase (P28838);
Meprin A-alpha subunit (Q16819); Meprin A-beta subunit (Q16820);
Midkine (P21741); MIP2-alpha (CXCL2, P19875); MMP-2 (P08253); MMP-9
(P14780); Netrin-1 (095631); Neutral endopeptidase (P08473);
Osteopontin (014788); Renal papillary antigen 1 (RPA1); Renal
papillary antigen 2 (RPA2); Retinol binding protein (P09455);
Ribonuclease; S100 calcium-binding protein A6 (P06703); Serum
Amyloid P Component (P02743); Sodium/Hydrogen exchanger isoform
(NHE3, P48764); Spermidine/spermine N1-acetyltransferase (P21673);
TGF-Beta1 (P01137); Transferrin (P02787); Trefoil factor 3 (TFF3,
Q07654); Toll-Like protein 4 (000206); Total protein;
Tubulointerstitial nephritis antigen (Q9UJW2); Uromodulin
(Tamm-Horsfall protein, P07911).
[0095] For purposes of risk stratification, Adiponectin (Q15848);
Alkaline phosphatase (P05186); Aminopeptidase N (P15144);
CalbindinD28k (P05937); Cystatin C (P01034); 8 subunit of F1FO
ATPase (P03928); Gamma-glutamyltransferase (P19440); GSTa
(alpha-glutathione-S-transferase, P08263); GSTpi
(Glutathione-S-transferase P; GST class-pi; P09211); IGFBP-1
(P08833); IGFBP-2 (P18065); IGFBP-6 (P24592); Integral membrane
protein 1 (Itm1, P46977); Interleukin-6 (P05231); Interleukin-8
(P10145); Interleukin-18 (Q14116); IP-10 (10 kDa
interferon-gamma-induced protein, P02778); IRPR (IFRD1, 000458);
Isovaleryl-CoA dehydrogenase (IVD, P26440); I-TAC/CXCL11 (014625);
Keratin 19 (P08727); Kim-1 (Hepatitis A virus cellular receptor 1,
043656); L-arginine:glycine amidinotransferase (P50440); Leptin
(P41159); Lipocalin2 (NGAL, P80188); MCP-1 (P13500); MIG
(Gamma-interferon-induced monokine Q07325); MIP-1a (P10147); MIP-3a
(P78556); MIP-1beta (P13236); MIP-1d (Q16663); NAG
(N-acetyl-beta-D-glucosaminidase, P54802); Organic ion transporter
(OCT2, 015244); Osteoprotegerin (014788); P8 protein (060356);
Plasminogen activator inhibitor 1 (PAI-1, P05121); ProANP(1-98)
(P01160); Protein phosphatase 1-beta (PPI-beta, P62140); Rab
GDI-beta (P50395); Renal kallikrein (P06870); RT1.B-1 (alpha) chain
of the integral membrane protein (Q5Y7A8); soluble tumor necrosis
factor receptor superfamily member 1A (sTNFR-I, P19438); soluble
tumor necrosis factor receptor superfamily member 1B (sTNFR-II,
P20333); Tissue inhibitor of metalloproteinases 3 (TIMP-3, P35625);
uPAR (Q03405) may be combined with the kidney injury marker assay
result(s) of the present invention.
[0096] Other clinical indicia which may be combined with the kidney
injury marker assay result(s) of the present invention includes
demographic information (e.g., weight, sex, age, race), medical
history (e.g., family history, type of surgery, pre-existing
disease such as aneurism, congestive heart failure, preeclampsia,
eclampsia, diabetes mellitus, hypertension, coronary artery
disease, proteinuria, renal insufficiency, or sepsis, type of toxin
exposure such as NSAIDs, cyclosporines, tacrolimus,
aminoglycosides, foscarnet, ethylene glycol, hemoglobin, myoglobin,
ifosfamide, heavy metals, methotrexate, radiopaque contrast agents,
or streptozotocin), clinical variables (e.g., blood pressure,
temperature, respiration rate), risk scores (APACHE score, PREDICT
score, TIMI Risk Score for UA/NSTEMI, Framingham Risk Score), a
urine total protein measurement, a glomerular filtration rate, an
estimated glomerular filtration rate, a urine production rate, a
serum or plasma creatinine concentration, a renal papillary antigen
1 (RPA1) measurement; a renal papillary antigen 2 (RPA2)
measurement; a urine creatinine concentration, a fractional
excretion of sodium, a urine sodium concentration, a urine
creatinine to serum or plasma creatinine ratio, a urine specific
gravity, a urine osmolality, a urine urea nitrogen to plasma urea
nitrogen ratio, a plasma BUN to creatnine ratio, and/or a renal
failure index calculated as urine sodium/(urine creatinine/plasma
creatinine). Other measures of renal function which may be combined
with the kidney injury marker assay result(s) are described
hereinafter and in Harrison's Principles of Internal Medicine,
17.sup.th Ed., McGraw Hill, N.Y., pages 1741-1830, and Current
Medical Diagnosis & Treatment 2008, 47.sup.th Ed, McGraw Hill,
N.Y., pages 785-815, each of which are hereby incorporated by
reference in their entirety.
[0097] Combining assay results/clinical indicia in this manner can
comprise the use of multivariate logistical regression, loglinear
modeling, neural network analysis, n-of-m analysis, decision tree
analysis, etc. This list is not meant to be limiting.
[0098] Diagnosis of Acute Renal Failure
[0099] As noted above, the terms "acute renal (or kidney) injury"
and "acute renal (or kidney) failure" as used herein are defined in
part in terms of changes in serum creatinine from a baseline value.
Most definitions of ARF have common elements, including the use of
serum creatinine and, often, urine output. Patients may present
with renal dysfunction without an available baseline measure of
renal function for use in this comparison. In such an event, one
may estimate a baseline serum creatinine value by assuming the
patient initially had a normal GFR. Glomerular filtration rate
(GFR) is the volume of fluid filtered from the renal (kidney)
glomerular capillaries into the Bowman's capsule per unit time.
Glomerular filtration rate (GFR) can be calculated by measuring any
chemical that has a steady level in the blood, and is freely
filtered but neither reabsorbed nor secreted by the kidneys. GFR is
typically expressed in units of ml/min:
GFR = Urine .times. .times. Concentration .times. Urine .times.
.times. Flow Plasma .times. .times. Concentration ##EQU00001##
[0100] By normalizing the GFR to the body surface area, a GFR of
approximately 75-100 ml/min per 1.73 m.sup.2 can be assumed. The
rate therefore measured is the quantity of the substance in the
urine that originated from a calculable volume of blood.
[0101] There are several different techniques used to calculate or
estimate the glomerular filtration rate (GFR or eGFR). In clinical
practice, however, creatinine clearance is used to measure GFR.
Creatinine is produced naturally by the body (creatinine is a
metabolite of creatine, which is found in muscle). It is freely
filtered by the glomerulus, but also actively secreted by the renal
tubules in very small amounts such that creatinine clearance
overestimates actual GFR by 10-20%. This margin of error is
acceptable considering the ease with which creatinine clearance is
measured.
[0102] Creatinine clearance (CCr) can be calculated if values for
creatinine's urine concentration (U.sub.Cr), urine flow rate (V),
and creatinine's plasma concentration (Per) are known. Since the
product of urine concentration and urine flow rate yields
creatinine's excretion rate, creatinine clearance is also said to
be its excretion rate (U.sub.Cr.times.V) divided by its plasma
concentration. This is commonly represented mathematically as:
C Cr = U Cr .times. V P Cr ##EQU00002##
[0103] Commonly a 24 hour urine collection is undertaken, from
empty-bladder one morning to the contents of the bladder the
following morning, with a comparative blood test then taken:
C Cr = U Cr .times. 24 .times. - .times. hour .times. .times.
volume P Cr .times. 24 .times. 60 .times. .times. mins
##EQU00003##
[0104] To allow comparison of results between people of different
sizes, the CCr is often corrected for the body surface area (BSA)
and expressed compared to the average sized man as ml/min/1.73 m2.
While most adults have a BSA that approaches 1.7 (1.6-1.9),
extremely obese or slim patients should have their CCr corrected
for their actual BSA:
C Cr .times. .times. corrected = C Cr .times. 1.73 BSA
##EQU00004##
[0105] The accuracy of a creatinine clearance measurement (even
when collection is complete) is limited because as glomerular
filtration rate (GFR) falls creatinine secretion is increased, and
thus the rise in serum creatinine is less. Thus, creatinine
excretion is much greater than the filtered load, resulting in a
potentially large overestimation of the GFR (as much as a twofold
difference). However, for clinical purposes it is important to
determine whether renal function is stable or getting worse or
better. This is often determined by monitoring serum creatinine
alone. Like creatinine clearance, the serum creatinine will not be
an accurate reflection of GFR in the non-steady-state condition of
ARF. Nonetheless, the degree to which serum creatinine changes from
baseline will reflect the change in GFR. Serum creatinine is
readily and easily measured and it is specific for renal
function.
[0106] For purposes of determining urine output on a Urine output
on a mL/kg/hr basis, hourly urine collection and measurement is
adequate. In the case where, for example, only a cumulative 24-h
output was available and no patient weights are provided, minor
modifications of the RIFLE urine output criteria have been
described. For example, Bagshaw et al., Nephrol. Dial. Transplant.
23: 1203-1210, 2008, assumes an average patient weight of 70 kg,
and patients are assigned a RIFLE classification based on the
following: <35 mL/h (Risk), <21 mL/h (Injury) or <4 mL/h
(Failure).
[0107] Selecting a Treatment Regimen
[0108] Once a diagnosis is obtained, the clinician can readily
select a treatment regimen that is compatible with the diagnosis,
such as initiating renal replacement therapy, withdrawing delivery
of compounds that are known to be damaging to the kidney, kidney
transplantation, delaying or avoiding procedures that are known to
be damaging to the kidney, modifying diuretic administration,
initiating goal directed therapy, etc. The skilled artisan is aware
of appropriate treatments for numerous diseases discussed in
relation to the methods of diagnosis described herein. See, e.g.,
Merck Manual of Diagnosis and Therapy, 17th Ed. Merck Research
Laboratories, Whitehouse Station, N J, 1999. In addition, since the
methods and compositions described herein provide prognostic
information, the markers of the present invention may be used to
monitor a course of treatment. For example, improved or worsened
prognostic state may indicate that a particular treatment is or is
not efficacious.
[0109] One skilled in the art readily appreciates that the present
invention is well adapted to carry out the objects and obtain the
ends and advantages mentioned, as well as those inherent therein.
The examples provided herein are representative of preferred
embodiments, are exemplary, and are not intended as limitations on
the scope of the invention.
Example 1: Contrast-Induced Nephropathy Sample Collection
[0110] The objective of this sample collection study is to collect
samples of plasma and urine and clinical data from patients before
and after receiving intravascular contrast media. Approximately 250
adults undergoing radiographic/angiographic procedures involving
intravascular administration of iodinated contrast media are
enrolled. To be enrolled in the study, each patient must meet all
of the following inclusion criteria and none of the following
exclusion criteria:
Inclusion Criteria
[0111] males and females 18 years of age or older; undergoing a
radiographic/angiographic procedure (such as a CT scan or coronary
intervention) involving the intravascular administration of
contrast media; expected to be hospitalized for at least 48 hours
after contrast administration. able and willing to provide written
informed consent for study participation and to comply with all
study procedures.
Exclusion Criteria
[0112] renal transplant recipients; acutely worsening renal
function prior to the contrast procedure; already receiving
dialysis (either acute or chronic) or in imminent need of dialysis
at enrollment; expected to undergo a major surgical procedure (such
as involving cardiopulmonary bypass) or an additional imaging
procedure with contrast media with significant risk for further
renal insult within the 48 hrs following contrast administration;
participation in an interventional clinical study with an
experimental therapy within the previous 30 days; known infection
with human immunodeficiency virus (HIV) or a hepatitis virus.
[0113] Immediately prior to the first contrast administration (and
after any pre-procedure hydration), an EDTA anti-coagulated blood
sample (10 mL) and a urine sample (10 mL) are collected from each
patient. Blood and urine samples are then collected at 4 (.+-.0.5),
8 (.+-.1), 24 (.+-.2) 48 (.+-.2), and 72 (.+-.2) hrs following the
last administration of contrast media during the index contrast
procedure. Blood is collected via direct venipuncture or via other
available venous access, such as an existing femoral sheath,
central venous line, peripheral intravenous line or hep-lock. These
study blood samples are processed to plasma at the clinical site,
frozen and shipped to Astute Medical, Inc., San Diego, Calif. The
study urine samples are frozen and shipped to Astute Medical,
Inc.
[0114] Serum creatinine is assessed at the site immediately prior
to the first contrast administration (after any pre-procedure
hydration) and at 4 (.+-.0.5), 8 (.+-.1), 24 (.+-.2) and 48
(.+-.2)), and 72 (.+-.2) hours following the last administration of
contrast (ideally at the same time as the study samples are
obtained). In addition, each patient's status is evaluated through
day 30 with regard to additional serum and urine creatinine
measurements, a need for dialysis, hospitalization status, and
adverse clinical outcomes (including mortality).
[0115] Prior to contrast administration, each patient is assigned a
risk based on the following assessment: systolic blood pressure
<80 mm Hg=5 points; intra-arterial balloon pump=5 points;
congestive heart failure (Class III-IV or history of pulmonary
edema)=5 points; age >75 yrs=4 points; hematocrit level <39%
for men, <35% for women=3 points; diabetes=3 points; contrast
media volume=1 point for each 100 mL; serum creatinine level
>1.5 g/dL=4 points OR estimated GFR 40-60 mL/min/1.73 m.sup.2=2
points, 20-40 mL/min/1.73 m.sup.2=4 points, <20 mL/min/1.73
m.sup.2=6 points. The risks assigned are as follows: risk for CIN
and dialysis: 5 or less total points=risk of CIN -7.5%, risk of
dialysis -0.04%; 6-10 total points=risk of CIN -14%, risk of
dialysis -0.12%; 11-16 total points=risk of CIN -26.1%, risk of
dialysis -1.09%; >16 total points=risk of CIN -57.3%, risk of
dialysis -12.8%.
Example 2: Cardiac Surgery Sample Collection
[0116] The objective of this sample collection study is to collect
samples of plasma and urine and clinical data from patients before
and after undergoing cardiovascular surgery, a procedure known to
be potentially damaging to kidney function. Approximately 900
adults undergoing such surgery are enrolled. To be enrolled in the
study, each patient must meet all of the following inclusion
criteria and none of the following exclusion criteria:
Inclusion Criteria
[0117] males and females 18 years of age or older; undergoing
cardiovascular surgery; Toronto/Ottawa Predictive Risk Index for
Renal Replacement risk score of at least 2 (Wijeysundera et al.,
JAMA 297: 1801-9, 2007); and able and willing to provide written
informed consent for study participation and to comply with all
study procedures.
Exclusion Criteria
[0118] known pregnancy; previous renal transplantation; acutely
worsening renal function prior to enrollment (e.g., any category of
RIFLE criteria); already receiving dialysis (either acute or
chronic) or in imminent need of dialysis at enrollment; currently
enrolled in another clinical study or expected to be enrolled in
another clinical study within 7 days of cardiac surgery that
involves drug infusion or a therapeutic intervention for AKI; known
infection with human immunodeficiency virus (HIV) or a hepatitis
virus.
[0119] Within 3 hours prior to the first incision (and after any
pre-procedure hydration), an EDTA anti-coagulated blood sample (10
mL), whole blood (3 mL), and a urine sample (35 mL) are collected
from each patient. Blood and urine samples are then collected at 3
(.+-.0.5), 6 (.+-.0.5), 12 (.+-.1), 24 (.+-.2) and 48 (.+-.2) hrs
following the procedure and then daily on days 3 through 7 if the
subject remains in the hospital. Blood is collected via direct
venipuncture or via other available venous access, such as an
existing femoral sheath, central venous line, peripheral
intravenous line or hep-lock. These study blood samples are frozen
and shipped to Astute Medical, Inc., San Diego, Calif. The study
urine samples are frozen and shipped to Astute Medical, Inc.
Example 3: Acutely Ill Subject Sample Collection
[0120] The objective of this study is to collect samples from
acutely ill patients. Approximately 900 adults expected to be in
the ICU for at least 48 hours will be enrolled. To be enrolled in
the study, each patient must meet all of the following inclusion
criteria and none of the following exclusion criteria:
Inclusion Criteria
[0121] males and females 18 years of age or older; Study population
1: approximately 300 patients that have at least one of: shock
(SBP<90 mmHg and/or need for vasopressor support to maintain
MAP>60 mmHg and/or documented drop in SBP of at least 40 mmHg);
and sepsis; Study population 2: approximately 300 patients that
have at least one of: IV antibiotics ordered in computerized
physician order entry (CPOE) within 24 hours of enrollment;
contrast media exposure within 24 hours of enrollment; increased
Intra-Abdominal Pressure with acute decompensated heart failure;
and severe trauma as the primary reason for ICU admission and
likely to be hospitalized in the ICU for 48 hours after enrollment;
Study population 3: approximately 300 patients expected to be
hospitalized through acute care setting (ICU or ED) with a known
risk factor for acute renal injury (e.g. sepsis, hypotension/shock
(Shock=systolic BP<90 mmHg and/or the need for vasopressor
support to maintain a MAP>60 mmHg and/or a documented drop in
SBP>40 mmHg), major trauma, hemorrhage, or major surgery);
and/or expected to be hospitalized to the ICU for at least 24 hours
after enrollment.
Exclusion Criteria
[0122] known pregnancy; institutionalized individuals; previous
renal transplantation; known acutely worsening renal function prior
to enrollment (e.g., any category of RIFLE criteria); received
dialysis (either acute or chronic) within 5 days prior to
enrollment or in imminent need of dialysis at the time of
enrollment; known infection with human immunodeficiency virus (HIV)
or a hepatitis virus; meets only the SBP<90 mmHg inclusion
criterion set forth above, and does not have shock in the attending
physician's or principal investigator's opinion.
[0123] After providing informed consent, an EDTA anti-coagulated
blood sample (10 mL) and a urine sample (25-30 mL) are collected
from each patient. Blood and urine samples are then collected at 4
(.+-.0.5) and 8 (.+-.1) hours after contrast administration (if
applicable); at 12 (.+-.1), 24 (.+-.2), and 48 (.+-.2) hours after
enrollment, and thereafter daily up to day 7 to day 14 while the
subject is hospitalized. Blood is collected via direct venipuncture
or via other available venous access, such as an existing femoral
sheath, central venous line, peripheral intravenous line or
hep-lock. These study blood samples are processed to plasma at the
clinical site, frozen and shipped to Astute Medical, Inc., San
Diego, Calif. The study urine samples are frozen and shipped to
Astute Medical, Inc.
Example 4. Immunoassay Format
[0124] Analytes are measured using standard sandwich enzyme
immunoassay techniques. A first antibody which binds the analyte is
immobilized in wells of a 96 well polystyrene microplate. Analyte
standards and test samples are pipetted into the appropriate wells
and any analyte present is bound by the immobilized antibody. After
washing away any unbound substances, a horseradish
peroxidase-conjugated second antibody which binds the analyte is
added to the wells, thereby forming sandwich complexes with the
analyte (if present) and the first antibody. Following a wash to
remove any unbound antibody-enzyme reagent, a substrate solution
comprising tetramethylbenzidine and hydrogen peroxide is added to
the wells. Color develops in proportion to the amount of analyte
present in the sample. The color development is stopped and the
intensity of the color is measured at 540 nm or 570 nm. An analyte
concentration is assigned to the test sample by comparison to a
standard curve determined from the analyte standards. Units for
Insulin-like growth factor-binding protein 2, Insulin-like growth
factor-binding protein 3, Insulin-like growth factor-binding
protein 4, and Insulin-like growth factor-binding protein 6
reported herein are ng/mL.
Example 5. Apparently Healthy Donor and Chronic Disease Patient
Samples
[0125] Human urine samples from donors with no known chronic or
acute disease ("Apparently Healthy Donors") were purchased from two
vendors (Golden West Biologicals, Inc., 27625 Commerce Center Dr.,
Temecula, Calif. 92590 and Virginia Medical Research, Inc., 915
First Colonial Rd., Virginia Beach, Va. 23454). The urine samples
were shipped and stored frozen at less than -20.degree. C. The
vendors supplied demographic information for the individual donors
including gender, race (Black/White), smoking status and age.
[0126] Human urine samples from donors with various chronic
diseases ("Chronic Disease Patients") including congestive heart
failure, coronary artery disease, chronic kidney disease, chronic
obstructive pulmonary disease, diabetes mellitus and hypertension
were purchased from Virginia Medical Research, Inc., 915 First
Colonial Rd., Virginia Beach, Va. 23454. The urine samples were
shipped and stored frozen at less than -20 degrees centigrade. The
vendor provided a case report form for each individual donor with
age, gender, race (Black/White), smoking status and alcohol use,
height, weight, chronic disease(s) diagnosis, current medications
and previous surgeries.
Example 6. Use of CD97 Antigen for Evaluating Renal Status in
Patients Admitted to the ICU: Recovery to RIFLE 0 from RIFLE I and
F
[0127] Patients from the intensive care unit (ICU) are enrolled in
the following study. EDTA anti-coagulated blood samples (10 mL) and
a urine samples (25-30 mL) are collected from each patient at
enrollment, 4 (.+-.0.5) and 8 (.+-.1) hours after contrast
administration (if applicable); at 12 (.+-.1), 24 (.+-.2), and 48
(.+-.2) hours after enrollment, and thereafter daily up to day 7 to
day 14 while the subject is hospitalized. CD97 antigen is measured
in the earliest samples collected while the patients were in RIFLE
I or F by standard immunoassay methods using commercially available
assay reagents.
[0128] Kidney status is assessed by RIFLE criteria based on serum
creatinine, urine output, or both serum creatinine and urine output
during a period starting at 12, 24, 48, or 72 hours after sample
collection or at any time within 7 days after sample collection.
Two cohorts are defined to represent a "recovered" and a
"non-recovered" population. "Recovered" indicates those patients
whose maximum RIFLE stage during a period of 24, 48 or 72 hours is
non-injury (RIFLE 0). "Non-recovered" indicates those patients
whose maximum RIFLE stage during a period of 24, 48 or 72 hours is
risk of injury (R), injury (I) or failure (F). If a patient dies or
is placed on renal replacement therapy (RRT) within 9 days of
enrollment, the patient is considered "non-recovered".
[0129] The ability to distinguish the "recovered" and
"non-recovered" cohorts is determined using receiver operating
characteristic (ROC) analysis.
Example 6. Use of Insulin-Like Growth Factor-Binding Protein 2 for
Evaluating Renal Status in Patients Admitted to the ICU: Recovery
to RIFLE 0 from RIFLE I and F
[0130] Patients from the intensive care unit (ICU) with RIFLE stage
of injury (I) or failure (F) are enrolled in the following study.
EDTA anti-coagulated blood samples (10 mL) and urine samples (50
mL) are collected from each patient at enrollment, and at every 12
hours up to day 3, and then every 24 hours thereafter up to day 7
while the subject is hospitalized. Insulin-like growth
factor-binding protein 2 is measured in the enrollment samples by
standard immunoassay methods using commercially available assay
reagents.
[0131] Kidney status is assessed by RIFLE criteria based on serum
creatinine, urine output, or both serum creatinine and urine output
during a period starting at 12, 24, 48, or 72 hours after sample
collection or at any time within 7 days after sample collection.
Two cohorts are defined to represent a "recovered" and a
"non-recovered" population. "Recovered" indicates those patients
whose maximum RIFLE stage during a period of 24, 48 or 72 hours is
non-injury (RIFLE 0). "Non-recovered" indicates those patients
whose maximum RIFLE stage during a period of 24, 48 or 72 hours is
risk of injury (R), injury (I) or failure (F). If a patient dies or
is placed on renal replacement therapy (RRT) at any time from
sample collection to 12, 24, 48, or 72 hours after sample
collection or at any time within 7 days after sample collection,
the patient is considered "non-recovered".
[0132] The ability to distinguish the "recovered" and
"non-recovered" cohorts is determined using receiver operating
characteristic (ROC) analysis.
TABLE-US-00010 TABLE 6.1 Comparison of marker levels and the area
under the ROC curve (AUC) in urine samples for the "recovered" and
"non-recovered" cohorts where recovery starts at 12 hours after
sample collection and renal status is assessed by serum creatinine
(sCr) only, urine output (UO) only, or serum creatinine or urine
output RIFLE criteria. Recovery Period Duration (hr) 24 48 72
Recovered Non-recovered Recovered Non-recovered Recovered
Non-recovered Cohort Cohort Cohort Cohort Cohort Cohort sCr or UO
Median 1.23 5.74 0.497 5.72 0.497 5.72 Average 4.29 17.7 4.50 17.5
4.50 17.5 Stdev 9.77 26.8 10.3 26.7 10.3 26.7 p (t-test) 0.12 0.15
0.15 Min 3.16E-5 0.0532 3.16E-5 0.0532 3.16E-5 0.0532 Max 31.9 112
31.9 112 31.9 112 n (Patient) 10 139 9 140 9 140 sCr only Median
2.09 6.60 2.08 6.52 2.08 6.52 Average 5.77 18.8 5.74 18.7 5.74 18.7
Stdev 11.2 27.6 11.4 27.5 11.4 27.5 p (t-test) 0.028 0.032 0.032
Min 3.16E-5 0.0532 3.16E-5 0.0532 3.16E-5 0.0532 Max 46.5 112 46.5
112 46.5 112 n (Patient) 23 126 22 127 22 127 UO only Median 3.17
6.67 2.91 6.67 2.85 6.73 Average 13.4 20.4 12.9 20.2 11.3 21.1
Stdev 22.3 29.5 20.7 29.8 18.2 30.4 p (t-test) 0.11 0.091 0.024 Min
3.16E-5 0.0645 3.16E-5 0.0645 3.16E-5 0.0645 Max 102 112 91.0 112
90.4 112 n (Patient) 75 73 67 81 64 84 Recovery Period Duration
(hr) 24 48 72 sCr or UO sCr only UO only sCr or UO sCr only UO only
sCr or UO sCr only UO only AUC 0.78 0.71 0.61 0.79 0.72 0.62 0.79
0.72 0.63 SE 0.061 0.052 0.046 0.061 0.052 0.046 0.061 0.052 0.045
p Value 4.0E-6 7.8E-5 0.016 2.5E-6 3.2E-5 0.0097 2.5E-6 3.2E-5
0.0033 nCohort Recovered 10 23 75 9 22 67 9 22 64 nCohort
Non-recovered 139 126 73 140 127 81 140 127 84 Cutoff Quartile 2
1.89 1.89 1.93 1.89 1.89 1.93 1.89 1.89 1.93 Sensitivity 77% 77%
81% 77% 77% 81% 77% 77% 81% Specificity 50% 35% 31% 56% 36% 33% 56%
36% 33% Cutoff Quartile 3 4.13 4.13 4.52 4.13 4.13 4.52 4.13 4.13
4.52 Sensitivity 53% 56% 58% 53% 57% 58% 53% 57% 58% Specificity
90% 83% 57% 89% 86% 60% 89% 86% 61% Cutoff Quartile 4 20.0 20.0
20.2 20.0 20.0 20.2 20.0 20.0 20.2 Sensitivity 27% 29% 32% 26% 28%
30% 26% 28% 31% Specificity 90% 91% 81% 89% 91% 81% 89% 91% 83% OR
Quartile 2 3.34 1.78 1.86 4.22 1.93 2.15 4.22 1.93 2.08 p Value
0.069 0.23 0.11 0.040 0.18 0.048 0.040 0.18 0.058 Lower limit of
95% CI 0.910 0.688 0.870 1.07 0.738 1.01 1.07 0.738 0.976 Upper
limit of 95% CI 12.3 4.63 3.99 16.6 5.06 4.59 16.6 5.06 4.41 OR
Quartile 3 10.2 6.13 1.82 8.97 8.29 2.05 8.97 8.29 2.18 p Value
0.029 0.0017 0.072 0.041 0.0011 0.033 0.041 0.0011 0.021 Lower
limit of 95% CI 1.26 1.97 0.949 1.09 2.33 1.06 1.09 2.33 1.12 Upper
limit of 95% CI 83.1 19.1 3.49 73.6 29.4 3.95 73.6 29.4 4.24 OR
Quartile 4 3.26 4.20 2.00 2.87 3.96 1.75 2.87 3.96 2.16 p Value
0.27 0.061 0.074 0.33 0.073 0.16 0.33 0.073 0.058 Lower limit of
95% CI 0.400 0.936 0.935 0.348 0.879 0.809 0.348 0.879 0.973 Upper
limit of 95% CI 26.7 18.8 4.30 23.8 17.8 3.78 23.8 17.8 4.79
TABLE-US-00011 TABLE 6.2 Comparison of marker levels and the area
under the ROC curve (AUC) in urine samples for the "recovered" and
"non-recovered" cohorts where recovery starts at 24 hours after
sample collection and renal status is assessed by serum creatinine
(sCr) only, urine output (UO) only, or serum creatinine or urine
output RIFLE criteria. Recovery Period Duration (hr) 24 48 72
Recovered Non-recovered Recovered Non-recovered Recovered
Non-recovered Cohort Cohort Cohort Cohort Cohort Cohort sCr or UO
Median 2.21 6.52 2.01 6.39 1.96 6.06 Average 4.52 19.3 4.92 18.8
5.01 18.7 Stdev 6.85 28.0 7.40 27.7 7.57 27.6 p (t-test) 0.0082
0.021 0.026 Min 3.16E-5 0.0532 3.16E-5 0.0532 3.16E-5 0.0532 Max
31.9 112 31.9 112 31.9 112 n (Patient) 26 123 22 127 21 128 sCr
only Median 2.35 6.86 2.34 6.73 2.22 6.67 Average 5.67 20.5 5.74
20.2 5.83 20.0 Stdev 9.35 28.8 9.62 28.6 9.76 28.6 p (t-test)
0.0034 0.0051 0.0065 Min 3.16E-5 0.0532 3.16E-5 0.0532 3.16E-5
0.0532 Max 46.5 112 46.5 112 46.5 112 n (Patient) 35 112 33 114 32
115 UO only Median 3.47 6.78 3.47 6.60 3.17 6.67 Average 12.9 21.5
11.4 21.9 11.0 21.9 Stdev 20.1 31.2 15.6 32.2 15.4 31.8 p (t-test)
0.046 0.015 0.011 Min 3.16E-5 0.0645 3.16E-5 0.0645 3.16E-5 0.0645
Max 102 112 73.5 112 73.5 112 n (Patient) 81 63 72 72 69 75
Recovery Period Duration (hr) 24 48 72 sCr or UO sCr only UO only
sCr or UO sCr only UO only sCr or UO sCr only UO only AUC 0.72 0.69
0.61 0.71 0.69 0.60 0.71 0.69 0.62 SE 0.049 0.047 0.048 0.053 0.048
0.047 0.054 0.048 0.047 p Value 1.1E-5 6.2E-5 0.026 7.8E-5 4.6E-5
0.029 8.3E-5 5.5E-5 0.011 nCohort Recovered 26 35 81 22 33 72 21 32
69 nCohort Non-recovered 123 112 63 127 114 72 128 115 75 Cutoff
Quartile 2 1.89 1.91 1.93 1.89 1.91 1.93 1.89 1.91 1.93 Sensitivity
79% 78% 81% 79% 78% 81% 79% 78% 81% Specificity 42% 34% 30% 45% 36%
31% 48% 38% 32% Cutoff Quartile 3 4.13 4.13 4.99 4.13 4.13 4.99
4.13 4.13 4.99 Sensitivity 56% 58% 57% 54% 58% 56% 54% 57% 56%
Specificity 77% 74% 56% 73% 76% 56% 71% 75% 57% Cutoff Quartile 4
20.0 20.5 20.2 20.0 20.5 20.2 20.0 20.5 20.2 Sensitivity 30% 31%
32% 29% 31% 31% 29% 30% 31% Specificity 96% 94% 80% 95% 94% 81% 95%
94% 81% OR Quartile 2 2.74 1.82 1.79 3.09 2.03 1.82 3.40 2.16 2.04
p Value 0.027 0.16 0.15 0.019 0.096 0.13 0.012 0.073 0.070 Lower
limit of 95% CI 1.12 0.794 0.813 1.20 0.881 0.844 1.31 0.931 0.944
Upper limit of 95% CI 6.66 4.15 3.94 7.91 4.70 3.93 8.85 5.01 4.41
OR Quartile 3 4.26 4.00 1.67 3.17 4.30 1.56 2.92 4.04 1.65 p Value
0.0037 0.0013 0.13 0.024 0.0011 0.18 0.037 0.0019 0.13 Lower limit
of 95% CI 1.60 1.71 0.858 1.17 1.78 0.810 1.07 1.67 0.856 Upper
limit of 95% CI 11.3 9.31 3.24 8.63 10.3 3.02 8.02 9.76 3.20 OR
Quartile 4 10.8 7.50 1.89 8.63 6.87 1.82 8.13 6.56 1.91 p Value
0.022 0.0077 0.10 0.039 0.011 0.13 0.045 0.013 0.10 Lower limit of
95% CI 1.40 1.70 0.882 1.12 1.56 0.844 1.05 1.49 0.875 Upper limit
of 95% CI 82.4 33.0 4.05 66.5 30.3 3.93 62.8 29.0 4.15
TABLE-US-00012 TABLE 6.3 Comparison of marker levels and the area
under the ROC curve (AUC) in urine samples for the "recovered" and
"non-recovered" cohorts where recovery starts at 48 hours after
sample collection and renal status is assessed by serum creatinine
(sCr) only, urine output (UO) only, or serum creatinine or urine
output RIFLE criteria. Recovery Period Duration (hr) 24 48 72
Recovered Non-recovered Recovered Non-recovered Recovered
Non-recovered Cohort Cohort Cohort Cohort Cohort Cohort sCr or UO
Median 2.09 7.04 2.07 7.04 2.07 6.93 Average 3.90 21.2 3.59 20.9
3.72 20.4 Stdev 4.68 29.1 4.29 28.8 4.42 28.6 p (t-test) 4.5E-4
6.8E-4 0.0016 Min 3.16E-5 0.0532 3.16E-5 0.0532 0.242 3.16E-5 Max
17.4 112 17.4 112 17.4 112 n (Patient) 37 109 34 112 31 115 sCr
only Median 2.30 8.85 2.09 8.85 2.09 8.85 Average 4.85 22.4 4.61
22.1 4.61 22.1 Stdev 7.76 29.9 7.71 29.6 7.71 29.6 p (t-test)
1.6E-4 2.0E-4 2.0E-4 Min 3.16E-5 0.0532 3.16E-5 0.0532 3.16E-5
0.0532 Max 46.5 112 46.5 112 46.5 112 n (Patient) 45 100 43 102 43
102 UO only Median 3.49 6.98 3.34 6.98 3.17 6.67 Average 14.8 21.4
14.7 21.2 15.7 19.6 Stdev 23.3 30.6 23.7 29.9 24.8 28.8 p (t-test)
0.17 0.17 0.42 Min 3.16E-5 0.0645 3.16E-5 0.0645 0.0532 3.16E-5 Max
109 112 109 112 109 112 n (Patient) 70 58 66 62 59 69 Recovery
Period Duration (hr) 24 48 72 sCr or UO sCr only UO only sCr or UO
sCr only UO only sCr or UO sCr only UO only AUC 0.74 0.73 0.60 0.75
0.74 0.61 0.73 0.74 0.59 SE 0.043 0.042 0.050 0.043 0.042 0.050
0.045 0.042 0.050 p Value 5.1E-8 4.0E-8 0.041 9.6E-9 7.9E-9 0.024
2.9E-7 7.9E-9 0.062 nCohort Recovered 37 45 70 34 43 66 31 43 59
nCohort Non-recovered 109 100 58 112 102 62 115 102 69 Cutoff
Quartile 2 1.90 1.89 1.89 1.90 1.89 1.89 1.90 1.89 1.89 Sensitivity
79% 81% 83% 79% 81% 84% 78% 81% 83% Specificity 38% 38% 31% 41% 40%
33% 39% 40% 34% Cutoff Quartile 3 4.11 4.13 5.38 4.11 4.13 5.38
4.11 4.13 5.38 Sensitivity 60% 62% 59% 59% 62% 58% 58% 62% 57%
Specificity 78% 76% 57% 79% 77% 58% 81% 77% 58% Cutoff Quartile 4
19.7 20.0 22.3 19.7 20.0 22.3 19.7 20.0 22.3 Sensitivity 34% 36%
29% 33% 35% 29% 32% 35% 26% Specificity 100% 98% 79% 100% 98% 79%
100% 98% 76% OR Quartile 2 2.28 2.59 2.20 2.71 2.86 2.60 2.27 2.86
2.44 p Value 0.046 0.017 0.068 0.018 0.0091 0.027 0.058 0.0091
0.034 Lower limit of 95% CI 1.01 1.18 0.942 1.19 1.30 1.11 0.974
1.30 1.07 Upper limit of 95% CI 5.11 5.66 5.14 6.17 6.29 6.07 5.31
6.29 5.55 OR Quartile 3 5.36 5.04 1.89 5.53 5.33 1.88 5.82 5.33
1.77 p Value 1.6E-4 6.1E-5 0.077 2.4E-4 5.4E-5 0.078 3.5E-4 5.4E-5
0.11 Lower limit of 95% CI 2.24 2.29 0.933 2.22 2.37 0.931 2.22
2.37 0.876 Upper limit of 95% CI 12.8 11.1 3.82 13.8 12.0 3.79 15.3
12.0 3.57 OR Quartile 4 38.8 24.8 1.52 34.3 22.9 1.52 30.1 22.9
1.13 p Value 0.011 0.0019 0.31 0.014 0.0024 0.31 0.018 0.0024 0.76
Lower limit of 95% CI 2.32 3.27 0.681 2.04 3.03 0.679 1.79 3.03
0.507 Upper limit of 95% CI 650 187 3.40 575 173 3.40 505 173
2.54
TABLE-US-00013 TABLE 6.4 Comparison of marker levels and the area
under the ROC curve (AUC) in urine samples for the "recovered" and
"non-recovered" cohorts where recovery starts at 72 hours after
sample collection and renal status is assessed by serum creatinine
(sCr) only, urine output (UO) only, or serum creatinine or urine
output RIFLE criteria. Recovery Period Duration (hr) 24 48 72
Recovered Non-recovered Recovered Non-recovered Recovered
Non-recovered Cohort Cohort Cohort Cohort Cohort Cohort sCr or UO
Median 2.30 7.74 2.20 7.04 2.20 7.04 Average 6.89 21.7 7.15 20.9
7.30 20.6 Stdev 12.2 29.8 12.8 29.3 13.1 29.1 p (t-test) 0.0020
0.0059 0.0091 Min 3.16E-5 0.0532 0.242 3.16E-5 0.242 3.16E-5 Max
56.0 112 56.0 112 56.0 112 n (Patient) 43 99 38 104 36 106 sCr only
Median 2.32 9.30 2.32 9.30 2.32 8.42 Average 7.38 22.6 7.38 22.6
7.51 22.2 Stdev 12.7 30.5 12.7 30.5 12.9 30.3 p (t-test) 9.7E-4
9.7E-4 0.0016 Min 3.16E-5 0.0532 3.16E-5 0.0532 3.16E-5 0.0532 Max
56.0 112 56.0 112 56.0 112 n (Patient) 50 92 50 92 48 94 UO only
Median 3.21 7.04 3.21 6.93 3.53 6.86 Average 15.8 21.0 17.3 19.2
18.1 18.4 Stdev 26.4 28.9 28.0 27.5 28.7 26.8 p (t-test) 0.31 0.71
0.95 Min 3.16E-5 0.0645 0.0532 3.16E-5 0.0532 3.16E-5 Max 109 112
109 112 109 112 n (Patient) 62 57 54 65 50 70 Recovery Period
Duration (hr) 24 48 72 sCr or UO sCr only UO only sCr or UO sCr
only UO only sCr or UO sCr only UO only AUC 0.71 0.70 0.63 0.70
0.70 0.61 0.69 0.69 0.57 SE 0.044 0.044 0.051 0.046 0.044 0.052
0.047 0.044 0.052 p Value 2.4E-6 3.8E-6 0.011 1.8E-5 3.8E-6 0.041
5.2E-5 1.2E-5 0.15 nCohort Recovered 43 50 62 38 50 54 36 48 50
nCohort Non-recovered 99 92 57 104 92 65 106 94 70 Cutoff Quartile
2 1.90 1.90 1.88 1.90 1.90 1.88 1.90 1.90 1.89 Sensitivity 81% 80%
86% 80% 80% 85% 79% 80% 81% Specificity 40% 36% 35% 39% 36% 37% 39%
35% 34% Cutoff Quartile 3 4.99 4.99 5.74 4.99 4.99 5.74 4.99 4.99
6.06 Sensitivity 59% 61% 60% 58% 61% 57% 58% 61% 54% Specificity
70% 70% 58% 71% 70% 57% 72% 71% 56% Cutoff Quartile 4 20.7 20.7
22.6 20.7 20.7 22.6 20.7 20.7 22.3 Sensitivity 33% 35% 30% 32% 35%
26% 31% 34% 26% Specificity 93% 92% 79% 92% 92% 76% 92% 92% 76% OR
Quartile 2 2.75 2.31 3.37 2.58 2.31 3.24 2.43 2.16 2.26 p Value
0.012 0.034 0.0089 0.022 0.034 0.0083 0.033 0.051 0.057 Lower limit
of 95% CI 1.25 1.07 1.36 1.15 1.07 1.35 1.07 0.996 0.975 Upper
limit of 95% CI 6.07 5.01 8.37 5.78 5.01 7.73 5.51 4.71 5.23 OR
Quartile 3 3.26 3.63 2.05 3.35 3.63 1.78 3.52 3.74 1.51 p Value
0.0024 5.9E-4 0.055 0.0031 5.9E-4 0.12 0.0028 5.4E-4 0.27 Lower
limit of 95% CI 1.52 1.74 0.985 1.50 1.74 0.859 1.54 1.77 0.728
Upper limit of 95% CI 7.01 7.57 4.25 7.46 7.57 3.69 8.04 7.90 3.14
OR Quartile 4 6.67 6.13 1.60 5.42 6.13 1.12 4.97 5.68 1.10 p Value
0.0028 0.0013 0.27 0.0080 0.0013 0.79 0.012 0.0021 0.83 Lower limit
of 95% CI 1.92 2.03 0.696 1.55 2.03 0.485 1.42 1.87 0.472 Upper
limit of 95% CI 23.2 18.6 3.69 18.9 18.6 2.57 17.4 17.2 2.54
TABLE-US-00014 TABLE 6.5 Comparison of marker levels and the area
under the ROC curve (AUC) in urine samples for the "recovered" and
"non-recovered" cohorts where recovery starts within 7 days after
sample collection and renal status is assessed by serum creatinine
(sCr) only, urine output (UO) only, or serum creatinine or urine
output RIFLE criteria. Recovery Period Duration (hr) 24 48 72
Recovered Non-recovered Recovered Non-recovered Recovered
Non-recovered Cohort Cohort Cohort Cohort Cohort Cohort sCr or UO
Median 3.09 7.74 3.15 7.39 3.15 7.39 Average 13.8 20.8 13.9 20.5
13.9 20.5 Stdev 23.3 29.3 23.4 29.2 23.4 29.2 p (t-test) 0.10 0.13
0.13 Min 3.16E-5 0.0645 3.16E-5 0.0645 3.16E-5 0.0645 Max 109 112
109 112 109 112 n (Patient) 86 63 85 64 85 64 sCr only Median 2.65
10.8 2.79 10.2 2.79 10.2 Average 9.32 23.5 9.56 23.0 9.56 23.0
Stdev 15.7 31.5 15.9 31.3 15.9 31.3 p (t-test) 7.8E-4 0.0016 0.0016
Min 3.16E-5 0.0532 3.16E-5 0.0532 3.16E-5 0.0532 Max 78.7 112 78.7
112 78.7 112 n (Patient) 71 78 69 80 69 80 UO only Median 3.32 7.39
3.47 7.04 3.49 6.91 Average 15.0 20.2 15.3 19.6 15.6 19.0 Stdev
25.1 28.1 25.3 27.8 25.5 27.5 p (t-test) 0.25 0.34 0.45 Min 3.16E-5
0.0645 3.16E-5 0.0645 3.16E-5 0.0645 Max 109 112 109 112 109 112 n
(Patient) 96 52 94 54 92 56 Recovery Period Duration (hr) 24 48 72
sCr or UO sCr only UO only sCr or UO sCr only UO only sCr or UO sCr
only UO only AUC 0.62 0.67 0.62 0.62 0.65 0.61 0.62 0.65 0.59 SE
0.047 0.044 0.049 0.047 0.045 0.049 0.047 0.045 0.049 p Value 0.010
9.5E-5 0.016 0.012 7.1E-4 0.026 0.012 7.1E-4 0.058 nCohort
Recovered 86 71 96 85 69 94 85 69 92 nCohort Non-recovered 63 78 52
64 80 54 64 80 56 Cutoff Quartile 2 1.89 1.89 1.93 1.89 1.89 1.93
1.89 1.89 1.93 Sensitivity 81% 81% 83% 81% 79% 83% 81% 79% 82%
Specificity 29% 31% 29% 29% 29% 30% 29% 29% 29% Cutoff Quartile 3
4.13 4.13 4.52 4.13 4.13 4.52 4.13 4.13 4.52 Sensitivity 62% 64%
63% 61% 62% 61% 61% 62% 59% Specificity 58% 65% 57% 58% 64% 56% 58%
64% 55% Cutoff Quartile 4 20.0 20.0 20.2 20.0 20.0 20.2 20.0 20.0
20.2 Sensitivity 33% 36% 33% 33% 35% 31% 33% 35% 30% Specificity
80% 86% 79% 80% 86% 79% 80% 86% 78% OR Quartile 2 1.74 1.89 1.97
1.81 1.51 2.12 1.81 1.51 1.91 p Value 0.16 0.100 0.12 0.14 0.28
0.080 0.14 0.28 0.12 Lower limit of 95% CI 0.797 0.886 0.847 0.826
0.717 0.915 0.826 0.717 0.843 Upper limit of 95% CI 3.81 4.01 4.57
3.95 3.19 4.92 3.95 3.19 4.33 OR Quartile 3 2.26 3.29 2.33 2.12
2.93 2.03 2.12 2.93 1.78 p Value 0.016 5.2E-4 0.017 0.026 0.0016
0.042 0.026 0.0016 0.091 Lower limit of 95% CI 1.16 1.68 1.16 1.10
1.50 1.03 1.10 1.50 0.911 Upper limit of 95% CI 4.39 6.43 4.67 4.11
5.72 4.02 4.11 5.72 3.50 OR Quartile 4 2.03 3.42 1.85 1.95 3.18
1.70 1.95 3.18 1.57 p Value 0.063 0.0031 0.11 0.078 0.0053 0.17
0.078 0.0053 0.24 Lower limit of 95% CI 0.963 1.51 0.863 0.928 1.41
0.797 0.928 1.41 0.738 Upper limit of 95% CI 4.28 7.70 3.95 4.11
7.16 3.63 4.11 7.16 3.34
Example 7. Use of Insulin-Like Growth Factor-Binding Protein 2 for
Evaluating Renal Status in Patients Admitted to the ICU: Recovery
to RIFLE 0 and R from RIFLE I and F
[0133] Patients from the intensive care unit (ICU) with RIFLE stage
of injury (I) or failure (F) are enrolled in the following study.
EDTA anti-coagulated blood samples (10 mL) and urine samples (50
mL) are collected from each patient at enrollment, and at every 12
hours up to day 3, and then every 24 hours thereafter up to day 7
while the subject is hospitalized. Insulin-like growth
factor-binding protein 2 is measured in the enrollment samples by
standard immunoassay methods using commercially available assay
reagents.
[0134] Kidney status is assessed by RIFLE criteria based on serum
creatinine, urine output, or both serum creatinine and urine output
during a period starting at 12, 24, 48, or 72 hours after sample
collection or at any time within 7 days after sample collection.
Two cohorts are defined to represent a "recovered" and a
"non-recovered" population. "Recovered" indicates those patients
whose maximum RIFLE stage during a period of 24, 48 or 72 hours is
non-injury (RIFLE 0) or risk of injury (R). "Non-recovered"
indicates those patients whose maximum RIFLE stage during a period
of 24, 48 or 72 hours is injury (I) or failure (F). If a patient
dies or is placed on renal replacement therapy (RRT) at any time
from sample collection to 12, 24, 48, or 72 hours after sample
collection or at any time within 7 days after sample collection,
the patient is considered "non-recovered".
[0135] The ability to distinguish the "recovered" and
"non-recovered" cohorts is determined using receiver operating
characteristic (ROC) analysis.
TABLE-US-00015 TABLE 7.1 Comparison of marker levels and the area
under the ROC curve (AUC) in urine samples for the "recovered" and
"non-recovered" cohorts where recovery starts at 12 hours after
sample collection and renal status is assessed by serum creatinine
(sCr) only, urine output (UO) only, or serum creatinine or urine
output RIFLE criteria. Recovery Period Duration (hr) 24 48 72
Recovered Non-recovered Recovered Non-recovered Recovered
Non-recovered Cohort Cohort Cohort Cohort Cohort Cohort sCr or UO
Median 2.52 6.86 2.52 6.73 2.44 6.67 Average 6.75 20.1 6.91 19.8
7.01 19.6 Stdev 13.8 28.4 14.1 28.2 14.3 28.2 p (t-test) 0.0068
0.010 0.013 Min 3.16E-5 0.0532 3.16E-5 0.0532 3.16E-5 0.0532 Max
78.7 112 78.7 112 78.7 112 n (Patient) 37 112 35 114 34 115 sCr
only Median 2.79 7.04 2.79 7.04 2.68 7.04 Average 7.47 21.3 7.47
21.3 7.55 21.1 Stdev 13.4 29.5 13.4 29.5 13.5 29.4 p (t-test)
0.0022 0.0022 0.0028 Min 3.16E-5 0.0532 3.16E-5 0.0532 3.16E-5
0.0532 Max 78.7 112 78.7 112 78.7 112 n (Patient) 49 100 49 100 48
101 UO only Median 3.47 7.04 3.16 6.98 3.15 7.04 Average 14.2 21.4
14.6 20.1 13.9 20.8 Stdev 23.7 29.7 24.5 28.5 23.4 29.3 p (t-test)
0.11 0.21 0.11 Min 3.16E-5 0.0645 3.16E-5 0.0645 3.16E-5 0.0645 Max
109 112 109 112 109 112 n (Patient) 94 54 88 60 85 63 Recovery
Period Duration (hr) 24 48 72 sCr or UO sCr only UO only sCr or UO
sCr only UO only sCr or UO sCr only UO only AUC 0.68 0.65 0.62 0.68
0.65 0.62 0.68 0.65 0.63 SE 0.047 0.046 0.049 0.048 0.046 0.047
0.048 0.046 0.047 p Value 1.2E-4 8.0E-4 0.013 2.1E-4 8.0E-4 0.011
1.9E-4 8.0E-4 0.0067 nCohort Recovered 37 49 94 35 49 88 34 48 85
nCohort Non-recovered 112 100 54 114 100 60 115 101 63 Cutoff
Quartile 2 1.89 1.89 1.93 1.89 1.89 1.93 1.89 1.89 1.93 Sensitivity
79% 78% 83% 79% 78% 83% 79% 78% 83% Specificity 38% 31% 30% 37% 31%
31% 38% 31% 31% Cutoff Quartile 3 4.13 4.13 4.52 4.13 4.13 4.52
4.13 4.13 4.52 Sensitivity 58% 58% 63% 58% 58% 63% 57% 57% 63%
Specificity 73% 65% 57% 74% 65% 59% 74% 65% 60% Cutoff Quartile 4
20.0 20.0 20.2 20.0 20.0 20.2 20.0 20.0 20.2 Sensitivity 32% 35%
35% 32% 35% 32% 31% 35% 32% Specificity 95% 94% 81% 94% 94% 80% 94%
94% 80% OR Quartile 2 2.36 1.56 2.12 2.22 1.56 2.21 2.35 1.63 2.08
p Value 0.038 0.25 0.080 0.057 0.25 0.056 0.043 0.21 0.071 Lower
limit of 95% CI 1.05 0.724 0.915 0.976 0.724 0.978 1.03 0.754 0.938
Upper limit of 95% CI 5.28 3.38 4.92 5.03 3.38 5.01 5.36 3.53 4.62
OR Quartile 3 3.73 2.60 2.30 3.97 2.60 2.49 3.74 2.46 2.61 p Value
0.0016 0.0083 0.018 0.0014 0.0083 0.0080 0.0023 0.013 0.0052 Lower
limit of 95% CI 1.65 1.28 1.15 1.71 1.28 1.27 1.60 1.21 1.33 Upper
limit of 95% CI 8.45 5.29 4.56 9.24 5.29 4.90 8.73 5.01 5.11 OR
Quartile 4 8.29 8.26 2.29 7.62 8.26 1.80 7.29 7.95 1.86 p Value
0.0051 8.3E-4 0.032 0.0072 8.3E-4 0.12 0.0086 0.0010 0.11 Lower
limit of 95% CI 1.89 2.39 1.07 1.73 2.39 0.850 1.66 2.31 0.878
Upper limit of 95% CI 36.4 28.5 4.90 33.5 28.5 3.82 32.1 27.4
3.94
TABLE-US-00016 TABLE 7.2 Comparison of marker levels and the area
under the ROC curve (AUC) in urine samples for the "recovered" and
"non-recovered" cohorts where recovery starts at 24 hours after
sample collection and renal status is assessed by serum creatinine
(sCr) only, urine output (UO) only, or serum creatinine or urine
output RIFLE criteria. Recovery Period Duration (hr) 24 48 72
Recovered Non-recovered Recovered Non-recovered Recovered
Non-recovered Cohort Cohort Cohort Cohort Cohort Cohort sCr or UO
Median 2.34 7.81 2.34 7.04 2.34 7.04 Average 6.95 21.9 7.13 21.5
7.13 21.5 Stdev 13.1 29.7 13.3 29.5 13.3 29.5 p (t-test) 8.1E-4
0.0015 0.0015 Min 3.16E-5 0.0532 3.16E-5 0.0532 3.16E-5 0.0532 Max
78.7 112 78.7 112 78.7 112 n (Patient) 51 98 49 100 49 100 sCr only
Median 2.35 10.0 2.34 9.57 2.34 9.57 Average 7.37 22.8 7.44 22.6
7.44 22.6 Stdev 13.6 30.3 13.7 30.2 13.7 30.2 p (t-test) 4.4E-4
5.9E-4 5.9E-4 Min 3.16E-5 0.0532 3.16E-5 0.0532 3.16E-5 0.0532 Max
78.7 112 78.7 112 78.7 112 n (Patient) 56 91 55 92 55 92 UO only
Median 3.49 6.86 3.47 6.93 3.47 6.93 Average 13.8 22.0 13.2 22.2
13.2 22.2 Stdev 22.3 30.8 21.3 31.1 21.3 31.1 p (t-test) 0.072
0.043 0.043 Min 3.16E-5 0.0645 3.16E-5 0.0645 3.16E-5 0.0645 Max
109 112 109 112 109 112 n (Patient) 94 50 89 55 89 55 Recovery
Period Duration (hr) 24 48 72 sCr or UO sCr only UO only sCr or UO
sCr only UO only sCr or UO sCr only UO only AUC 0.70 0.70 0.61 0.69
0.70 0.61 0.69 0.70 0.61 SE 0.043 0.043 0.050 0.044 0.043 0.049
0.044 0.043 0.049 p Value 4.7E-6 5.3E-6 0.034 1.4E-5 5.3E-6 0.027
1.4E-5 5.3E-6 0.027 nCohort Recovered 51 56 94 49 55 89 49 55 89
nCohort Non-recovered 98 91 50 100 92 55 100 92 55 Cutoff Quartile
2 1.89 1.91 1.93 1.89 1.91 1.93 1.89 1.91 1.93 Sensitivity 81% 79%
82% 80% 79% 80% 80% 79% 80% Specificity 35% 32% 29% 35% 33% 28% 35%
33% 28% Cutoff Quartile 3 4.13 4.13 4.99 4.13 4.13 4.99 4.13 4.13
4.99 Sensitivity 61% 63% 58% 60% 62% 58% 60% 62% 58% Specificity
71% 70% 54% 69% 69% 55% 69% 69% 55% Cutoff Quartile 4 20.0 20.5
20.2 20.0 20.5 20.2 20.0 20.5 20.2 Sensitivity 36% 36% 36% 35% 36%
35% 35% 36% 35% Specificity 94% 93% 81% 94% 93% 81% 94% 93% 81% OR
Quartile 2 2.27 1.80 1.84 2.12 1.87 1.56 2.12 1.87 1.56 p Value
0.035 0.13 0.16 0.054 0.11 0.28 0.054 0.11 0.28 Lower limit of 95%
CI 1.06 0.844 0.786 0.988 0.877 0.698 0.988 0.877 0.698 Upper limit
of 95% CI 4.86 3.82 4.29 4.57 3.98 3.50 4.57 3.98 3.50 OR Quartile
3 3.79 3.85 1.64 3.40 3.64 1.70 3.40 3.64 1.70 p Value 3.3E-4
2.0E-4 0.16 9.8E-4 3.6E-4 0.12 9.8E-4 3.6E-4 0.12 Lower limit of
95% CI 1.83 1.89 0.819 1.64 1.79 0.864 1.64 1.79 0.864 Upper limit
of 95% CI 7.84 7.83 3.27 7.04 7.41 3.36 7.04 7.41 3.36 OR Quartile
4 8.89 7.40 2.38 8.26 7.13 2.24 8.26 7.13 2.24 p Value 5.4E-4
3.8E-4 0.028 8.3E-4 4.8E-4 0.040 8.3E-4 4.8E-4 0.040 Lower limit of
95% CI 2.58 2.45 1.10 2.39 2.37 1.04 2.39 2.37 1.04 Upper limit of
95% CI 30.6 22.3 5.14 28.5 21.5 4.81 28.5 21.5 4.81
TABLE-US-00017 TABLE 7.3 Comparison of marker levels and the area
under the ROC curve (AUC) in urine samples for the "recovered" and
"non-recovered" cohorts where recovery starts at 48 hours after
sample collection and renal status is assessed by serum creatinine
(sCr) only, urine output (UO) only, or serum creatinine or urine
output RIFLE criteria. Recovery Period Duration (hr) 24 48 72
Recovered Non-recovered Recovered Non-recovered Recovered
Non-recovered Cohort Cohort Cohort Cohort Cohort Cohort sCr or UO
Median 2.56 7.04 2.56 7.04 2.52 7.04 Average 9.30 22.6 9.30 22.6
9.21 22.3 Stdev 14.6 31.5 14.6 31.5 14.8 31.1 p (t-test) 0.0023
0.0023 0.0028 Min 3.16E-5 0.0532 3.16E-5 0.0532 3.16E-5 0.0532 Max
78.7 112 78.7 112 78.7 112 n (Patient) 63 83 63 83 61 85 sCr only
Median 2.65 8.16 2.65 8.16 2.61 8.58 Average 9.56 23.3 9.56 23.3
9.45 23.2 Stdev 14.9 32.0 14.9 32.0 15.0 31.8 p (t-test) 0.0016
0.0016 0.0016 Min 3.16E-5 0.0532 3.16E-5 0.0532 3.16E-5 0.0532 Max
78.7 112 78.7 112 78.7 112 n (Patient) 67 78 67 78 66 79 UO only
Median 3.49 7.39 3.49 7.39 3.47 7.04 Average 14.9 22.7 14.9 22.7
15.2 21.7 Stdev 24.2 30.7 24.2 30.7 24.6 30.1 p (t-test) 0.11 0.11
0.19 Min 3.16E-5 0.0645 3.16E-5 0.0645 3.16E-5 0.0645 Max 109 112
109 112 109 112 n (Patient) 80 48 80 48 77 51 Recovery Period
Duration (hr) 24 48 72 sCr or UO sCr only UO only sCr or UO sCr
only UO only sCr or UO sCr only UO only AUC 0.64 0.65 0.62 0.64
0.65 0.62 0.65 0.65 0.61 SE 0.045 0.045 0.052 0.045 0.045 0.052
0.045 0.045 0.052 p Value 0.0016 0.0010 0.025 0.0016 0.0010 0.025
7.2E-4 5.7E-4 0.031 nCohort Recovered 63 67 80 63 67 80 61 66 77
nCohort Non-recovered 83 78 48 83 78 48 85 79 51 Cutoff Quartile 2
1.90 1.89 1.89 1.90 1.89 1.89 1.90 1.89 1.89 Sensitivity 77% 79%
81% 77% 79% 81% 78% 80% 82% Specificity 29% 30% 29% 29% 30% 29% 30%
30% 30% Cutoff Quartile 3 4.11 4.13 5.38 4.11 4.13 5.38 4.11 4.13
5.38 Sensitivity 59% 60% 60% 59% 60% 60% 60% 61% 61% Specificity
62% 61% 56% 62% 61% 56% 64% 62% 57% Cutoff Quartile 4 19.7 20.0
22.3 19.7 20.0 22.3 19.7 20.0 22.3 Sensitivity 35% 36% 33% 35% 36%
33% 34% 35% 31% Specificity 87% 87% 80% 87% 87% 80% 87% 86% 79% OR
Quartile 2 1.35 1.65 1.75 1.35 1.65 1.75 1.45 1.71 1.99 p Value
0.44 0.20 0.21 0.44 0.20 0.21 0.33 0.17 0.12 Lower limit of 95% CI
0.637 0.772 0.731 0.637 0.772 0.731 0.687 0.801 0.833 Upper limit
of 95% CI 2.85 3.52 4.18 2.85 3.52 4.18 3.08 3.66 4.74 OR Quartile
3 2.34 2.39 1.96 2.34 2.39 1.96 2.66 2.54 2.07 p Value 0.013 0.011
0.069 0.013 0.011 0.069 0.0048 0.0066 0.048 Lower limit of 95% CI
1.20 1.23 0.948 1.20 1.23 0.948 1.35 1.30 1.01 Upper limit of 95%
CI 4.58 4.67 4.06 4.58 4.67 4.06 5.24 4.97 4.25 OR Quartile 4 3.69
3.61 2.00 3.69 3.61 2.00 3.43 3.48 1.74 p Value 0.0032 0.0028 0.095
0.0032 0.0028 0.095 0.0054 0.0037 0.18 Lower limit of 95% CI 1.55
1.56 0.887 1.55 1.56 0.887 1.44 1.50 0.777 Upper limit of 95% CI
8.80 8.37 4.51 8.80 8.37 4.51 8.17 8.06 3.91
TABLE-US-00018 TABLE 7.4 Comparison of marker levels and the area
under the ROC curve (AUC) in urine samples for the "recovered" and
"non-recovered" cohorts where recovery starts at 72 hours after
sample collection and renal status is assessed by serum creatinine
(sCr) only, urine output (UO) only, or serum creatinine or urine
output RIFLE criteria. Recovery Period Duration (hr) 24 48 72
Recovered Non-recovered Recovered Non-recovered Recovered
Non-recovered Cohort Cohort Cohort Cohort Cohort Cohort sCr or UO
Median 2.79 10.3 2.65 10.0 2.61 10.2 Average 9.37 25.1 9.50 24.1
9.44 23.6 Stdev 15.1 32.8 15.4 32.2 15.7 31.7 p (t-test) 3.4E-4
9.0E-4 0.0014 Min 3.16E-5 0.0532 3.16E-5 0.0532 3.16E-5 0.0532 Max
78.7 112 78.7 112 78.7 112 n (Patient) 71 71 67 75 64 78 sCr only
Median 2.79 10.3 2.72 10.8 2.65 11.3 Average 9.77 25.1 9.67 25.0
9.54 24.9 Stdev 15.5 33.0 15.6 32.8 15.7 32.6 p (t-test) 4.8E-4
4.8E-4 4.6E-4 Min 3.16E-5 0.0532 3.16E-5 0.0532 3.16E-5 0.0532 Max
78.7 112 78.7 112 78.7 112 n (Patient) 73 69 72 70 71 71 UO only
Median 3.49 8.58 3.49 7.04 3.51 7.04 Average 15.9 22.3 15.6 21.9
15.9 21.3 Stdev 26.3 29.6 25.6 30.0 25.8 29.5 p (t-test) 0.22 0.22
0.29 Min 3.16E-5 0.0645 3.16E-5 0.0645 3.16E-5 0.0645 Max 109 112
109 112 109 112 n (Patient) 74 45 68 51 67 53 Recovery Period
Duration (hr) 24 48 72 sCr or UO sCr only UO only sCr or UO sCr
only UO only sCr or UO sCr only UO only AUC 0.67 0.67 0.64 0.67
0.67 0.63 0.67 0.68 0.62 SE 0.045 0.045 0.053 0.045 0.045 0.052
0.045 0.045 0.052 p Value 2.1E-4 2.7E-4 0.011 1.9E-4 1.5E-4 0.014
1.7E-4 7.0E-5 0.027 nCohort Recovered 71 73 74 67 72 68 64 71 67
nCohort Non-recovered 71 69 45 75 70 51 78 71 53 Cutoff Quartile 2
1.90 1.90 1.88 1.90 1.90 1.88 1.90 1.90 1.89 Sensitivity 77% 78%
82% 79% 79% 84% 78% 79% 83% Specificity 28% 29% 30% 30% 29% 32% 30%
30% 31% Cutoff Quartile 3 4.99 4.99 5.74 4.99 4.99 5.74 4.99 4.99
6.06 Sensitivity 65% 65% 64% 64% 66% 63% 64% 66% 60% Specificity
65% 64% 58% 66% 65% 59% 67% 66% 58% Cutoff Quartile 4 20.7 20.7
22.6 20.7 20.7 22.6 20.7 20.7 22.3 Sensitivity 38% 38% 33% 36% 37%
31% 35% 37% 30% Specificity 87% 86% 80% 87% 86% 79% 86% 86% 79% OR
Quartile 2 1.35 1.45 1.96 1.57 1.51 2.57 1.52 1.57 2.23 p Value
0.44 0.34 0.15 0.25 0.29 0.042 0.28 0.25 0.075 Lower limit of 95%
CI 0.631 0.677 0.786 0.733 0.703 1.03 0.709 0.730 0.922 Upper limit
of 95% CI 2.88 3.12 4.87 3.36 3.24 6.38 3.24 3.37 5.40 OR Quartile
3 3.39 3.39 2.51 3.40 3.60 2.41 3.66 3.84 2.12 p Value 5.2E-4
5.2E-4 0.018 5.1E-4 2.8E-4 0.021 2.7E-4 1.5E-4 0.044 Lower limit of
95% CI 1.70 1.70 1.17 1.71 1.80 1.14 1.82 1.91 1.02 Upper limit of
95% CI 6.74 6.75 5.40 6.78 7.20 5.07 7.34 7.69 4.42 OR Quartile 4
4.23 3.81 1.97 3.62 3.66 1.76 3.24 3.52 1.64 p Value 8.6E-4 0.0015
0.11 0.0028 0.0020 0.18 0.0065 0.0028 0.25 Lower limit of 95% CI
1.81 1.67 0.849 1.56 1.60 0.766 1.39 1.54 0.713 Upper limit of 95%
CI 9.87 8.70 4.55 8.45 8.36 4.06 7.53 8.04 3.76
TABLE-US-00019 TABLE 7.5 Comparison of marker levels and the area
under the ROC curve (AUC) in urine samples for the "recovered" and
"non-recovered" cohorts where recovery starts within 7 days after
sample collection and renal status is assessed by serum creatinine
(sCr) only, urine output (UO) only, or serum creatinine or urine
output RIFLE criteria. Recovery Period Duration (hr) 24 48 72
Recovered Non-recovered Recovered Non-recovered Recovered
Non-recovered Cohort Cohort Cohort Cohort Cohort Cohort sCr or UO
Median 3.03 8.85 3.09 8.58 3.15 8.16 Average 13.3 22.6 13.4 22.2
13.5 21.9 Stdev 22.6 30.6 22.7 30.4 22.8 30.3 p (t-test) 0.035
0.044 0.055 Min 3.16E-5 0.0645 3.16E-5 0.0645 3.16E-5 0.0645 Max
109 112 109 112 109 112 n (Patient) 93 56 92 57 91 58 sCr only
Median 2.91 9.73 2.91 9.73 2.91 9.73 Average 9.79 25.5 9.79 25.5
9.79 25.5 Stdev 15.0 33.7 15.0 33.7 15.0 33.7 p (t-test) 2.0E-4
2.0E-4 2.0E-4 Min 3.16E-5 0.0532 3.16E-5 0.0532 3.16E-5 0.0532 Max
78.7 112 78.7 112 78.7 112 n (Patient) 83 66 83 66 83 66 UO only
Median 3.32 9.46 3.32 9.46 3.47 8.16 Average 14.6 21.7 14.6 21.7
14.8 20.9 Stdev 24.7 28.8 24.7 28.8 24.9 28.5 p (t-test) 0.12 0.12
0.18 Min 3.16E-5 0.0645 3.16E-5 0.0645 3.16E-5 0.0645 Max 109 112
109 112 109 112 n (Patient) 100 48 100 48 98 50 Recovery Period
Duration (hr) 24 48 72 sCr or UO sCr only UO only sCr or UO sCr
only UO only sCr or UO sCr only UO only AUC 0.64 0.66 0.64 0.64
0.66 0.64 0.64 0.66 0.63 SE 0.048 0.045 0.050 0.048 0.045 0.050
0.047 0.045 0.050 p Value 0.0024 5.1E-4 0.0057 0.0034 5.1E-4 0.0057
0.0044 5.1E-4 0.010 nCohort Recovered 93 83 100 92 83 100 91 83 98
nCohort Non-recovered 56 66 48 57 66 48 58 66 50 Cutoff Quartile 2
1.89 1.89 1.93 1.89 1.89 1.93 1.89 1.89 1.93 Sensitivity 82% 80%
81% 82% 80% 81% 83% 80% 82% Specificity 29% 29% 28% 29% 29% 28% 30%
29% 29% Cutoff Quartile 3 4.13 4.13 4.52 4.13 4.13 4.52 4.13 4.13
4.52 Sensitivity 64% 64% 67% 63% 64% 67% 62% 64% 64% Specificity
58% 60% 58% 58% 60% 58% 57% 60% 57% Cutoff Quartile 4 20.0 20.0
20.2 20.0 20.0 20.2 20.0 20.0 20.2 Sensitivity 36% 38% 35% 35% 38%
35% 34% 38% 34% Specificity 81% 84% 80% 80% 84% 80% 80% 84% 80% OR
Quartile 2 1.88 1.66 1.69 1.95 1.66 1.69 2.02 1.66 1.82 p Value
0.13 0.20 0.23 0.11 0.20 0.23 0.090 0.20 0.16 Lower limit of 95% CI
0.831 0.768 0.723 0.863 0.768 0.723 0.895 0.768 0.783 Upper limit
of 95% CI 4.26 3.58 3.93 4.42 3.58 3.93 4.58 3.58 4.24 OR Quartile
3 2.49 2.65 2.76 2.33 2.65 2.76 2.18 2.65 2.37 p Value 0.0089
0.0042 0.0057 0.015 0.0042 0.0057 0.023 0.0042 0.016 Lower limit of
95% CI 1.26 1.36 1.34 1.18 1.36 1.34 1.11 1.36 1.17 Upper limit of
95% CI 4.94 5.17 5.67 4.59 5.17 5.67 4.28 5.17 4.79 OR Quartile 4
2.31 3.28 2.19 2.22 3.28 2.19 2.13 3.28 2.01 p Value 0.028 0.0026
0.045 0.037 0.0026 0.045 0.047 0.0026 0.073 Lower limit of 95% CI
1.09 1.52 1.02 1.05 1.52 1.02 1.01 1.52 0.936 Upper limit of 95% CI
4.90 7.11 4.73 4.70 7.11 4.73 4.51 7.11 4.31
Example 8. Use of Insulin-Like Growth Factor-Binding Protein 3 for
Evaluating Renal Status in Patients Admitted to the ICU: Recovery
to RIFLE 0 from RIFLE I and F
[0136] Patients from the intensive care unit (ICU) with RIFLE stage
of injury (I) or failure (F) are enrolled in the following study.
EDTA anti-coagulated blood samples (10 mL) and urine samples (50
mL) are collected from each patient at enrollment, and at every 12
hours up to day 3, and then every 24 hours thereafter up to day 7
while the subject is hospitalized. Insulin-like growth
factor-binding protein 3 is measured in the enrollment samples by
standard immunoassay methods using commercially available assay
reagents.
[0137] Kidney status is assessed by RIFLE criteria based on serum
creatinine, urine output, or both serum creatinine and urine output
during a period starting at 12, 24, 48, or 72 hours after sample
collection or at any time within 7 days after sample collection.
Two cohorts are defined to represent a "recovered" and a
"non-recovered" population. "Recovered" indicates those patients
whose maximum RIFLE stage during a period of 24, 48 or 72 hours is
non-injury (RIFLE 0). "Non-recovered" indicates those patients
whose maximum RIFLE stage during a period of 24, 48 or 72 hours is
risk of injury (R), injury (I) or failure (F). If a patient dies or
is placed on renal replacement therapy (RRT) at any time from
sample collection to 12, 24, 48, or 72 hours after sample
collection or at any time within 7 days after sample collection,
the patient is considered "non-recovered".
[0138] The ability to distinguish the "recovered" and
"non-recovered" cohorts is determined using receiver operating
characteristic (ROC) analysis.
TABLE-US-00020 TABLE 8.1 Comparison of marker levels and the area
under the ROC curve (AUC) in urine samples for the "recovered" and
"non-recovered" cohorts where recovery starts at 12 hours after
sample collection and renal status is assessed by serum creatinine
(sCr) only, urine output (UO) only, or serum creatinine or urine
output RIFLE criteria. Recovery Period Duration (hr) 24 48 72
Recovered Non-recovered Recovered Non-recovered Recovered
Non-recovered Cohort Cohort Cohort Cohort Cohort Cohort sCr or UO
Median 375 822 316 824 316 824 Average 662 2930 486 2930 486 2930
Stdev 763 5170 555 5160 555 5160 p (t-test) 0.17 0.16 0.16 Min 30.5
20.6 30.5 20.6 30.5 20.6 Max 2240 18800 1890 18800 1890 18800 n
(Patient) 10 139 9 140 9 140 sCr only Median 463 828 457 826 457
826 Average 1470 3020 1510 3000 1510 3000 Stdev 3810 5200 3900 5180
3900 5180 p (t-test) 0.18 0.20 0.20 Min 30.5 20.6 30.5 20.6 305
20.6 Max 18800 18800 18800 18800 18800 18800 n (Patient) 23 126 22
127 22 127 UO only Median 615 1010 569 1000 567 1010 Average 2050
3570 1900 3540 1640 3680 Stdev 4200 5720 3920 5740 3380 5880 p
(t-test) 0.066 0.049 0.014 Min 20.6 172 20.6 172 20.6 172 Max 18800
18800 18800 18800 18800 18800 n (Patient) 75 73 67 81 64 84
Recovery Period Duration (hr) 24 48 72 sCr or UO sCr only UO only
sCr or UO sCr only UO only sCr or UO sCr only UO only AUC 0.70 0.63
0.65 0.76 0.63 0.66 0.76 0.63 0.68 SE 0.074 0.059 0.045 0.068 0.060
0.044 0.068 0.060 0.043 p Value 0.0063 0.027 9.2E-4 1.4E-4 0.033
2.6E-4 1.4E-4 0.033 3.9E-5 nCohort Recovered 10 23 75 9 22 67 9 22
64 nCohort Non-recovered 139 126 73 140 127 81 140 127 84 Cutoff
Quartile 2 401 401 410 401 401 410 401 401 410 Sensitivity 77% 76%
85% 77% 76% 85% 77% 76% 86% Specificity 50% 30% 35% 56% 32% 37% 56%
32% 39% Cutoff Quartile 3 794 794 801 794 794 801 794 794 801
Sensitivity 53% 54% 63% 53% 54% 60% 53% 54% 61% Specificity 80% 70%
63% 89% 68% 63% 89% 68% 64% Cutoff Quartile 4 1830 1830 1840 1830
1830 1840 1830 1830 1840 Sensitivity 26% 28% 27% 26% 28% 28% 26%
28% 30% Specificity 80% 87% 77% 89% 86% 79% 89% 86% 81% OR Quartile
2 3.34 1.40 2.99 4.22 1.51 3.42 4.22 1.51 3.85 p Value 0.069 0.50
0.0072 0.040 0.41 0.0022 0.040 0.41 8.4E-4 Lower limit of 95% CI
0.910 0.526 1.35 1.07 0.563 1.56 1.07 0.563 1.74 Upper limit of 95%
CI 12.3 3.72 6.64 16.6 4.05 7.53 16.6 4.05 8.48 OR Quartile 3 4.42
2.68 2.86 8.97 2.47 2.57 8.97 2.47 2.75 p Value 0.066 0.043 0.0020
0.041 0.066 0.0054 0.041 0.066 0.0031 Lower limit of 95% CI 0.907
1.03 1.47 1.09 0.943 1.32 1.09 0.943 1.41 Upper limit of 95% CI
21.6 6.96 5.57 73.6 6.47 5.01 73.6 6.47 5.40 OR Quartile 4 1.40
2.56 1.29 2.87 2.41 1.50 2.87 2.41 1.84 p Value 0.68 0.15 0.51 0.33
0.18 0.30 0.33 0.18 0.13 Lower limit of 95% CI 0.284 0.717 0.610
0.348 0.671 0.701 0.348 0.671 0.839 Upper limit of 95% CI 6.89 9.17
2.72 23.8 8.65 3.22 23.8 8.65 4.02
TABLE-US-00021 TABLE 8.2 Comparison of marker levels and the area
under the ROC curve (AUC) in urine samples for the "recovered" and
"non-recovered" cohorts where recovery starts at 24 hours after
sample collection and renal status is assessed by serum creatinine
(sCr) only, urine output (UO) only, or serum creatinine or urine
output RIFLE criteria. Recovery Period Duration (hr) 24 48 72
Recovered Non-recovered Recovered Non-recovered Recovered
Non-recovered Cohort Cohort Cohort Cohort Cohort Cohort sCr or UO
Median 416 907 321 907 316 911 Average 578 3250 494 3180 467 3160
Stdev 545 5420 454 5350 448 5330 p (t-test) 0.013 0.020 0.022 Min
30.5 20.6 30.5 20.6 30.5 20.6 Max 2240 18800 1890 18800 1890 18800
n (Patient) 26 123 22 127 21 128 sCr only Median 463 911 451 904
442 907 Average 1200 3320 1230 3270 1240 3250 Stdev 3100 5440 3190
5410 3240 5390 p (t-test) 0.030 0.041 0.046 Min 30.5 20.6 30.5 20.6
30.5 20.6 Max 18800 18800 18800 18800 18800 18800 n (Patient) 35
112 33 114 32 115 UO only Median 626 1070 611 1060 569 1070 Average
2110 3710 1770 3850 1610 3920 Stdev 4330 5830 3610 6070 3440 6040 p
(t-test) 0.062 0.014 0.0061 Min 20.6 172 20.6 172 20.6 172 Max
18800 18800 18800 18800 18800 18800 n (Patient) 81 63 72 72 69 75
Recovery Period Duration (hr) 24 48 72 sCr or UO sCr only UO only
sCr or UO sCr only UO only sCr or UO sCr only UO only AUC 0.73 0.66
0.66 0.77 0.66 0.68 0.78 0.66 0.70 SE 0.048 0.049 0.046 0.047 0.051
0.045 0.045 0.051 0.043 p Value 1.2E-6 0.0013 4.9E-4 1.3E-8 0.0022
7.0E-5 4.8E-10 0.0013 4.8E-6 nCohort Recovered 26 35 81 22 33 72 21
32 69 nCohort Non-recovered 123 112 63 127 114 72 128 115 75 Cutoff
Quartile 2 401 407 399 401 407 399 401 407 399 Sensitivity 80% 78%
89% 80% 78% 89% 80% 78% 89% Specificity 46% 34% 36% 55% 36% 39% 57%
38% 41% Cutoff Quartile 3 794 808 812 794 808 812 794 808 812
Sensitivity 56% 57% 65% 56% 56% 64% 56% 57% 65% Specificity 77% 71%
62% 82% 70% 64% 86% 72% 67% Cutoff Quartile 4 1830 1850 1840 1830
1850 1840 1830 1850 1840 Sensitivity 29% 30% 29% 29% 30% 29% 29%
30% 31% Specificity 92% 91% 78% 95% 91% 79% 95% 91% 81% OR Quartile
2 3.36 1.82 4.46 4.90 2.03 5.09 5.49 2.16 5.72 p Value 0.0074 0.16
0.0012 0.0010 0.096 2.6E-4 5.7E-4 0.073 9.7E-5 Lower limit of 95%
CI 1.38 0.794 1.80 1.90 0.881 2.12 2.09 0.931 2.38 Upper limit of
95% CI 8.16 4.15 11.1 12.6 4.70 12.2 14.5 5.01 13.7 OR Quartile 3
4.26 3.33 3.01 5.71 2.94 3.13 7.71 3.32 3.77 p Value 0.0037 0.0042
0.0016 0.0027 0.011 0.0010 0.0016 0.0059 1.7E-4 Lower limit of 95%
CI 1.60 1.46 1.52 1.83 1.28 1.59 2.16 1.41 1.89 Upper limit of 95%
CI 11.3 7.59 5.96 17.8 6.75 6.18 27.5 7.81 7.52 OR Quartile 4 4.97
4.65 1.40 8.63 4.25 1.56 8.13 4.06 1.91 p Value 0.036 0.016 0.38
0.039 0.024 0.25 0.045 0.029 0.10 Lower limit of 95% CI 1.11 1.33
0.657 1.12 1.21 0.730 1.05 1.16 0.875 Upper limit of 95% CI 22.1
16.2 2.98 66.5 14.9 3.35 62.8 14.2 4.15
TABLE-US-00022 TABLE 8.3 Comparison of marker levels and the area
under the ROC curve (AUC) in urine samples for the "recovered" and
"non-recovered" cohorts where recovery starts at 48 hours after
sample collection and renal status is assessed by serum creatinine
(sCr) only, urine output (UO) only, or serum creatinine or urine
output RIFLE criteria. Recovery Period Duration (hr) 24 48 72
Recovered Non-recovered Recovered Non-recovered Recovered
Non-recovered Cohort Cohort Cohort Cohort Cohort Cohort sCr or UO
Median 451 942 442 962 434 942 Average 863 3470 528 3500 525 3430
Stdev 2000 5620 333 5620 324 5570 p (t-test) 0.0065 0.0025 0.0044
Min 30.5 20.6 30.5 20.6 88.7 20.6 Max 12500 18800 1430 18800 1430
18800 n (Patient) 37 109 34 112 31 115 sCr only Median 540 911 512
929 512 929 Average 1330 3500 1070 3560 1070 3560 Stdev 3220 5620
2800 5640 2800 5640 p (t-test) 0.017 0.0067 0.0067 Min 30.5 20.6
30.5 20.6 30.5 20.6 Max 18800 18800 18800 18800 18800 18800 n
(Patient) 45 100 43 102 43 102 UO only Median 685 1120 637 1120 766
1000 Average 2180 4160 2060 4160 2230 3800 Stdev 4250 6280 4170
6190 4380 5970 p (t-test) 0.036 0.025 0.099 Min 20.6 172 20.6 172
20.6 30.5 Max 18800 18800 18800 18800 18800 18800 n (Patient) 70 58
66 62 59 69 Recovery Period Duration (hr) 24 48 72 sCr or UO sCr
only UO only sCr or UO sCr only UO only sCr or UO sCr only UO only
AUC 0.71 0.65 0.66 0.74 0.67 0.67 0.73 0.67 0.63 SE 0.045 0.047
0.049 0.044 0.047 0.048 0.046 0.047 0.049 p Value 2.5E-6 0.0018
8.6E-4 1.0E-7 3.0E-4 2.6E-4 3.5E-7 3.0E-4 0.0056 nCohort Recovered
37 45 70 34 43 66 31 43 59 nCohort Non-recovered 109 100 58 112 102
62 115 102 69 Cutoff Quartile 2 404 401 414 404 401 414 404 401 414
Sensitivity 80% 78% 90% 79% 78% 89% 79% 78% 87% Specificity 41% 31%
37% 41% 33% 38% 42% 33% 39% Cutoff Quartile 3 790 794 878 790 794
878 790 794 878 Sensitivity 58% 56% 62% 58% 57% 61% 57% 57% 57%
Specificity 73% 62% 60% 76% 65% 61% 77% 65% 58% Cutoff Quartile 4
1770 1790 2020 1770 1790 2020 1770 1790 2020 Sensitivity 33% 34%
31% 33% 34% 32% 32% 34% 29% Specificity 97% 93% 80% 100% 95% 82%
100% 95% 80% OR Quartile 2 2.70 1.60 5.12 2.71 1.76 4.79 2.74 1.76
4.26 p Value 0.016 0.24 0.0010 0.018 0.16 9.7E-4 0.019 0.16 0.0012
Lower limit of 95% CI 1.20 0.728 1.93 1.19 0.794 1.89 1.18 0.794
1.78 Upper limit of 95% CI 6.04 3.52 13.6 6.17 3.88 12.1 6.36 3.88
10.2 OR Quartile 3 3.70 2.10 2.45 4.49 2.46 2.44 4.62 2.46 1.77 p
Value 0.0018 0.044 0.014 7.8E-4 0.017 0.014 0.0011 0.017 0.11 Lower
limit of 95% CI 1.63 1.02 1.20 1.87 1.17 1.20 1.84 1.17 0.876 Upper
limit of 95% CI 8.39 4.31 5.01 10.8 5.15 4.96 11.6 5.15 3.57 OR
Quartile 4 17.8 7.21 1.80 34.3 10.7 2.14 30.1 10.7 1.60 p Value
0.0054 0.0018 0.15 0.014 0.0017 0.069 0.018 0.0017 0.26 Lower limit
of 95% CI 2.34 2.08 0.803 2.04 2.45 0.942 1.79 2.45 0.704 Upper
limit of 95% CI 135 25.0 4.04 575 46.9 4.87 505 46.9 3.63
TABLE-US-00023 TABLE 8.4 Comparison of marker levels and the area
under the ROC curve (AUC) in urine samples for the "recovered" and
"non-recovered" cohorts where recovery starts at 72 hours after
sample collection and renal status is assessed by serum creatinine
(sCr) only, urine output (UO) only, or serum creatinine or urine
output RIFLE criteria. Recovery Period Duration (hr) 24 48 72
Recovered Non-recovered Recovered Non-recovered Recovered
Non-recovered Cohort Cohort Cohort Cohort Cohort Cohort sCr or UO
Median 463 1070 427 1050 427 1050 Average 963 3710 967 3580 980
3530 Stdev 2490 5740 2640 5630 2710 5590 p (t-test) 0.0030 0.0068
0.0097 Min 21.1 20.6 21.1 20.6 88.7 20.6 Max 16600 18800 16600
18800 16600 18800 n (Patient) 43 99 38 104 36 106 sCr only Median
526 1060 526 1060 526 1060 Average 1330 3720 1330 3720 1360 3660
Stdev 3420 5700 3420 5700 3480 5660 p (t-test) 0.0075 0.0075 0.011
Min 21.1 20.6 21.1 20.6 30.5 20.6 Max 18800 18800 18800 18800 18800
18800 n (Patient) 50 92 50 92 48 94 UO only Median 747 1070 776
1040 797 992 Average 2530 4040 2760 3660 2890 3500 Stdev 4770 6130
5070 5830 5220 5670 p (t-test) 0.14 0.37 0.55 Min 20.6 172 20.6
30.5 20.6 21.1 Max 18800 18800 18800 18800 18800 18800 n (Patient)
62 57 54 65 50 70 Recovery Period Duration (hr) 24 48 72 sCr or UO
sCr only UO only sCr or UO sCr only UO only sCr or UO sCr only UO
only AUC 0.72 0.68 0.63 0.73 0.68 0.61 0.72 0.68 0.58 SE 0.044
0.045 0.051 0.044 0.045 0.051 0.045 0.046 0.052 p Value 5.5E-7
5.0E-5 0.0092 2.8E-7 5.0E-5 0.030 6.4E-7 1.1E-4 0.13 nCohort
Recovered 43 50 62 38 50 54 36 48 50 nCohort Non-recovered 99 92 57
104 92 65 106 94 70 Cutoff Quartile 2 397 397 419 397 397 419 397
397 420 Sensitivity 81% 80% 84% 81% 80% 83% 80% 80% 81% Specificity
40% 36% 34% 42% 36% 35% 42% 35% 34% Cutoff Quartile 3 812 812 901
812 812 901 812 812 904 Sensitivity 62% 61% 60% 61% 61% 57% 60% 61%
54% Specificity 77% 70% 58% 79% 70% 57% 81% 71% 56% Cutoff Quartile
4 1870 1870 2240 1870 1870 2240 1870 1870 2240 Sensitivity 34% 36%
28% 34% 36% 28% 33% 35% 27% Specificity 95% 94% 77% 97% 94% 78% 97%
94% 78% OR Quartile 2 2.75 2.31 2.73 3.05 2.31 2.66 2.89 2.16 2.26
p Value 0.012 0.034 0.026 0.0067 0.034 0.025 0.011 0.051 0.057
Lower limit of 95% CI 1.25 1.07 1.13 1.36 1.07 1.13 1.28 0.996
0.975 Upper limit of 95% CI 6.07 5.01 6.62 6.85 5.01 6.27 6.54 4.71
5.23 OR Quartile 3 5.30 3.63 2.05 5.76 3.63 1.78 6.31 3.74 1.51 p
Value 6.1E-5 5.9E-4 0.055 8.5E-5 5.9E-4 0.12 7.6E-5 5.4E-4 0.27
Lower limit of 95% CI 2.34 1.74 0.985 2.41 1.74 0.859 2.53 1.77
0.728 Upper limit of 95% CI 12.0 7.57 4.25 13.8 7.57 3.69 15.7 7.90
3.14 OR Quartile 4 10.7 8.76 1.34 18.8 8.76 1.34 17.3 8.11 1.32 p
Value 0.0017 6.2E-4 0.49 0.0046 6.2E-4 0.49 0.0059 9.6E-4 0.52
Lower limit of 95% CI 2.44 2.53 0.584 2.47 2.53 0.578 2.27 2.34
0.564 Upper limit of 95% CI 47.0 30.4 3.07 143 30.4 3.11 131 28.1
3.10
TABLE-US-00024 TABLE 8.5 Comparison of marker levels and the area
under the ROC curve (AUC) in urine samples for the "recovered" and
"non-recovered" cohorts where recovery starts within 7 days after
sample collection and renal status is assessed by serum creatinine
(sCr) only, urine output (UO) only, or serum creatinine or urine
output RIFLE criteria. Recovery Period Duration (hr) 24 48 72
Recovered Non-recovered Recovered Non-recovered Recovered
Non-recovered Cohort Cohort Cohort Cohort Cohort Cohort sCr or UO
Median 747 942 729 1000 729 1000 Average 2110 3690 2130 3660 2130
3660 Stdev 4460 5630 4480 5600 4480 5600 p (t-test) 0.058 0.066
0.066 Min 20.6 166 20.6 166 20.6 166 Max 18800 18800 18800 18800
18800 18800 n (Patient) 86 63 85 64 85 64 sCr only Median 569 1070
583 1070 583 1070 Average 1430 4010 1470 3920 1470 3920 Stdev 3400
5910 3450 5860 3450 5860 p (t-test) 0.0015 0.0027 0.0027 Min 21.1
20.6 21.1 20.6 21.1 20.6 Max 18800 18800 18800 18800 18800 18800 n
(Patient) 71 78 69 80 69 80 UO only Median 747 1030 747 1030 682
1030 Average 2200 3910 2230 3790 2210 3760 Stdev 4320 6050 4360
5970 4400 5870 p (t-test) 0.048 0.069 0.070 Min 20.6 175 20.6 172
20.6 172 Max 18800 18800 18800 18800 18800 18800 n (Patient) 96 52
94 54 92 56 Recovery Period Duration (hr) 24 48 72 sCr or UO sCr
only UO only sCr or UO sCr only UO only sCr or UO sCr only UO only
AUC 0.62 0.69 0.63 0.62 0.67 0.62 0.62 0.67 0.63 SE 0.047 0.043
0.049 0.047 0.044 0.049 0.047 0.044 0.048 p Value 0.013 8.5E-6
0.011 0.010 1.2E-4 0.018 0.010 1.2E-4 0.0090 nCohort Recovered 86
71 96 85 69 94 85 69 92 nCohort Non-recovered 63 78 52 64 80 54 64
80 56 Cutoff Quartile 2 401 401 410 401 401 410 401 401 410
Sensitivity 84% 85% 88% 84% 82% 87% 84% 82% 88% Specificity 31% 35%
32% 32% 33% 32% 32% 33% 33% Cutoff Quartile 3 794 794 801 794 794
801 794 794 801 Sensitivity 56% 62% 60% 56% 60% 59% 56% 60% 61%
Specificity 53% 62% 55% 54% 61% 55% 54% 61% 57% Cutoff Quartile 4
1830 1830 1840 1830 1830 1840 1830 1830 1840 Sensitivity 33% 40%
29% 33% 39% 28% 33% 39% 29% Specificity 80% 90% 77% 80% 90% 77% 80%
90% 77% OR Quartile 2 2.43 2.99 3.66 2.51 2.36 3.15 2.51 2.36 3.39
p Value 0.033 0.0062 0.0076 0.027 0.028 0.013 0.027 0.028 0.0082
Lower limit of 95% CI 1.07 1.36 1.41 1.11 1.10 1.27 1.11 1.10 1.37
Upper limit of 95% CI 5.48 6.55 9.48 5.68 5.06 7.78 5.68 5.06 8.36
OR Quartile 3 1.44 2.61 1.82 1.52 2.33 1.80 1.52 2.33 2.01 p Value
0.28 0.0045 0.087 0.21 0.012 0.089 0.21 0.012 0.043 Lower limit of
95% CI 0.748 1.35 0.918 0.790 1.21 0.914 0.790 1.21 1.02 Upper
limit of 95% CI 2.76 5.05 3.61 2.91 4.51 3.55 2.91 4.51 3.95 OR
Quartile 4 2.03 6.03 1.36 1.95 5.60 1.26 1.95 5.60 1.35 p Value
0.063 9.5E-5 0.43 0.078 1.8E-4 0.55 0.078 1.8E-4 0.43 Lower limit
of 95% CI 0.963 2.45 0.634 0.928 2.27 0.587 0.928 2.27 0.634 Upper
limit of 95% CI 4.28 14.9 2.93 4.11 13.8 2.70 4.11 13.8 2.88
Example 9. Use of Insulin-Like Growth Factor-Binding Protein 3 for
Evaluating Renal Status in Patients Admitted to the ICU: Recovery
to RIFLE 0 and R from RIFLE I and F
[0139] Patients from the intensive care unit (ICU) with RIFLE stage
of injury (I) or failure (F) are enrolled in the following study.
EDTA anti-coagulated blood samples (10 mL) and urine samples (50
mL) are collected from each patient at enrollment, and at every 12
hours up to day 3, and then every 24 hours thereafter up to day 7
while the subject is hospitalized. Insulin-like growth
factor-binding protein 3 is measured in the enrollment samples by
standard immunoassay methods using commercially available assay
reagents.
[0140] Kidney status is assessed by RIFLE criteria based on serum
creatinine, urine output, or both serum creatinine and urine output
during a period starting at 12, 24, 48, or 72 hours after sample
collection or at any time within 7 days after sample collection.
Two cohorts are defined to represent a "recovered" and a
"non-recovered" population. "Recovered" indicates those patients
whose maximum RIFLE stage during a period of 24, 48 or 72 hours is
non-injury (RIFLE 0) or risk of injury (R). "Non-recovered"
indicates those patients whose maximum RIFLE stage during a period
of 24, 48 or 72 hours is injury (I) or failure (F). If a patient
dies or is placed on renal replacement therapy (RRT) at any time
from sample collection to 12, 24, 48, or 72 hours after sample
collection or at any time within 7 days after sample collection,
the patient is considered "non-recovered".
[0141] The ability to distinguish the "recovered" and
"non-recovered" cohorts is determined using receiver operating
characteristic (ROC) analysis.
TABLE-US-00025 TABLE 9.1 Comparison of marker levels and the area
under the ROC curve (AUC) in urine samples for the "recovered" and
"non-recovered" cohorts where recovery starts at 12 hours after
sample collection and renal status is assessed by serum creatinine
(sCr) only, urine output (UO) only, or scrum creatinine or urine
output RIFLE criteria. Recovery Period Duration (hr) 24 48 72
Recovered Non-recovered Recovered Non-recovered Recovered
Non-recovered Cohort Cohort Cohort Cohort Cohort Cohort sCr or UO
Median 553 904 463 904 448 901 Average 1110 3330 1110 3300 1120
3270 Stdev 2570 5510 2640 5470 2680 5450 p (t-test) 0.019 0.024
0.028 Min 30.5 20.6 30.5 20.6 30.5 20.6 Max 15900 18800 15900 18800
15900 18800 n (Patient) 37 112 35 114 34 115 sCr only Median 601
920 601 920 592 916 Average 1400 3460 1400 3460 1410 3440 Stdev
3380 5560 3380 5560 3410 5540 p (t-test) 0.018 0.018 0.021 Min 30.5
20.6 30.5 20.6 30.5 20.6 Max 18800 18800 18800 18800 18800 18800 n
(Patient) 49 100 49 100 48 101 UO only Median 637 1130 630 1120 626
1070 Average 2300 3660 2380 3410 2230 3570 Stdev 4630 5640 4770
5400 4510 5630 p (t-test) 0.11 0.23 0.11 Min 20.6 172 20.6 172 20.6
172 Max 18800 18800 18800 18800 18800 18800 n (Patient) 94 54 88 60
85 63 Recovery Period Duration (hr) 24 48 72 sCr or UO sCr only UO
only sCr or UO sCr only UO only sCr or UO sCr only UO only AUC 0.65
0.63 0.66 0.66 0.63 0.66 0.66 0.63 0.67 SE 0.049 0.047 0.048 0.049
0.047 0.046 0.049 0.047 0.046 p Value 0.0022 0.0050 0.0012 0.0012
0.0050 7.3E-4 9.1E-4 0.0044 2.9E-4 nCohort Recovered 37 49 94 35 49
88 34 48 85 nCohort Non-recovered 112 100 54 114 100 60 115 101 63
Cutoff Quartile 2 401 401 410 401 401 410 401 401 410 Sensitivity
79% 77% 89% 79% 77% 90% 79% 77% 90% Specificity 35% 29% 33% 37% 29%
35% 38% 29% 36% Cutoff Quartile 3 794 794 801 794 794 801 794 794
801 Sensitivity 54% 56% 65% 54% 56% 63% 55% 56% 63% Specificity 62%
61% 59% 63% 61% 59% 65% 62% 60% Cutoff Quartile 4 1830 1830 1840
1830 1830 1840 1830 1830 1840 Sensitivity 30% 33% 31% 30% 33% 30%
30% 33% 30% Specificity 89% 90% 79% 89% 90% 78% 88% 90% 79% OR
Quartile 2 1.99 1.34 3.94 2.22 1.34 4.89 2.35 1.40 5.45 p Value
0.098 0.46 0.0048 0.057 0.46 0.0011 0.043 0.40 4.7E-4 Lower limit
of 95% CI 0.882 0.617 1.52 0.976 0.617 1.89 1.03 0.642 2.11 Upper
limit of 95% CI 4.47 2.91 10.2 5.03 2.91 12.7 5.36 3.04 14.1 OR
Quartile 3 1.96 2.01 2.60 2.02 2.01 2.49 2.22 2.16 2.61 p Value
0.082 0.050 0.0069 0.077 0.050 0.0080 0.049 0.032 0.0052 Lower
limit of 95% CI 0.918 1.00 1.30 0.926 1.00 1.27 1.00 1.07 1.33
Upper limit of 95% CI 4.21 4.04 5.20 4.39 4.04 4.90 4.91 4.37 5.11
OR Quartile 4 3.60 4.33 1.70 3.29 4.33 1.56 3.15 4.17 1.61 p Value
0.024 0.0046 0.17 0.036 0.0046 0.25 0.044 0.0058 0.21 Lower limit
of 95% CI 1.18 1.57 0.797 1.08 1.57 0.735 1.03 1.51 0.760 Upper
limit of 95% CI 10.9 12.0 3.63 10.1 12.0 3.30 9.62 11.5 3.40
TABLE-US-00026 TABLE 9.2 Comparison of marker levels and the area
under the ROC curve (AUC) in urine samples for the "recovered" and
"non-recovered" cohorts where recovery starts at 24 hours after
sample collection and renal status is assessed by serum creatinine
(sCr) only, urine output (UO) only, or serum creatinine or urine
output RIFLE criteria. Recovery Period Duration (hr) 24 48 72
Recovered Non-recovered Recovered Non-recovered Recovered
Non-recovered Cohort Cohort Cohort Cohort Cohort Cohort sCr or UO
Median 553 992 540 992 540 992 Average 1290 3560 1290 3520 1290
3520 Stdev 3110 5650 3170 5600 3170 5600 p (t-test) 0.0083 0.011
0.011 Min 30.5 20.6 30.5 20.6 30.5 20.6 Max 16600 18800 16600 18800
16600 18800 n (Patient) 51 98 49 100 49 100 sCr only Median 576
1070 569 1020 569 1020 Average 1570 3580 1590 3550 1590 3550 Stdev
3770 5590 3810 5570 3810 5570 p (t-test) 0.019 0.022 0.022 Min 30.5
20.6 30.5 20.6 30.5 20.6 Max 18800 18800 18800 18800 18800 18800 n
(Patient) 56 91 55 92 55 92 UO only Median 672 1190 640 1180 640
1180 Average 2280 3800 2160 3870 2160 3870 Stdev 4600 5810 4380
5950 4380 5950 p (t-test) 0.088 0.049 0.049 Min 20.6 172 20.6 172
20.6 172 Max 18800 18800 18800 18800 18800 18800 n (Patient) 94 50
89 55 89 55 Recovery Period Duration (hr) 24 48 72 sCr or UO sCr
only UO only sCr or UO sCr only UO only sCr or UO sCr only UO only
AUC 0.67 0.65 0.66 0.68 0.65 0.67 0.68 0.65 0.67 SE 0.045 0.045
0.049 0.044 0.045 0.047 0.044 0.045 0.047 p Value 1.1E-4 8.6E-4
8.9E-4 3.3E-5 7.7E-4 2.7E-4 3.3E-5 7.7E-4 2.7E-4 nCohort Recovered
51 56 94 49 55 89 49 55 89 nCohort Non-recovered 98 91 50 100 92 55
100 92 55 Cutoff Quartile 2 401 407 399 401 407 399 401 407 399
Sensitivity 81% 79% 90% 81% 79% 91% 81% 79% 91% Specificity 35% 32%
33% 37% 33% 35% 37% 33% 35% Cutoff Quartile 3 794 808 812 794 808
812 794 808 812 Sensitivity 59% 59% 68% 60% 60% 67% 60% 60% 67%
Specificity 67% 64% 60% 69% 65% 61% 69% 65% 61% Cutoff Quartile 4
1830 1850 1840 1830 1850 1840 1830 1850 1840 Sensitivity 34% 34%
32% 33% 34% 31% 33% 34% 31% Specificity 90% 89% 79% 90% 89% 79% 90%
89% 79% OR Quartile 2 2.27 1.80 4.43 2.48 1.87 5.34 2.48 1.87 5.34
p Value 0.035 0.13 0.0042 0.020 0.11 0.0012 0.020 0.11 0.0012 Lower
limit of 95% CI 1.06 0.844 1.60 1.15 0.877 1.93 1.15 0.877 1.93
Upper limit of 95% CI 4.86 3.82 12.3 5.33 3.98 14.8 5.33 3.98 14.8
OR Quartile 3 2.90 2.63 3.13 3.40 2.82 3.17 3.40 2.82 3.17 p Value
0.0032 0.0060 0.0020 9.8E-4 0.0035 0.0013 9.8E-4 0.0035 0.0013
Lower limit of 95% CI 1.43 1.32 1.52 1.64 1.41 1.57 1.64 1.41 1.57
Upper limit of 95% CI 5.89 5.23 6.45 7.04 5.64 6.42 7.04 5.64 6.42
OR Quartile 4 4.67 4.31 1.74 4.33 4.15 1.65 4.33 4.15 1.65 p Value
0.0029 0.0026 0.16 0.0046 0.0034 0.20 0.0046 0.0034 0.20 Lower
limit of 95% CI 1.70 1.66 0.804 1.57 1.60 0.768 1.57 1.60 0.768
Upper limit of 95% CI 12.9 11.1 3.77 12.0 10.7 3.54 12.0 10.7
3.54
TABLE-US-00027 TABLE 9.3 Comparison of marker levels and the area
under the ROC curve (AUC) in urine samples for the "recovered" and
"non-recovered" cohorts where recovery starts at 48 hours after
sample collection and renal status is assessed by serum creatinine
(sCr) only, urine output (UO) only, or serum creatinine or urine
output RIFLE criteria. Recovery Period Duration (hr) 24 48 72
Recovered Non-recovered Recovered Non-recovered Recovered
Non-recovered Cohort Cohort Cohort Cohort Cohort Cohort sCr or UO
Median 569 1070 569 1070 569 1070 Average 1430 3860 1430 3860 1270
3920 Stdev 3210 5940 3210 5940 2920 5960 p (t-test) 0.0039 0.0039
0.0017 Min 21.1 20.6 21.1 20.6 21.1 20.6 Max 16600 18800 16600
18800 16600 18800 n (Patient) 63 83 63 83 61 85 sCr only Median 601
1020 601 1020 592 1070 Average 1680 3810 1680 3810 1520 3920 Stdev
3760 5850 3760 5850 3540 5900 p (t-test) 0.012 0.012 0.0044 Min
21.1 20.6 21.1 20.6 21.1 20.6 Max 18800 18800 18800 18800 18800
18800 n (Patient) 67 78 67 78 66 79 UO only Median 722 1200 722
1200 766 1070 Average 2260 4430 2260 4430 2340 4190 Stdev 4410 6420
4410 6420 4480 6300 p (t-test) 0.026 0.026 0.054 Min 20.6 194 20.6
194 20.6 172 Max 18800 18800 18800 18800 18800 18800 n (Patient) 80
48 80 48 77 51 Recovery Period Duration (hr) 24 48 72 sCr or UO sCr
only UO only sCr or UO sCr only UO only sCr or UO sCr only UO only
AUC 0.68 0.65 0.67 0.68 0.65 0.67 0.68 0.66 0.64 SE 0.044 0.045
0.051 0.044 0.045 0.051 0.044 0.045 0.051 p Value 4.2E-5 6.6E-4
9.0E-4 4.2E-5 6.6E-4 9.0E-4 3.0E-5 2.2E-4 0.0076 nCohort Recovered
63 67 80 63 67 80 61 66 77 nCohort Non-recovered 83 78 48 83 78 48
85 79 51 Cutoff Quartile 2 404 401 414 404 401 414 404 401 414
Sensitivity 82% 81% 92% 82% 81% 92% 81% 81% 88% Specificity 35% 31%
35% 35% 31% 35% 34% 32% 34% Cutoff Quartile 3 790 794 878 790 794
878 790 794 878 Sensitivity 61% 60% 65% 61% 60% 65% 61% 61% 61%
Specificity 65% 61% 59% 65% 61% 59% 66% 62% 57% Cutoff Quartile 4
1770 1790 2020 1770 1790 2020 1770 1790 2020 Sensitivity 36% 37%
31% 36% 37% 31% 36% 38% 29% Specificity 89% 88% 79% 89% 88% 79% 90%
89% 78% OR Quartile 2 2.43 1.92 5.92 2.43 1.92 5.92 2.26 1.99 3.82
p Value 0.022 0.095 0.0019 0.022 0.095 0.0019 0.035 0.077 0.0070
Lower limit of 95% CI 1.14 0.893 1.93 1.14 0.893 1.93 1.06 0.927
1.44 Upper limit of 95% CI 5.21 4.12 18.2 5.21 4.12 18.2 4.83 4.28
10.1 OR Quartile 3 2.97 2.39 2.60 2.97 2.39 2.60 3.00 2.54 2.07 p
Value 0.0017 0.011 0.012 0.0017 0.011 0.012 0.0017 0.0066 0.048
Lower limit of 95% CI 1.50 1.23 1.24 1.50 1.23 1.24 1.51 1.30 1.01
Upper limit of 95% CI 5.87 4.67 5.45 5.87 4.67 5.45 5.95 4.97 4.25
OR Quartile 4 4.53 4.36 1.68 4.53 4.36 1.68 5.26 5.16 1.47 p Value
0.0011 9.0E-4 0.21 0.0011 9.0E-4 0.21 6.2E-4 3.8E-4 0.35 Lower
limit of 95% CI 1.83 1.83 0.748 1.83 1.83 0.748 2.03 2.09 0.656
Upper limit of 95% CI 11.2 10.4 3.79 11.2 10.4 3.79 13.6 12.8
3.30
TABLE-US-00028 TABLE 9.4 Comparison of marker levels and the area
under the ROC curve (AUC) in urine samples for the "recovered" and
"non-recovered" cohorts where recovery starts at 72 hours after
sample collection and renal status is assessed by serum creatinine
(sCr) only, urine output (UO) only, or serum creatinine or urine
output RIFLE criteria. Recovery Period Duration (hr) 24 48 72
Recovered Non-recovered Recovered Non-recovered Recovered
Non-recovered Cohort Cohort Cohort Cohort Cohort Cohort sCr or UO
Median 583 1250 583 1220 573 1240 Average 1360 4400 1230 4360 1220
4240 Stdev 3030 6260 2790 6210 2850 6120 p (t-test) 3.3E-4 2.2E-4
4.0E-4 Min 21.1 20.6 21.1 20.6 21.1 20.6 Max 16600 18800 16600
18800 16600 18800 n (Patient) 71 71 67 75 64 78 sCr only Median 601
1180 592 1210 583 1250 Average 1600 4230 1450 4350 1440 4320 Stdev
3620 6100 3400 6140 3420 6100 p (t-test) 0.0020 6.3E-4 6.9E-4 Min
21.1 20.6 21.1 20.6 21.1 20.6 Max 18800 18800 18800 18800 18800
18800 n (Patient) 73 69 72 70 71 71 UO only Median 776 1180 797
1070 808 1070 Average 2680 4200 2600 4120 2650 4000 Stdev 4940 6240
4730 6310 4760 6220 p (t-test) 0.14 0.14 0.18 Min 20.6 194 20.6 172
20.6 169 Max 18800 18800 18800 18800 18800 18800 n (Patient) 74 45
68 51 67 53 Recovery Period Duration (hr) 24 48 72 sCr or UO sCr
only UO only sCr or UO sCr only UO only sCr or UO sCr only UO only
AUC 0.71 0.69 0.64 0.70 0.70 0.61 0.70 0.71 0.60 SE 0.043 0.045
0.053 0.043 0.044 0.053 0.043 0.043 0.052 p Value 1.7E-6 2.4E-5
0.0087 3.3E-6 5.7E-6 0.033 2.1E-6 1.9E-6 0.064 nCohort Recovered 71
73 74 67 72 68 64 71 67 nCohort Non-recovered 71 69 45 75 70 51 78
71 53 Cutoff Quartile 2 397 397 419 397 397 419 397 397 420
Sensitivity 85% 84% 89% 83% 84% 84% 82% 85% 83% Specificity 35% 34%
34% 34% 35% 32% 34% 35% 31% Cutoff Quartile 3 812 812 901 812 812
901 812 812 904 Sensitivity 65% 64% 62% 64% 64% 59% 64% 65% 58%
Specificity 65% 63% 57% 66% 64% 56% 67% 65% 57% Cutoff Quartile 4
1870 1870 220 1870 1870 2240 1870 1870 2240 Sensitivity 39% 39% 29%
39% 40% 27% 38% 41% 26% Specificity 89% 88% 77% 90% 89% 76% 91% 90%
76% OR Quartile 2 2.96 2.75 4.08 2.49 2.85 2.57 2.39 2.96 2.23 p
Value 0.0083 0.014 0.0085 0.022 0.011 0.042 0.027 0.0083 0.075
Lower limit of 95% CI 1.32 1.23 1.43 1.14 1.27 1.03 1.10 1.32 0.922
Upper limit of 95% CI 6.64 6.15 11.6 5.45 6.39 6.38 5.20 6.64 5.40
OR Quartile 3 3.39 3.00 2.16 3.40 3.18 1.81 3.66 3.39 1.85 p Value
5.2E-4 0.0016 0.046 5.1E-4 9.3E-4 0.11 2.7E-4 5.2E-4 0.099 Lower
limit of 95% CI 1.70 1.51 1.01 1.71 1.60 0.868 1.82 1.70 0.890
Upper limit of 95% CI 6.74 5.94 4.61 6.78 6.32 3.77 7.34 6.74 3.83
OR Quartile 4 5.13 4.57 1.36 5.40 5.33 1.23 6.04 6.31 1.14 p Value
2.6E-4 4.5E-4 0.47 2.8E-4 1.8E-4 0.63 2.3E-4 7.6E-5 0.75 Lower
limit of 95% CI 2.14 1.96 0.587 2.17 2.22 0.535 2.32 2.53 0.499
Upper limit of 95% CI 12.3 10.7 3.16 13.4 12.8 2.83 15.7 15.7
2.62
TABLE-US-00029 TABLE 9.5 Comparison of marker levels and the area
under the ROC curve (AUC) in urine samples for the "recovered" and
"non-recovered" cohorts where recovery starts within 7 days after
sample collection and renal status is assessed by serum creatinine
(sCr) only, urine output (UO) only, or serum creatinine or urine
output RIFLE criteria. Recovery Period Duration (hr) 24 48 72
Recovered Non-recovered Recovered Non-recovered Recovered
Non-recovered Cohort Cohort Cohort Cohort Cohort Cohort sCr or UO
Median 642 1070 686 1070 642 1070 Average 2060 3980 2080 3920 2090
3870 Stdev 4310 5890 4330 5860 4360 5820 p (t-test) 0.023 0.030
0.035 Min 20.6 166 20.6 166 20.6 166 Max 18800 18800 18800 18800
18800 18800 n (Patient) 93 56 92 57 91 58 sCr only Median 622 1070
622 1070 622 1070 Average 1480 4420 1480 4420 1480 4420 Stdev 3210
6310 3210 6310 3210 6310 p (t-test) 3.1E-4 3.1E-4 3.1E-4 Min 21.1
20.6 21.1 20.6 21.1 20.6 Max 18800 18800 18800 18800 18800 18800 n
(Patient) 83 66 83 66 83 66 UO only Median 747 1070 747 1070 747
1070 Average 2140 4170 2140 4170 2170 4040 Stdev 4250 6230 4250
6230 4280 6140 p (t-test) 0.021 0.021 0.033 Min 20.6 175 20.6 175
20.6 172 Max 18800 18800 18800 18800 18800 18800 n (Patient) 100 48
100 48 98 50 Recovery Period Duration (hr) 24 48 72 sCr or UO sCr
only UO only sCr or UO sCr only UO only sCr or UO sCr only UO only
AUC 0.64 0.68 0.63 0.62 0.68 0.63 0.63 0.68 0.62 SE 0.048 0.045
0.050 0.048 0.045 0.050 0.048 0.045 0.050 p Value 0.0045 8.8E-5
0.0077 0.011 8.8E-5 0.0077 0.0080 8.8E-5 0.014 nCohort Recovered 93
83 100 92 83 100 91 83 98 nCohort Non-recovered 56 66 48 57 66 48
58 66 50 Cutoff Quartile 2 401 401 410 401 401 410 401 401 410
Sensitivity 86% 85% 88% 84% 85% 88% 84% 85% 86% Specificity 31% 33%
31% 30% 33% 31% 31% 33% 31% Cutoff Quartile 3 794 794 801 794 794
801 794 794 801 Sensitivity 59% 62% 60% 58% 62% 60% 59% 62% 60%
Specificity 55% 59% 55% 54% 59% 55% 55% 59% 55% Cutoff Quartile 4
1830 1830 1840 1830 1830 1840 1830 1830 1840 Sensitivity 34% 38%
31% 33% 38% 31% 33% 38% 30% Specificity 80% 84% 78% 79% 84% 78% 79%
84% 78% OR Quartile 2 2.72 2.70 3.14 2.33 2.70 3.14 2.42 2.70 2.71
p Value 0.024 0.017 0.019 0.048 0.017 0.019 0.039 0.017 0.031 Lower
limit of 95% CI 1.14 1.20 1.21 1.01 1.20 1.21 1.05 1.20 1.09 Upper
limit of 95% CI 6.47 6.10 8.17 5.40 6.10 8.17 5.60 6.10 6.71 OR
Quartile 3 1.74 2.36 1.87 1.64 2.36 1.87 1.73 2.36 1.84 p Value
0.10 0.011 0.081 0.15 0.011 0.081 0.11 0.011 0.084 Lower limit of
95% CI 0.891 1.22 0.926 0.840 1.22 0.926 0.888 1.22 0.922 Upper
limit of 95% CI 3.41 4.58 3.76 3.19 4.58 3.76 3.36 4.58 3.68 OR
Quartile 4 2.00 3.28 1.61 1.92 3.28 1.61 1.85 3.2 1.48 p Value
0.069 0.0026 0.23 0.087 0.0026 0.23 0.11 0.0026 0.32 Lower limit of
95% CI 0.946 1.52 0.744 0.910 1.52 0.744 0.876 1.52 0.686 Upper
limit of 95% CI 4.23 7.11 3.49 4.05 7.11 3.49 3.89 7.11 3.19
Example 10. Use of Insulin-Like Growth Factor-Binding Protein 4 for
Evaluating Renal Status in Patients Admitted to the ICU: Recovery
to RIFLE 0 from RIFLE I and F
[0142] Patients from the intensive care unit (ICU) with RIFLE stage
of injury (I) or failure (F) arc enrolled in the following study.
EDTA anti-coagulated blood samples (10 mL) and urine samples (50
mL) are collected from each patient at enrollment, and at every 12
hours up to day 3, and then every 24 hours thereafter up to day 7
while the subject is hospitalized. Insulin-like growth
factor-binding protein 4 is measured in the enrollment samples by
standard immunoassay methods using commercially available assay
reagents.
[0143] Kidney status is assessed by RIFLE criteria based on serum
creatinine, urine output, or both serum creatinine and urine output
during a period starting at 12, 24, 48, or 72 hours after sample
collection or at any time within 7 days after sample collection.
Two cohorts are defined to represent a "recovered" and a
"non-recovered" population. "Recovered" indicates those patients
whose maximum RIFLE stage during a period of 24, 48 or 72 hours is
non-injury (RIFLE 0). "Non-recovered" indicates those patients
whose maximum RIFLE stage during a period of 24, 48 or 72 hours is
risk of injury (R), injury (I) or failure (F). If a patient dies or
is placed on renal replacement therapy (RRT) at any time from
sample collection to 12, 24, 48, or 72 hours after sample
collection or at any time within 7 days after sample collection,
the patient is considered "non-recovered".
[0144] The ability to distinguish the "recovered" and
"non-recovered" cohorts is determined using receiver operating
characteristic (ROC) analysis.
TABLE-US-00030 TABLE 10.1 Comparison of marker levels and the area
under the ROC curve (AUC) in urine samples for the "recovered" and
"non-recovered" cohorts where recovery starts at 12 hours after
sample collection and renal status is assessed by serum creatinine
(sCr) only, urine output (UO) only, or serum creatinine or urine
output RIFLE criteria. Recovery Period Duration (hr) 24 48 72
Recovered Non-recovered Recovered Non-recovered Recovered
Non-recovered Cohort Cohort Cohort Cohort Cohort Cohort sCr or UO
Median 0.000286 0.394 0.000286 0.341 0.000286 0.341 Average 0.236
8.15 0.262 8.09 0.262 8.09 Stdev 0.746 19.5 0.786 19.4 0.786 19.4 p
(t-test) 0.20 0.23 0.23 Min 0.000212 0.000212 0.000212 0.000212
0.000212 0.000212 Max 2.36 120 2.36 120 2.36 120 n (Patient) 10 139
9 140 9 140 sCr only Median 0.000339 0.538 0.000339 0.443 0.000339
0.443 Average 0.740 8.87 0.773 8.80 0.773 8.80 Stdev 2.66 20.3 2.72
20.3 2.72 20.3 p (t-test) 0.058 0.066 0.066 Min 0.000212 0.000212
0.000212 0.000212 0.000212 0.000212 Max 12.7 120 12.7 120 12.7 120
n (Patient) 23 126 22 127 22 127 UO only Median 0.126 0.394 0.165
0.265 0.142 0.330 Average 7.26 8.08 7.17 8.07 4.67 9.95 Stdev 19.8
18.3 19.7 18.5 12.3 22.6 p (t-test) 0.79 0.77 0.094 Min 0.000212
0.000212 0.000212 0.000212 0.000212 0.000212 Max 120 110 120 110
73.0 120 n (Patient) 75 73 67 81 64 84 Recovery Period Duration
(hr) 24 48 72 sCr or UO sCr only UO only sCr or UO sCr only UO only
sCr or UO sCr only UO only AUC 0.86 0.75 0.54 0.87 0.75 0.55 0.87
0.75 0.57 SE 0.045 0.048 0.047 0.042 0.049 0.047 0.042 0.049 0.047
p Value 2.2E-15 1.0E-7 0.35 0 2.7E-7 0.28 0 2.7E-7 0.15 nCohort
Recovered 10 23 75 9 22 67 9 22 64 nCohort Non-recovered 139 126 73
140 127 81 140 127 84 Cutoff Quartile 2 0.000339 0.000339 0.000339
0.000339 0.000339 0.000339 0.000339 0.000339 0.000339 Sensitivity
85% 85% 84% 85% 85% 85% 85% 85% 85% Specificity 70% 39% 20% 78% 41%
22% 78% 41% 22% Cutoff Quartile 3 0.170 0.170 0.205 0.170 0.170
0.205 0.170 0.170 0.205 Sensitivity 53% 55% 52% 53% 54% 51% 53% 54%
51% Specificity 90% 74% 52% 89% 73% 51% 89% 73% 52% Cutoff Quartile
4 2.99 2.99 3.01 2.99 2.99 3.01 2.99 2.99 3.01 Sensitivity 27% 29%
30% 27% 29% 28% 27% 29% 30% Specificity 100% 96% 80% 100% 95% 79%
100% 95% 81% OR Quartile 2 13.1 3.62 1.27 19.8 3.94 1.66 19.8 3.94
1.53 p Value 4.2E-4 0.0093 0.58 3.5E-4 0.0061 0.24 3.5E-4 0.0061
0.32 Lower limit of 95% CI 3.14 1.37 0.549 3.85 1.48 0.716 3.85
1.48 0.662 Upper limit of 95% CI 54.8 9.54 2.94 102 10.5 3.84 102
10.5 3.53 OR Quartile 3 10.2 3.43 1.18 8.97 3.17 1.06 8.97 3.17
1.12 p Value 0.029 0.015 0.62 0.041 0.024 0.87 0.041 0.024 0.74
Lower limit of 95% CI 1.26 1.27 0.617 1.09 1.17 0.553 1.09 1.17
0.582 Upper limit of 95% CI 83.1 9.27 2.24 73.6 8.63 2.02 73.6 8.63
2.14 OR Quartile 4 7.97 9.15 1.73 7.14 8.63 1.50 7.14 8.63 1.84 p
Value 0.16 0.033 0.16 0.18 0.039 0.30 0.18 0.039 0.13 Lower limit
of 95% CI 0.456 1.19 0.811 0.405 1.12 0.701 0.405 1.12 0.839 Upper
limit of 95% CI 139 70.4 3.67 126 66.5 3.22 126 66.5 4.02
TABLE-US-00031 TABLE 10.2 Comparison of marker levels and the area
under the ROC curve (AUC) in urine samples for the "recovered" and
"non-recovered" cohorts where recovery starts at 24 hours after
sample collection and renal status is assessed by serum creatinine
(sCr) only, urine output (UO) only, or serum creatinine or urine
output RIFLE criteria. Recovery Period Duration (hr) 24 48 72
Recovered Non-recovered Recovered Non-recovered Recovered
Non-recovered Cohort Cohort Cohort Cohort Cohort Cohort sCr or UO
Median 0.000457 0.633 0.000391 0.449 0.000339 0.446 Average 0.209
9.18 0.234 8.89 0.224 8.83 Stdev 0.501 20.5 0.542 20.2 0.553 20.2 p
(t-test) 0.028 0.047 0.053 Min 0.000212 0.000212 0.000212 0.000212
0.000212 0.000212 Max 2.36 120 2.36 120 2.36 120 n (Patient) 26 123
22 127 21 128 sCr only Median 0.000471 0.752 0.000471 0.685
0.000471 0.659 Average 0.550 9.94 0.580 9.77 0.584 9.69 Stdev 2.16
21.3 2.23 21.2 2.26 21.1 p (t-test) 0.010 0.014 0.016 Min 0.000212
0.000212 0.000212 0.000212 0.000212 0.000212 Max 12.7 120 12.7 120
12.7 120 n (Patient) 35 112 33 114 32 115 UO only Median 0.118
0.555 0.102 0.422 0.0851 0.449 Average 6.50 9.12 4.74 10.6 3.86
11.1 Stdev 18.9 19.5 13.0 23.4 11.3 23.7 p (t-test) 0.42 0.067
0.022 Min 0.000212 0.000212 0.000212 0.000212 0.000212 0.000212 Max
120 110 73.0 120 73.0 120 n (Patient) 81 63 72 72 69 75 Recovery
Period Duration (hr) 24 48 72 sCr or UO sCr only UO only sCr or UO
sCr only UO only sCr or UO sCr only UO only AUC 0.75 0.74 0.58 0.75
0.73 0.59 0.76 0.74 0.60 SE 0.046 0.044 0.048 0.048 0.045 0.047
0.048 0.044 0.047 p Value 1.1E-7 7.2E-8 0.099 1.7E-7 1.3E-7 0.067
2.6E-8 4.8E-8 0.033 nCohort Recovered 26 35 81 22 33 72 21 32 69
nCohort Non-recovered 123 112 63 127 114 72 128 115 75 Cutoff
Quartile 2 0.000339 0.000339 0.000339 0.000339 0.000339 0.000339
0.000339 0.000339 0.000339 Sensitivity 85% 85% 84% 84% 85% 85% 84%
85% 84% Specificity 35% 29% 21% 36% 30% 22% 38% 31% 22% Cutoff
Quartile 3 0.170 0.170 0.218 0.170 0.170 0.218 0.170 0.170 0.218
Sensitivity 56% 58% 56% 55% 57% 53% 55% 57% 53% Specificity 77% 74%
54% 77% 73% 53% 81% 75% 54% Cutoff Quartile 4 2.99 3.02 3.01 2.99
3.02 3.01 2.99 3.02 3.01 Sensitivity 31% 32% 32% 30% 32% 32% 30%
31% 33% Specificity 100% 97% 80% 100% 97% 82% 100% 97% 84% OR
Quartile 2 2.90 2.24 1.41 3.06 2.48 1.58 3.32 2.62 1.46 p Value
0.027 0.079 0.44 0.027 0.049 0.29 0.019 0.038 0.38 Lower limit of
95% CI 1.13 0.912 0.595 1.13 1.00 0.678 1.22 1.06 0.629 Upper limit
of 95% CI 7.45 5.48 3.33 8.24 6.12 3.70 9.05 6.49 3.38 OR Quartile
3 4.26 4.00 1.49 4.18 3.54 1.25 5.29 4.04 1.32 p Value 0.0037
0.0013 0.24 0.0080 0.0036 0.51 0.0043 0.0019 0.40 Lower limit of
95% CI 1.60 1.71 0.767 1.45 1.51 0.649 1.69 1.67 0.686 Upper limit
of 95% CI 11.3 9.31 2.88 12.0 8.29 2.40 16.6 9.76 2.55 OR Quartile
4 23.9 16.1 1.89 19.4 14.8 2.13 18.3 14.1 2.64 p Value 0.028 0.0072
0.10 0.040 0.0093 0.057 0.044 0.011 0.018 Lower limit of 95% CI
1.42 2.12 0.882 1.14 1.94 0.978 1.08 1.86 1.18 Upper limit of 95%
CI 402 122 4.05 327 112 4.64 310 108 5.89
TABLE-US-00032 TABLE 10.3 Comparison of marker levels and the area
under the ROC curve (AUC) in urine samples for the "recovered" and
"non-recovered" cohorts where recovery starts at 48 hours after
sample collection and renal status is assessed by serum creatinine
(sCr) only, urine output (UO) only, or serum creatinine or urine
output RIFLE criteria. Recovery Period Duration (hr) 24 48 72
Recovered Non-recovered Recovered Non-recovered Recovered
Non-recovered Cohort Cohort Cohort Cohort Cohort Cohort sCr or UO
Median 0.000443 0.710 0.000339 0.685 0.000443 0.633 Average 0.555
10.2 0.201 10.0 0.220 9.78 Stdev 2.20 21.6 0.497 21.3 0.517 21.1 p
(t-test) 0.0076 0.0081 0.013 Min 0.000212 0.000212 0.000212
0.000212 0.000212 0.000212 Max 13.2 120 2.56 120 2.56 120 n
(Patient) 37 109 34 112 31 115 sCr only Median 0.000471 0.866
0.000443 0.866 0.000443 0.866 Average 0.750 11.0 0.467 10.9 0.467
10.9 Stdev 2.70 22.3 1.96 22.1 1.96 22.1 p (t-test) 0.0027 0.0025
0.0025 Min 0.000212 0.000212 0.000212 0.000212 0.000212 0.000212
Max 13.2 120 12.7 120 12.7 120 n (Patient) 45 100 43 102 43 102 UO
only Median 0.341 0.706 0.341 0.706 0.404 0.265 Average 7.43 9.90
6.75 10.5 7.51 9.44 Stdev 19.3 21.1 18.6 21.5 19.6 20.6 p (t-test)
0.49 0.30 0.59 Min 0.000212 0.000212 0.000212 0.000212 0.000212
0.000212 Max 110 120 110 120 110 120 n (Patient) 70 58 66 62 59 69
Recovery Period Duration (hr) 24 48 72 sCr or UO sCr only UO only
sCr or UO sCr only UO only sCr or UO sCr only UO only AUC 0.75 0.76
0.57 0.78 0.78 0.58 0.74 0.78 0.54 SE 0.042 0.040 0.051 0.040 0.038
0.050 0.045 0.038 0.051 p Value 1.9E-9 4.0E-11 0.15 4.8E-12 1.5E-13
0.10 5.4E-8 1.5E-13 0.42 nCohort Recovered 37 45 70 34 43 66 31 43
59 nCohort Non-recovered 109 100 58 112 102 62 115 102 69 Cutoff
Quartile 2 0.000339 0.000339 0.000471 0.000339 0.000339 0.000471
0.000339 0.000339 0.000471 Sensitivity 85% 87% 81% 86% 87% 81% 83%
87% 78% Specificity 30% 31% 29% 32% 33% 29% 26% 33% 27% Cutoff
Quartile 3 0.168 0.165 0.399 0.168 0.165 0.399 0.168 0.165 0.399
Sensitivity 59% 62% 52% 59% 63% 52% 57% 63% 49% Specificity 76% 73%
51% 79% 77% 52% 77% 77% 49% Cutoff Quartile 4 3.04 3.05 4.89 3.04
3.05 4.89 3.04 3.05 4.89 Sensitivity 33% 35% 29% 33% 35% 31% 32%
35% 28% Specificity 97% 96% 79% 100% 98% 80% 100% 98% 78% OR
Quartile 2 2.46 3.02 1.71 2.87 3.31 1.68 1.76 3.31 1.34 p Value
0.046 0.012 0.21 0.021 0.0067 0.22 0.24 0.0067 0.48 Lower limit of
95% CI 1.02 1.28 0.740 1.18 1.39 0.738 0.684 1.39 0.596 Upper limit
of 95% CI 5.94 7.14 3.95 7.00 7.84 3.84 4.51 7.84 3.01 OR Quartile
3 4.42 4.49 1.13 5.53 5.56 1.13 4.62 5.56 0.939 p Value 5.4E-4
1.4E-4 0.72 2.4E-4 3.6E-5 0.72 0.0011 3.6E-5 0.86 Lower limit of
95% CI 1.91 2.07 0.565 2.22 2.46 0.566 1.84 2.46 0.469 Upper limit
of 95% CI 10.3 9.73 2.28 13.8 12.5 2.27 11.6 12.5 1.88 OR Quartile
4 17.8 11.6 1.52 34.3 22.9 1.80 30.1 22.9 1.34 p Value 0.0054
0.0011 0.31 0.014 0.0024 0.16 0.018 0.0024 0.47 Lower limit of 95%
CI 2.34 2.65 0.681 2.04 3.03 0.800 1.79 3.03 0.597 Upper limit of
95% CI 135 50.7 3.40 575 173 4.06 505 173 3.03
TABLE-US-00033 TABLE 10.4 Comparison of marker levels and the area
under the ROC curve (AUC) in urine samples for the "recovered" and
"non-recovered" cohorts where recovery starts at 72 hours after
sample collection and renal status is assessed by serum creatinine
(sCr) only, urine output (UO) only, or serum creatinine or urine
output RIFLE criteria. Recovery Period Duration (hr) 24 48 72
Recovered Non-recovered Recovered Non-recovered Recovered
Non-recovered Cohort Cohort Cohort Cohort Cohort Cohort sCr or UO
Median 0.000471 0.857 0.000471 0.646 0.000471 0.646 Average 1.29
10.9 1.46 10.3 1.52 10.1 Stdev 5.58 22.3 5.93 21.9 6.09 21.7 p
(t-test) 0.0063 0.015 0.020 Min 0.000212 0.000212 0.000212 0.000212
0.000212 0.000212 Max 35.9 120 35.9 120 35.9 120 n (Patient) 43 99
38 104 36 106 sCr only Median 0.000472 0.869 0.000472 0.869
0.000472 0.866 Average 1.38 11.5 1.38 11.5 1.42 11.3 Stdev 5.44
22.9 5.44 22.9 5.55 22.8 p (t-test) 0.0025 0.0025 0.0036 Min
0.000212 0.000212 0.000212 0.000212 0.000212 0.000212 Max 35.9 120
35.9 120 35.9 120 n (Patient) 50 92 50 92 48 94 UO only Median
0.142 0.866 0.399 0.555 0.446 0.330 Average 7.83 10.1 8.92 8.96
9.71 8.45 Stdev 20.4 21.3 21.6 20.1 22.3 19.5 p (t-test) 0.54 0.99
0.74 Min 0.000212 0.000286 0.000212 0.000212 0.000212 0.000212 Max
110 120 110 120 110 120 n (Patient) 62 57 54 65 50 70 Recovery
Period Duration (hr) 24 48 72 sCr or UO sCr only UO only sCr or UO
sCr only UO only sCr or UO sCr only UO only AUC 0.74 0.74 0.59 0.70
0.74 0.54 0.70 0.73 0.52 SE 0.042 0.041 0.052 0.046 0.041 0.053
0.047 0.042 0.054 p Value 9.4E-9 1.1E-8 0.071 9.8E-6 1.1E-8 0.40
1.6E-5 2.3E-8 0.73 nCohort Recovered 43 50 62 38 50 54 36 48 50
nCohort Non-recovered 99 92 57 104 92 65 106 94 70 Cutoff Quartile
2 0.000365 0.000365 0.000471 0.000365 0.000365 0.000471 0.000365
0.000365 0.000471 Sensitivity 83% 83% 82% 81% 83% 80% 80% 82% 79%
Specificity 44% 40% 29% 42% 40% 28% 42% 40% 26% Cutoff Quartile 3
0.205 0.205 0.404 0.205 0.205 0.404 0.205 0.205 0.424 Sensitivity
61% 63% 54% 58% 63% 51% 58% 63% 49% Specificity 74% 74% 53% 71% 74%
50% 72% 75% 48% Cutoff Quartile 4 3.58 3.58 4.63 3.58 3.58 4.63
3.58 3.58 4.89 Sensitivity 34% 36% 32% 33% 36% 28% 32% 35% 26%
Specificity 95% 94% 81% 95% 94% 78% 94% 94% 76% OR Quartile 2 3.82
3.17 1.92 3.05 3.17 1.54 2.89 2.97 1.29 p Value 9.8E-4 0.0038 0.14
0.0067 0.0038 0.32 0.011 0.0064 0.56 Lower limit of 95% CI 1.72
1.45 0.801 1.36 1.45 0.657 1.28 1.36 0.550 Upper limit of 95% CI
8.47 6.92 4.62 6.85 6.92 3.60 6.54 6.48 3.02 OR Quartile 3 4.48
4.86 1.36 3.35 4.86 1.03 3.52 5.06 0.872 p Value 2.2E-4 4.7E-5 0.41
0.0031 4.7E-5 0.93 0.0028 4.2E-5 0.71 Lower limit of 95% CI 2.02
2.27 0.659 1.50 2.27 0.501 1.54 2.33 0.422 Upper limit of 95% CI
9.91 10.4 2.79 7.46 10.4 2.12 8.04 11.0 1.80 OR Quartile 4 10.7
8.76 1.92 8.74 8.76 1.34 8.03 8.11 1.10 p Value 0.0017 6.2E-4 0.13
0.0041 6.2E-4 0.49 0.0059 9.6E-4 0.83 Lower limit of 95% CI 2.44
2.53 0.829 1.99 2.53 0.578 1.82 2.34 0.472 Upper limit of 95% CI
47.0 30.4 4.46 38.5 30.4 3.11 35.4 28.1 2.54
TABLE-US-00034 TABLE 10.5 Comparison of marker levels and the area
under the ROC curve (AUC) in urine samples for the "recovered" and
"non-recovered" cohorts where recovery starts within 7 days after
sample collection and renal status is assessed by serum creatinine
(sCr) only, urine output (UO) only, or serum creatinine or urine
output RIFLE criteria. Recovery Period Duration (hr) 24 48 72
Recovered Non-recovered Recovered Non-recovered Recovered
Non-recovered Cohort Cohort Cohort Cohort Cohort Cohort sCr or UO
Median 0.0328 0.872 0.0328 0.869 0.0328 0.869 Average 6.80 8.72
6.88 8.59 6.88 8.59 Stdev 21.2 15.5 21.3 15.4 21.3 15.4 p (t-test)
0.54 0.59 0.59 Min 0.000212 0.000212 0.000212 0.000212 0.000212
0.000212 Max 120 59.1 120 59.1 120 59.1 n (Patient) 86 63 85 64 85
64 sCr only Median 0.000473 1.17 0.000473 1.13 0.000473 1.13
Average 2.89 11.9 2.97 11.6 2.97 11.6 Stdev 13.8 21.9 13.9 21.7
13.9 21.7 p (t-test) 0.0033 0.0051 0.0051 Min 0.000212 0.000212
0.000212 0.000212 0.000212 0.000212 Max 110 120 110 120 110 120 n
(Patient) 71 78 69 80 69 80 UO only Median 0.0873 0.899 0.104 0.869
0.0873 0.869 Average 7.22 8.48 7.38 8.17 7.44 8.04 Stdev 20.9 14.9
21.1 14.7 21.4 14.4 p (t-test) 0.70 0.81 0.85 Min 0.000212 0.000212
0.000212 0.000212 0.000212 0.000212 Max 120 50.9 120 50.9 120 50.9
n (Patient) 96 52 94 54 92 56 Recovery Period Duration (hr) 24 48
72 sCr or UO sCr only UO only sCr or UO sCr only UO only sCr or UO
sCr only UO only AUC 0.66 0.73 0.60 0.66 0.72 0.59 0.66 0.72 0.60
SE 0.046 0.041 0.050 0.046 0.041 0.049 0.046 0.041 0.049 p Value
4.0E-4 1.6E-8 0.040 6.0E-4 9.2E-8 0.069 6.0E-4 9.2E-8 0.046 nCohort
Recovered 86 71 96 85 69 94 85 69 92 nCohort Non-recovered 63 78 52
64 80 54 64 80 56 Cutoff Quartile 2 0.000339 0.000339 0.000339
0.000339 0.000339 0.000339 0.000339 0.000339 0.000339 Sensitivity
89% 87% 85% 89% 88% 85% 89% 88% 86% Specificity 24% 25% 20% 25% 26%
20% 25% 26% 21% Cutoff Quartile 3 0.170 0.170 0.205 0.170 0.170
0.205 0.170 0.170 0.205 Sensitivity 65% 67% 58% 64% 65% 56% 64% 65%
55% Specificity 60% 68% 54% 60% 67% 53% 60% 67% 53% Cutoff Quartile
4 2.99 2.99 3.01 2.99 2.99 3.01 2.99 2.99 3.01 Sensitivity 33% 40%
35% 33% 39% 33% 33% 39% 34% Specificity 80% 90% 80% 80% 90% 80% 80%
90% 80% OR Quartile 2 2.58 2.31 1.36 2.67 2.47 1.46 2.67 2.47 1.56
p Value 0.045 0.054 0.51 0.038 0.038 0.41 0.038 0.038 0.33 Lower
limit of 95% CI 1.02 0.985 0.549 1.06 1.05 0.590 1.06 1.05 0.633
Upper limit of 95% CI 6.53 5.42 3.36 6.75 5.80 3.60 6.75 5.80 3.85
OR Quartile 3 2.85 4.17 1.61 2.67 3.71 1.42 2.67 3.71 1.41 p Value
0.0023 4.3E-5 0.17 0.0040 1.5E-4 0.31 0.0040 1.5E-4 0.31 Lower
limit of 95% CI 1.45 2.10 0.816 1.37 1.88 0.725 1.37 1.88 0.725
Upper limit of 95% CI 5.60 8.28 3.18 5.23 7.33 2.78 5.23 7.33 2.75
OR Quartile 4 2.03 6.03 2.15 1.95 5.60 1.97 1.95 5.60 2.11 p Value
0.063 9.5E-5 0.049 0.078 1.8E-4 0.078 0.078 1.8E-4 0.053 Lower
limit of 95% CI 0.963 2.45 1.00 0.928 2.27 0.925 0.928 2.27 0.991
Upper limit of 95% CI 4.28 14.9 4.59 4.11 13.8 4.21 4.11 13.8
4.50
Example 11. Use of Insulin-Like Growth Factor-Binding Protein 4 for
Evaluating Renal Status in Patients Admitted to the ICU: Recovery
to RIFLE 0 and R from RIFLE I and F
[0145] Patients from the intensive care unit (ICU) with RIFLE stage
of injury (I) or failure (F) are enrolled in the following study.
EDTA anti-coagulated blood samples (10 mL) and urine samples (50
mL) are collected from each patient at enrollment, and at every 12
hours up to day 3, and then every 24 hours thereafter up to day 7
while the subject is hospitalized. Insulin-like growth
factor-binding protein 4 is measured in the enrollment samples by
standard immunoassay methods using commercially available assay
reagents.
[0146] Kidney status is assessed by RIFLE criteria based on serum
creatinine, urine output, or both serum creatinine and urine output
during a period starting at 12, 24, 48, or 72 hours after sample
collection or at any time within 7 days after sample collection.
Two cohorts are defined to represent a "recovered" and a
"non-recovered" population. "Recovered" indicates those patients
whose maximum RIFLE stage during a period of 24, 48 or 72 hours is
non-injury (RIFLE 0) or risk of injury (R). "Non-recovered"
indicates those patients whose maximum RIFLE stage during a period
of 24, 48 or 72 hours is injury (I) or failure (F). If a patient
dies or is placed on renal replacement therapy (RRT) at any time
from sample collection to 12, 24, 48, or 72 hours after sample
collection or at any time within 7 days after sample collection,
the patient is considered "non-recovered".
[0147] The ability to distinguish the "recovered" and
"non-recovered" cohorts is determined using receiver operating
characteristic (ROC) analysis.
TABLE-US-00035 TABLE 11.1 Comparison of marker levels and the area
under the ROC curve (AUC) in urine samples for the "recovered" and
"non-recovered" cohorts where recovery starts at 12 hours after
sample collection and renal status is assessed by scrum creatinine
(sCr) only, urine output (UO) only, or serum creatinine or urine
output RIFLE criteria. Recovery Period Duration (hr) 24 48 72
Recovered Non-recovered Recovered Non-recovered Recovered
Non-recovered Cohort Cohort Cohort Cohort Cohort Cohort sCr or UO
Median 0.000471 0.685 0.000471 0.646 0.000471 0.633 Average 3.59
8.94 3.78 8.79 3.89 8.71 Stdev 18.1 19.1 18.6 19.0 18.9 18.9 p
(t-test) 0.14 0.17 0.19 Min 0.000212 0.000212 0.000212 0.000212
0.000212 0.000212 Max 110 120 110 120 110 120 n (Patient) 37 112 35
114 34 115 sCr only Median 0.000471 0.866 0.000471 0.866 0.000472
0.866 Average 3.00 9.87 3.00 9.87 3.07 9.78 Stdev 15.8 20.0 15.8
20.0 16.0 19.9 p (t-test) 0.037 0.037 0.043 Min 0.000212 0.000212
0.000212 0.000212 0.000212 0.000212 Max 110 120 110 120 110 120 n
(Patient) 49 100 49 100 48 101 UO only Median 0.122 0.679 0.122
0.594 0.118 0.633 Average 7.32 8.27 7.73 7.57 6.55 9.17 Stdev 20.8
15.4 21.5 14.8 18.0 20.3 p (t-test) 0.77 0.96 0.41 Min 0.000212
0.000212 0.000212 0.000212 0.000212 0.000212 Max 120 59.1 120 59.1
110 120 n (Patient) 94 54 88 60 85 63 Recovery Period Duration (hr)
24 48 72 sCr or UO sCr only UO only sCr or UO sCr only UO only sCr
or UO sCr only UO only AUC 0.70 0.73 0.57 0.71 0.73 0.57 0.69 0.72
0.58 SE 0.046 0.041 0.049 0.046 0.041 0.048 0.047 0.042 0.048 p
Value 7.5E-6 3.3E-8 0.15 8.6E-6 3.3E-8 0.15 4.5E-5 2.4E-7 0.087
nCohort Recovered 37 49 94 35 49 88 34 48 85 nCohort Non-recovered
112 100 54 114 100 60 115 101 63 Cutoff Quartile 2 0.000339
0.000339 0.000339 0.000339 0.000339 0.000339 0.000339 0.000339
0.000339 Sensitivity 85% 87% 83% 85% 87% 85% 84% 86% 86%
Specificity 30% 31% 19% 31% 31% 20% 29% 29% 21% Cutoff Quartile 3
0.170 0.170 0.205 0.170 0.170 0.205 0.170 0.170 0.205 Sensitivity
57% 61% 56% 57% 61% 55% 57% 60% 56% Specificity 70% 71% 53% 71% 71%
53% 71% 71% 54% Cutoff Quartile 4 2.99 2.99 3.01 2.99 2.99 3.01
2.99 2.99 3.01 Sensitivity 32% 35% 33% 32% 35% 32% 31% 35% 33%
Specificity 95% 94% 80% 94% 94% 80% 94% 94% 81% OR Quartile 2 2.36
2.95 1.18 2.62 2.95 1.46 2.25 2.56 1.61 p Value 0.054 0.012 0.71
0.032 0.012 0.40 0.076 0.028 0.29 Lower limit of 95% CI 0.987 1.27
0.491 1.08 1.27 0.606 0.919 1.10 0.671 Upper limit of 95% CI 5.66
6.85 2.86 6.31 6.85 3.51 5.48 5.93 3.87 OR Quartile 3 3.15 3.91
1.42 3.32 3.91 1.40 3.12 3.70 1.47 p Value 0.0048 3.0E-4 0.31
0.0042 3.0E-4 0.32 0.0068 5.2E-4 0.25 Lower limit of 95% CI 1.42
1.87 0.725 1.46 1.87 0.725 1.37 1.77 0.766 Upper limit of 95% CI
7.00 8.18 2.78 7.54 8.18 2.71 7.12 7.76 2.84 OR Quartile 4 8.29
8.26 1.97 7.62 8.26 1.80 7.29 7.95 2.16 p Value 0.0051 8.3E-4 0.078
0.0072 8.3E-4 0.12 0.0086 0.0010 0.046 Lower limit of 95% CI 1.89
2.39 0.925 1.73 2.39 0.850 1.66 2.31 1.01 Upper limit of 95% CI
36.4 28.5 4.21 33.5 28.5 3.82 32.1 27.4 4.59
TABLE-US-00036 TABLE 11.2 Comparison of marker levels and the area
under the ROC curve (AUC) in urine samples for the "recovered" and
"non-recovered" cohorts where recovery starts at 24 hours after
sample collection and renal status is assessed by serum creatinine
(sCr) only, urine output (UO) only, or serum creatinine or urine
output RIFLE criteria. Recovery Period Duration (hr) 24 48 72
Recovered Non-recovered Recovered Non-recovered Recovered
Non-recovered Cohort Cohort Cohort Cohort Cohort Cohort sCr or UO
Median 0.000473 0.866 0.000473 0.862 0.000473 0.862 Average 2.71
10.2 2.81 9.97 2.81 9.97 Stdev 15.4 20.1 15.8 20.0 15.8 20.0 p
(t-test) 0.022 0.030 0.030 Min 0.000212 0.000212 0.000212 0.000212
0.000212 0.000212 Max 110 120 110 120 110 120 n (Patient) 51 98 49
100 49 100 sCr only Median 0.000473 0.927 0.000473 0.899 0.000473
0.899 Average 2.66 10.8 2.71 10.7 2.71 10.7 Stdev 14.8 20.7 14.9
20.6 14.9 20.6 p (t-test) 0.011 0.013 0.013 Min 0.000212 0.000212
0.000212 0.000212 0.000212 0.000212 Max 110 120 110 120 110 120 n
(Patient) 56 91 55 92 55 92 UO only Median 0.122 0.869 0.118 0.866
0.118 0.866 Average 7.03 8.82 6.02 10.3 6.02 10.3 Stdev 20.7 15.9
17.4 21.5 17.4 21.5 p (t-test) 0.59 0.19 0.19 Min 0.000212 0.000212
0.000212 0.000212 0.000212 0.000212 Max 120 59.1 110 120 110 120 n
(Patient) 94 50 89 55 89 55 Recovery Period Duration (hr) 24 48 72
sCr or UO sCr only UO only sCr or UO sCr only UO only sCr or UO sCr
only UO only AUC 0.71 0.74 0.59 0.70 0.73 0.60 0.70 0.73 0.60 SE
0.042 0.040 0.051 0.043 0.041 0.049 0.043 0.041 0.049 p Value
9.2E-7 3.9E-9 0.082 3.1E-6 3.3E-8 0.045 3.1E-6 3.3E-8 0.045 nCohort
Recovered 51 56 94 49 55 89 49 55 89 nCohort Non-recovered 98 91 50
100 92 55 100 92 55 Cutoff Quartile 2 0.000339 0.000339 0.000339
0.000339 0.000339 0.000339 0.000339 0.000339 0.000339 Sensitivity
85% 87% 84% 84% 86% 85% 84% 86% 85% Specificity 25% 27% 20% 24% 25%
21% 24% 25% 21% Cutoff Quartile 3 0.170 0.170 0.218 0.170 0.170
0.218 0.170 0.170 0.218 Sensitivity 60% 64% 56% 60% 63% 56% 60% 63%
56% Specificity 69% 71% 53% 69% 71% 54% 69% 71% 54% Cutoff Quartile
4 2.99 3.02 3.01 2.99 3.02 3.01 2.99 3.02 3.01 Sensitivity 37% 37%
36% 36% 37% 36% 36% 37% 36% Specificity 96% 95% 81% 96% 95% 82% 96%
95% 82% OR Quartile 2 1.89 2.41 1.33 1.70 2.08 1.59 1.70 2.08 1.59
p Value 0.13 0.042 0.54 0.22 0.090 0.31 0.22 0.090 0.31 Lower limit
of 95% CI 0.820 1.03 0.536 0.733 0.892 0.645 0.733 0.892 0.645
Upper limit of 95% CI 4.37 5.62 3.30 3.95 4.83 3.94 3.95 4.83 3.94
OR Quartile 3 3.31 4.39 1.45 3.40 4.16 1.51 3.40 4.16 1.51 p Value
0.0011 5.6E-5 0.29 9.8E-4 1.0E-4 0.23 9.8E-4 1.0E-4 0.23 Lower
limit of 95% CI 1.62 2.14 0.725 1.64 2.02 0.769 1.64 2.02 0.769
Upper limit of 95% CI 6.78 9.03 2.88 7.04 8.54 2.97 7.04 8.54 2.97
OR Quartile 4 14.2 10.5 2.38 13.2 10.2 2.61 13.2 10.2 2.61 p Value
4.1E-4 1.9E-4 0.028 5.9E-4 2.4E-4 0.015 5.9E-4 2.4E-4 0.015 Lower
limit of 95% CI 3.26 3.05 1.10 3.03 2.95 1.21 3.03 2.95 1.21 Upper
limit of 95% CI 62.0 36.4 5.14 57.7 35.1 5.64 57.7 35.1 5.64
TABLE-US-00037 TABLE 11.3 Comparison of marker levels and the area
under the ROC curve (AUC) in urine samples for the "recovered" and
"non-recovered" cohorts where recovery starts at 48 hours after
sample collection and renal status is assessed by serum creatinine
(sCr) only, urine output (UO) only, or serum creatinine or urine
output RIFLE criteria. Recovery Period Duration (hr) 24 48 72
Recovered Non-recovered Recovered Non-recovered Recovered
Non-recovered Cohort Cohort Cohort Cohort Cohort Cohort sCr or UO
Median 0.0328 0.866 0.0328 0.866 0.0328 0.866 Average 3.63 10.9
3.63 10.9 3.52 10.8 Stdev 14.7 21.4 14.7 21.4 14.9 21.2 p (t-test)
0.023 0.023 0.023 Min 0.000212 0.000212 0.000212 0.000212 0.000212
0.000212 Max 110 120 110 120 110 120 n (Patient) 63 83 63 83 61 85
sCr only Median 0.0328 0.899 0.0328 0.899 0.0169 0.927 Average 3.61
11.4 3.61 11.4 3.46 11.4 Stdev 14.3 21.9 14.3 21.9 14.4 21.8 p
(t-test) 0.014 0.014 0.012 Min 0.000212 0.000212 0.000212 0.000212
0.000212 0.000212 Max 110 120 110 120 110 120 n (Patient) 67 78 67
78 66 79 UO only Median 0.146 0.899 0.146 0.899 0.165 0.866 Average
7.31 10.6 7.31 10.6 7.58 10.0 Stdev 19.2 21.6 19.2 21.6 19.5 21.1 p
(t-test) 0.37 0.37 0.51 Min 0.000212 0.000212 0.000212 0.000212
0.000212 0.000212 Max 110 120 110 120 110 120 n (Patient) 80 48 80
48 77 51 Recovery Period Duration (hr) 24 48 72 sCr or UO sCr only
UO only sCr or UO sCr only UO only sCr or UO sCr only UO only AUC
0.65 0.67 0.60 0.65 0.67 0.60 0.67 0.68 0.59 SE 0.045 0.044 0.052
0.045 0.044 0.052 0.044 0.044 0.052 p Value 5.9E-4 1.4E-4 0.051
5.9E-4 1.4E-4 0.051 1.6E-4 4.3E-5 0.078 nCohort Recovered 63 67 80
63 67 80 61 66 77 nCohort Non-recovered 83 78 48 83 78 48 85 79 51
Cutoff Quartile 2 0.000339 0.000339 0.000471 0.000339 0.000339
0.000471 0.000339 0.000339 0.000471 Sensitivity 83% 85% 81% 83% 85%
81% 84% 85% 82% Specificity 21% 22% 28% 21% 22% 28% 21% 23% 29%
Cutoff Quartile 3 0.168 0.165 0.399 0.168 0.165 0.399 0.168 0.165
0.399 Sensitivity 59% 62% 58% 59% 62% 58% 60% 62% 57% Specificity
62% 61% 55% 62% 61% 55% 64% 62% 55% Cutoff Quartile 4 3.04 3.05
4.89 3.04 3.05 4.89 3.04 3.05 4.89 Sensitivity 35% 36% 33% 35% 36%
33% 35% 37% 31% Specificity 87% 87% 80% 87% 87% 80% 89% 88% 79% OR
Quartile 2 1.28 1.59 1.64 1.28 1.59 1.64 1.37 1.64 1.87 p Value
0.56 0.28 0.27 0.56 0.28 0.27 0.46 0.25 0.16 Lower limit of 95% CI
0.554 0.684 0.685 0.554 0.684 0.685 0.594 0.708 0.779 Upper limit
of 95% CI 2.96 3.68 3.94 2.96 3.68 3.94 3.18 3.81 4.47 OR Quartile
3 2.34 2.52 1.71 2.34 2.52 1.71 2.66 2.68 1.58 p Value 0.013 0.0068
0.15 0.013 0.0068 0.15 0.0048 0.0041 0.21 Lower limit of 95% CI
1.20 1.29 0.830 1.20 1.29 0.830 1.35 1.37 0.775 Upper limit of 95%
CI 4.58 4.93 3.53 4.58 4.93 3.53 5.24 5.25 3.23 OR Quartile 4 3.69
3.61 2.00 3.69 3.61 2.00 4.21 4.20 1.74 p Value 0.0032 0.0028 0.095
0.0032 0.0028 0.095 0.0018 0.0012 0.18 Lower limit of 95% CI 1.55
1.56 0.887 1.55 1.56 0.887 1.70 1.76 0.777 Upper limit of 95% CI
8.80 8.37 4.51 8.80 8.37 4.51 10.4 10.0 3.91
TABLE-US-00038 TABLE 11.4 Comparison of marker levels and the area
under the ROC curve (AUC) in urine samples for the "recovered" and
"non-recovered" cohorts where recovery starts at 72 hours after
sample collection and renal status is assessed by serum creatinine
(sCr) only, urine output (UO) only, or serum creatinine or urine
output RIFLE criteria. Recovery Period Duration (hr) 24 48 72
Recovered Non-recovered Recovered Non-recovered Recovered
Non-recovered Cohort Cohort Cohort Cohort Cohort Cohort sCr or UO
Median 0.000473 1.21 0.000473 1.14 0.000473 1.13 Average 3.27 12.6
3.26 12.2 3.21 11.9 Stdev 13.9 22.7 14.3 22.2 14.5 21.8 p (t-test)
0.0035 0.0057 0.0075 Min 0.000212 0.000212 0.000212 0.000212
0.000212 0.000212 Max 110 120 110 120 110 120 n (Patient) 71 71 67
75 64 78 sCr only Median 0.00102 1.21 0.000747 1.28 0.000473 1.35
Average 3.36 12.8 3.22 12.8 3.09 12.8 Stdev 13.8 23.0 13.8 22.8
13.9 22.6 p (t-test) 0.0032 0.0028 0.0024 Min 0.000212 0.000212
0.000212 0.000212 0.000212 0.000212 Max 110 120 110 120 110 120 n
(Patient) 73 69 72 70 71 71 UO only Median 0.0873 1.13 0.0873 0.872
0.118 0.866 Average 9.20 8.52 8.23 9.89 8.55 9.52 Stdev 23.8 14.7
20.6 21.1 20.7 20.8 p (t-test) 0.86 0.67 0.80 Min 0.000212 0.000286
0.000212 0.000286 0.000212 0.000286 Max 120 50.9 110 120 110 120 n
(Patient) 74 45 68 51 67 53 Recovery Period Duration (hr) 24 48 72
sCr or UO sCr only UO only sCr or UO sCr only UO only sCr or UO sCr
only UO only AUC 0.71 0.70 0.63 0.72 0.71 0.61 0.72 0.72 0.59 SE
0.043 0.044 0.054 0.043 0.043 0.053 0.042 0.043 0.053 p Value
6.7E-7 3.5E-6 0.019 4.2E-7 8.0E-7 0.038 3.6E-7 1.6E-7 0.097 nCohort
Recovered 71 73 74 67 72 68 64 71 67 nCohort Non-recovered 71 69 45
75 70 51 78 71 53 Cutoff Quartile 2 0.000365 0.000365 0.000471
0.000365 0.000365 0.000471 0.000365 0.000365 0.000471 Sensitivity
82% 81% 84% 83% 81% 84% 82% 82% 83% Specificity 32% 32% 28% 34% 32%
29% 34% 32% 28% Cutoff Quartile 3 0.205 0.205 0.404 0.205 0.205
0.404 0.205 0.205 0.424 Sensitivity 66% 65% 62% 65% 66% 59% 64% 66%
57% Specificity 66% 64% 57% 67% 65% 56% 67% 66% 55% Cutoff Quartile
4 3.58 3.58 4.63 3.58 3.58 4.63 3.58 3.58 4.89 Sensitivity 39% 39%
33% 39% 40% 31% 38% 41% 28% Specificity 89% 88% 80% 90% 89% 79% 91%
90% 78% OR Quartile 2 2.14 1.98 2.15 2.49 2.06 2.24 2.39 2.14 1.94
p Value 0.056 0.086 0.11 0.022 0.070 0.085 0.027 0.056 0.15 Lower
limit of 95% CI 0.980 0.909 0.831 1.14 0.943 0.895 1.10 0.980 0.793
Upper limit of 95% CI 4.66 4.32 5.57 5.45 4.49 5.61 5.20 4.66 4.72
OR Quartile 3 3.84 3.39 2.16 3.85 3.60 1.81 3.66 3.84 1.61 p Value
1.5E-4 5.2E-4 0.046 1.5E-4 2.8E-4 0.11 2.7E-4 1.5E-4 0.20 Lower
limit of 95% CI 1.91 1.70 1.01 1.92 1.80 0.868 1.82 1.91 0.778
Upper limit of 95% CI 7.69 6.75 4.61 7.74 7.20 3.77 7.34 7.69 3.32
OR Quartile 4 5.13 4.57 1.97 5.40 5.33 1.76 6.04 6.31 1.37 p Value
2.6E-4 4.5E-4 0.11 2.8E-4 1.8E-4 0.18 2.3E-4 7.6E-5 0.46 Lower
limit of 95% CI 2.14 1.96 0.849 2.17 2.22 0.766 2.32 2.53 0.597
Upper limit of 95% CI 12.3 10.7 4.55 13.4 12.8 4.06 15.7 15.7
3.13
TABLE-US-00039 TABLE 11.5 Comparison of marker levels and the area
under the ROC curve (AUC) in urine samples for the "recovered" and
"non-recovered" cohorts where recovery starts within 7 days after
sample collection and renal status is assessed by serum creatinine
(sCr) only, urine output (UO) only, or serum creatinine or urine
output RIFLE criteria. Recovery Period Duration (hr) 24 48 72
Recovered Non-recovered Recovered Non-recovered Recovered
Non-recovered Cohort Cohort Cohort Cohort Cohort Cohort sCr or UO
Median 0.0328 1.13 0.0328 1.13 0.0328 1.03 Average 6.41 9.62 6.48
9.45 6.55 9.29 Stdev 20.4 16.2 20.5 16.1 20.6 16.0 p (t-test) 0.32
0.35 0.39 Min 0.000212 0.000212 0.000212 0.000212 0.000212 0.000212
Max 120 59.1 120 59.1 120 59.1 n (Patient) 93 56 92 57 91 58 sCr
only Median 0.00102 1.28 0.00102 1.28 0.00102 1.28 Average 3.04
13.4 3.04 13.4 3.04 13.4 Stdev 12.9 23.4 12.9 23.4 12.9 23.4 p
(t-test) 8.0E-4 8.0E-4 8.0E-4 Min 0.000212 0.000212 0.000212
0.000212 0.000212 0.000212 Max 110 120 110 120 110 120 n (Patient)
83 66 83 66 83 66 UO only Median 0.0851 1.13 0.0851 1.13 0.0873
1.03 Average 6.94 9.19 6.94 9.19 7.08 8.82 Stdev 20.6 15.3 20.6
15.3 20.8 15.1 p (t-test) 0.50 0.50 0.60 Min 0.000212 0.000212
0.000212 0.000212 0.000212 0.000212 Max 120 50.9 120 50.9 120 50.9
n (Patient) 100 48 100 48 98 50 Recovery Period Duration (hr) 24 48
72 sCr or UO sCr only UO only sCr or UO sCr only UO only sCr or UO
sCr only UO only AUC 0.67 0.72 0.64 0.67 0.72 0.64 0.66 0.72 0.63
SE 0.047 0.043 0.050 0.047 0.043 0.050 0.047 0.043 0.050 p Value
2.2E-4 4.0E-7 0.0051 3.9E-4 4.0E-7 0.0051 5.9E-4 4.0E-7 0.011
nCohort Recovered 93 83 100 92 83 100 91 83 98 nCohort
Non-recovered 56 66 48 57 66 48 58 66 50 Cutoff Quartile 2 0.000339
0.000339 0.000339 0.000339 0.000339 0.000339 0.000339 0.000339
0.000339 Sensitivity 89% 88% 88% 89% 88% 88% 90% 88% 88%
Specificity 24% 24% 21% 24% 24% 21% 24% 24% 21% Cutoff Quartile 3
0.170 0.170 0.205 0.170 0.170 0.205 0.170 0.170 0.205 Sensitivity
64% 65% 62% 63% 65% 62% 62% 65% 60% Specificity 58% 61% 56% 58% 61%
56% 57% 61% 55% Cutoff Quartile 4 2.99 2.99 3.01 2.99 2.99 3.01
2.99 2.99 3.01 Sensitivity 36% 41% 38% 35% 41% 38% 34% 41% 36%
Specificity 81% 87% 81% 80% 87% 81% 80% 87% 81% OR Quartile 2 2.58
2.30 1.86 2.67 2.30 1.86 2.76 2.30 2.00 p Value 0.056 0.068 0.21
0.048 0.068 0.21 0.040 0.068 0.17 Lower limit of 95% CI 0.976 0.941
0.697 1.01 0.941 0.697 1.05 0.941 0.751 Upper limit of 95% CI 6.83
5.63 4.97 7.06 5.63 4.97 7.30 5.63 5.33 OR Quartile 3 2.49 2.98
2.12 2.33 2.98 2.12 2.18 2.98 1.84 p Value 0.0089 0.0015 0.037
0.015 0.0015 0.037 0.023 0.0015 0.084 Lower limit of 95% CI 1.26
1.52 1.05 1.18 1.52 1.05 1.11 1.52 0.922 Upper limit of 95% CI 4.94
5.84 4.29 4.59 5.84 4.29 4.28 5.84 3.68 OR Quartile 4 2.31 4.53
2.56 2.22 4.53 2.56 2.13 4.53 2.34 p Value 0.028 2.2E-4 0.017 0.037
2.2E-4 0.017 0.047 2.2E-4 0.029 Lower limit of 95% CI 1.09 2.03
1.19 1.05 2.03 1.19 1.01 2.03 1.09 Upper limit of 95% CI 4.90 10.1
5.52 4.70 10.1 5.52 4.51 10.1 5.02
Example 12. Use of Insulin-Like Growth Factor-Binding Protein 6 for
Evaluating Renal Status in Patients Admitted to the ICU: Recovery
to RIFLE 0 from RIFLE I and F
[0148] Patients from the intensive care unit (ICU) with RIFLE stage
of injury (I) or failure (F) are enrolled in the following study.
EDTA anti-coagulated blood samples (10 mL) and urine samples (50
mL) are collected from each patient at enrollment, and at every 12
hours up to day 3, and then every 24 hours thereafter up to day 7
while the subject is hospitalized. Insulin-like growth
factor-binding protein 6 is measured in the enrollment samples by
standard immunoassay methods using commercially available assay
reagents.
[0149] Kidney status is assessed by RIFLE criteria based on serum
creatinine, urine output, or both serum creatinine and urine output
during a period starting at 12, 24, 48, or 72 hours after sample
collection or at any time within 7 days after sample collection.
Two cohorts are defined to represent a "recovered" and a
"non-recovered" population. "Recovered" indicates those patients
whose maximum RIFLE stage during a period of 24, 48 or 72 hours is
non-injury (RIFLE 0). "Non-recovered" indicates those patients
whose maximum RIFLE stage during a period of 24, 48 or 72 hours is
risk of injury (R), injury (I) or failure (F). If a patient dies or
is placed on renal replacement therapy (RRT) at any time from
sample collection to 12, 24, 48, or 72 hours after sample
collection or at any time within 7 days after sample collection,
the patient is considered "non-recovered".
[0150] The ability to distinguish the "recovered" and
"non-recovered" cohorts is determined using receiver operating
characteristic (ROC) analysis.
TABLE-US-00040 TABLE 12.1 Comparison of marker levels and the area
under the ROC curve (AUC) in urine samples for the "recovered" and
"non-recovered" cohorts where recovery starts at 12 hours after
sample collection and renal status is assessed by serum creatinine
(sCr) only, urine output (UO) only, or serum creatinine or urine
output RIFLE criteria. Recovery Period Duration (hr) 24 48 72
Recovered Non-recovered Recovered Non-recovered Recovered
Non-recovered Cohort Cohort Cohort Cohort Cohort Cohort sCr or UO
Median 7.89 86.4 7.31 85.4 7.31 85.4 Average 70.0 296 71.2 294 71.2
294 Stdev 142 551 150 549 150 549 p (t-test) 0.20 0.23 0.23 Min
0.352 0.259 0.352 0.259 0.352 0.259 Max 460 3600 460 3600 460 3600
n (Patient) 10 139 9 140 9 140 sCr only Median 8.47 93.9 8.47 93.8
8.47 93.8 Average 70.6 319 72.8 317 72.8 317 Stdev 141 572 144 570
144 570 p (t-test) 0.041 0.049 0.049 Min 0.352 0.259 0.352 0.259
0.352 0.259 Max 532 3600 532 3600 532 3600 n (Patient) 23 126 22
127 22 127 UO only Median 63.7 98.2 63.7 93.8 61.7 94.8 Average 212
354 213 340 181 360 Stdev 381 655 381 635 320 648 p (t-test) 0.11
0.16 0.045 Min 0.259 1.14 0.259 1.14 0.259 1.14 Max 1830 3600 1830
3600 1650 3600 n (Patient) 75 73 67 81 64 84 Recovery Period
Duration (hr) 24 48 72 sCr or UO sCr only UO only sCr or UO sCr
only UO only sCr or UO sCr only UO only AUC 0.73 0.74 0.58 0.75
0.74 0.58 0.75 0.74 0.59 SE 0.069 0.049 0.047 0.069 0.050 0.047
0.069 0.050 0.047 p Value 6.7E-4 8.4E-7 0.073 2.7E-4 1.6E-6 0.081
2.7E-4 1.6E-6 0.042 nCohort Recovered 10 23 75 9 22 67 9 22 64
nCohort Non-recovered 139 126 73 140 127 81 140 127 84 Cutoff
Quartile 2 17.2 17.2 17.6 17.2 17.2 17.6 17.2 17.2 17.6 Sensitivity
78% 81% 79% 78% 81% 81% 78% 81% 81% Specificity 60% 57% 29% 67% 59%
33% 67% 59% 33% Cutoff Quartile 3 78.3 78.3 80.9 78.3 78.3 80.9
78.3 78.3 80.9 Sensitivity 53% 56% 56% 52% 55% 53% 52% 55% 54%
Specificity 80% 78% 56% 78% 77% 54% 78% 77% 55% Cutoff Quartile 4
331 331 331 331 331 331 331 331 331 Sensitivity 27% 29% 30% 26% 28%
28% 26% 28% 30% Specificity 90% 91% 80% 89% 91% 79% 89% 91% 81% OR
Quartile 2 5.23 5.52 1.61 7.03 6.20 2.15 7.03 6.20 2.08 p Value
0.015 3.5E-4 0.22 0.0080 1.9E-4 0.048 0.0080 1.9E-4 0.058 Lower
limit of 95% CI 1.39 2.17 0.755 1.66 2.38 1.01 1.66 2.38 0.976
Upper limit of 95% CI 19.7 14.1 3.41 29.7 16.2 4.59 29.7 16.2 4.41
OR Quartile 3 4.42 4.50 1.63 3.81 4.18 1.31 3.81 4.18 1.39 p Value
0.066 0.0050 0.14 0.10 0.0080 0.41 0.10 0.0080 0.32 Lower limit of
95% CI 0.907 1.57 0.852 0.765 1.45 0.687 0.765 1.45 0.725 Upper
limit of 95% CI 21.6 12.9 3.12 19.0 12.0 2.51 19.0 12.0 2.67 OR
Quartile 4 3.26 4.20 1.73 2.87 3.96 1.50 2.87 3.96 1.84 p Value
0.27 0.061 0.16 0.33 0.073 0.30 0.33 0.073 0.13 Lower limit of 95%
CI 0.400 0.936 0.811 0.348 0.879 0.701 0.348 0.879 0.839 Upper
limit of 95% CI 26.7 18.8 3.67 23.8 17.8 3.22 23.8 17.8 4.02
TABLE-US-00041 TABLE 12.2 Comparison of marker levels and the area
under the ROC curve (AUC) in urine samples for the "recovered" and
"non-recovered" cohorts where recovery starts at 24 hours after
sample collection and renal status is assessed by serum creatinine
(sCr) only, urine output (UO) only, or serum creatinine or urine
output RIFLE criteria. Recovery Period Duration (hr) 24 48 72
Recovered Non-recovered Recovered Non-recovered Recovered
Non-recovered Cohort Cohort Cohort Cohort Cohort Cohort sCr or UO
Median 15.1 95.7 12.9 93.8 8.47 93.6 Average 52.2 329 55.2 320 57.0
317 Stdev 94.7 577 102 570 104 569 p (t-test) 0.016 0.032 0.039 Min
0.352 0.259 0.352 0.259 0.352 0.259 Max 460 3600 460 3600 460 3600
n (Patient) 26 123 22 127 21 128 sCr only Median 19.4 98.7 17.2
97.0 16.2 95.7 Average 72.5 350 74.1 345 75.9 342 Stdev 124 599 128
595 129 593 p (t-test) 0.0073 0.011 0.013 Min 0.352 0.259 0.352
0.259 0.352 0.259 Max 532 3600 532 3600 532 3600 n (Patient) 35 112
33 114 32 115 UO only Median 59.7 99.2 59.3 98.7 58.8 99.2 Average
213 380 188 384 177 386 Stdev 372 697 320 688 315 677 p (t-test)
0.067 0.030 0.021 Min 0.259 2.24 0.259 2.24 0.259 2.24 Max 1830
3600 1650 3600 1650 3600 n (Patient) 81 63 72 72 69 75 Recovery
Period Duration (hr) 24 48 72 sCr or UO sCr only UO only sCr or UO
sCr only UO only sCr or UO sCr only UO only AUC 0.75 0.73 0.60 0.74
0.73 0.61 0.74 0.72 0.62 SE 0.046 0.045 0.048 0.050 0.045 0.047
0.051 0.046 0.046 p Value 8.4E-8 4.5E-7 0.037 1.2E-6 6.6E-7 0.023
3.3E-6 1.8E-6 0.0076 nCohort Recovered 26 35 81 22 33 72 21 32 69
nCohort Non-recovered 123 112 63 127 114 72 128 115 75 Cutoff
Quartile 2 17.2 17.5 16.5 17.2 17.5 16.5 17.2 17.5 16.5 Sensitivity
80% 82% 83% 80% 82% 82% 80% 82% 83% Specificity 50% 49% 31% 50% 52%
32% 52% 50% 33% Cutoff Quartile 3 78.3 83.5 80.9 78.3 83.5 80.9
78.3 83.5 80.9 Sensitivity 57% 58% 57% 55% 57% 56% 55% 57% 56%
Specificity 81% 74% 56% 77% 73% 56% 76% 72% 57% Cutoff Quartile 4
331 332 331 331 332 331 331 332 331 Sensitivity 30% 31% 30% 29% 31%
29% 29% 30% 31% Specificity 96% 94% 79% 95% 94% 79% 95% 94% 81% OR
Quartile 2 4.12 4.34 2.11 3.88 4.99 2.13 4.32 4.48 2.38 p Value
0.0018 4.5E-4 0.068 0.0047 1.6E-4 0.057 0.0028 4.6E-4 0.029 Lower
limit of 95% CI 1.70 1.91 0.945 1.52 2.16 0.978 1.65 1.93 1.09
Upper limit of 95% CI 10.0 9.87 4.71 9.95 11.5 4.64 11.3 10.4 5.20
OR Quartile 3 5.55 4.00 1.67 4.18 3.54 1.56 3.86 3.32 1.65 p Value
0.0012 0.0013 0.13 0.0080 0.0036 0.18 0.013 0.0059 0.13 Lower limit
of 95% CI 1.96 1.71 0.858 1.45 1.51 0.810 1.33 1.41 0.856 Upper
limit of 95% CI 15.7 9.31 3.24 12.0 8.29 3.02 11.2 7.81 3.20 OR
Quartile 4 10.8 7.50 1.63 8.63 6.87 1.56 8.13 6.56 1.91 p Value
0.022 0.0077 0.21 0.039 0.011 0.25 0.045 0.013 0.10 Lower limit of
95% CI 1.40 1.70 0.761 1.12 1.56 0.730 1.05 1.49 0.875 Upper limit
of 95% CI 82.4 33.0 3.47 66.5 30.3 3.35 62.8 29.0 4.15
TABLE-US-00042 TABLE 12.3 Comparison of marker levels and the area
under the ROC curve (AUC) in urine samples for the "recovered" and
"non-recovered" cohorts where recovery starts at 48 hours after
sample collection and renal status is assessed by serum creatinine
(sCr) only, urine output (UO) only, or serum creatinine or urine
output RIFLE criteria. Recovery Period Duration (hr) 24 48 72
Recovered Non-recovered Recovered Non-recovered Recovered
Non-recovered Cohort Cohort Cohort Cohort Cohort Cohort sCr or UO
Median 20.6 103 20.8 101 26.8 98.2 Average 54.4 360 47.7 354 51.6
345 Stdev 80.0 605 62.2 599 63.8 593 p (t-test) 0.0027 0.0035
0.0069 Min 0.352 0.259 0.352 0.259 1.13 0.259 Max 367 3600 225 3600
225 3600 n (Patient) 37 109 34 112 31 115 sCr only Median 21.0 106
21.0 106 21.0 106 Average 70.6 380 64.9 377 64.9 377 Stdev 110 626
102 621 102 621 p (t-test) 0.0013 0.0014 0.0014 Min 0.352 0.259
0.352 0.259 0.352 0.259 Max 532 3600 532 3600 532 3600 n (Patient)
45 100 43 102 43 102 UO only Median 61.7 114 61.7 114 63.7 99.2
Average 230 410 224 404 246 368 Stdev 404 713 406 695 424 667 p
(t-test) 0.076 0.074 0.23 Min 0.259 2.24 0.259 2.24 0.259 0.352 Max
2160 3600 2160 3600 2160 3600 n (Patient) 70 58 66 62 59 69
Recovery Period Duration (hr) 24 48 72 sCr or UO sCr only UO only
sCr or UO sCr only UO only sCr or UO sCr only UO only AUC 0.75 0.73
0.62 0.75 0.74 0.62 0.72 0.74 0.58 SE 0.042 0.042 0.050 0.043 0.042
0.050 0.046 0.042 0.050 p Value 2.9E-9 2.7E-8 0.020 3.7E-9 9.2E-9
0.014 1.8E-6 9.2E-9 0.13 nCohort Recovered 37 45 70 34 43 66 31 43
59 nCohort Non-recovered 109 100 58 112 102 62 115 102 69 Cutoff
Quartile 2 17.4 17.2 20.7 17.4 17.2 20.7 17.4 17.2 20.7 Sensitivity
82% 83% 83% 80% 83% 82% 79% 83% 80% Specificity 46% 42% 31% 44% 44%
32% 42% 44% 31% Cutoff Quartile 3 80.9 83.5 87.1 80.9 83.5 87.1
80.9 83.5 87.1 Sensitivity 59% 60% 57% 58% 60% 56% 57% 60% 54%
Specificity 76% 71% 56% 76% 72% 56% 74% 72% 54% Cutoff Quartile 4
325 331 369 325 331 369 325 331 369 Sensitivity 33% 35% 29% 33% 35%
29% 32% 35% 26% Specificity 97% 96% 79% 100% 98% 79% 100% 98% 76%
OR Quartile 2 3.78 3.57 2.20 3.23 3.96 2.16 2.74 3.96 1.72 p Value
0.0013 0.0016 0.068 0.0052 7.0E-4 0.069 0.019 7.0E-4 0.19 Lower
limit of 95% CI 1.69 1.62 0.942 1.42 1.79 0.941 1.18 1.79 0.770
Upper limit of 95% CI 8.49 7.85 5.14 7.35 8.77 4.97 6.36 8.77 3.87
OR Quartile 3 4.42 3.69 1.66 4.49 3.84 1.65 3.74 3.84 1.37 p Value
5.4E-4 7.4E-4 0.16 7.8E-4 6.6E-4 0.16 0.0035 6.6E-4 0.38 Lower
limit of 95% CI 1.91 1.73 0.823 1.87 1.77 0.822 1.54 1.77 0.682
Upper limit of 95% CI 10.3 7.88 3.35 10.8 8.34 3.33 9.06 8.34 2.75
OR Quartile 4 17.8 11.6 1.52 34.3 22.9 1.52 30.1 22.9 1.13 p Value
0.0054 0.0011 0.31 0.014 0.0024 0.31 0.018 0.0024 0.76 Lower limit
of 95% CI 2.34 2.65 0.681 2.04 3.03 0.679 1.79 3.03 0.507 Upper
limit of 95% CI 135 50.7 3.40 575 173 3.40 505 173 2.54
TABLE-US-00043 TABLE 12.4 Comparison of marker levels and the area
under the ROC curve (AUC) in urine samples for the "recovered" and
"non-recovered" cohorts where recovery starts at 72 hours after
sample collection and renal status is assessed by serum creatinine
(sCr) only, urine output (UO) only, or serum creatinine or urine
output RIFLE criteria. Recovery Period Duration (hr) 24 48 72
Recovered Non-recovered Recovered Non-recovered Recovered
Non-recovered Cohort Cohort Cohort Cohort Cohort Cohort sCr or UO
Median 22.2 108 24.5 98.7 24.5 98.7 Average 100 370 109 354 112 348
Stdev 239 619 253 608 259 604 p (t-test) 0.0065 0.018 0.024 Min
0.352 0.259 1.13 0.259 1.13 0.259 Max 1440 3600 1440 3600 1440 3600
n (Patient) 43 99 38 104 36 106 sCr only Median 33.4 106 33.4 106
33.4 106 Average 111 385 111 385 113 378 Stdev 232 638 232 638 236
633 p (t-test) 0.0040 0.0040 0.0059 Min 0.352 0.259 0.352 0.259
0.352 0.259 Max 1440 3600 1440 3600 1440 3600 n (Patient) 50 92 50
92 48 94 UO only Median 61.3 117 71.0 99.2 86.1 94.8 Average 245
403 266 365 289 348 Stdev 433 712 456 676 470 656 p (t-test) 0.14
0.36 0.59 Min 0.259 2.91 0.259 0.352 0.259 0.352 Max 2160 3600 2160
3600 2160 3600 n (Patient) 62 57 54 65 50 70 Recovery Period
Duration (hr) 24 48 72 sCr or UO sCr only UO only sCr or UO sCr
only UO only sCr or UO sCr only UO only AUC 0.73 0.70 0.63 0.70
0.70 0.58 0.70 0.69 0.55 SE 0.043 0.044 0.051 0.046 0.044 0.052
0.047 0.045 0.053 p Value 1.4E-7 7.0E-6 0.011 1.0E-5 7.0E-6 0.11
2.3E-5 1.7E-5 0.38 nCohort Recovered 43 50 62 38 50 54 36 48 50
nCohort Non-recovered 99 92 57 104 92 65 106 94 70 Cutoff Quartile
2 17.4 17.4 25.6 17.4 17.4 25.6 17.4 17.4 25.8 Sensitivity 82% 82%
84% 81% 82% 80% 80% 81% 79% Specificity 42% 38% 34% 42% 38% 31% 42%
38% 30% Cutoff Quartile 3 80.9 80.9 87.9 80.9 80.9 87.9 80.9 80.9
90.6 Sensitivity 60% 60% 58% 58% 60% 54% 58% 60% 51% Specificity
72% 68% 56% 71% 68% 54% 72% 69% 52% Cutoff Quartile 4 332 332 364
332 332 364 332 332 369 Sensitivity 33% 35% 28% 32% 35% 26% 31% 34%
24% Specificity 93% 92% 77% 92% 92% 76% 92% 92% 74% OR Quartile 2
3.24 2.70 2.73 3.05 2.70 1.84 2.89 2.53 1.57 p Value 0.0036 0.012
0.026 0.0067 0.012 0.15 0.011 0.019 0.29 Lower limit of 95% CI 1.47
1.24 1.13 1.36 1.24 0.796 1.28 1.16 0.684 Upper limit of 95% CI
7.16 5.88 6.62 6.85 5.88 4.24 6.54 5.52 3.61 OR Quartile 3 3.81
3.16 1.78 3.35 3.16 1.35 3.52 3.24 1.15 p Value 7.5E-4 0.0019 0.12
0.0031 0.0019 0.41 0.0028 0.0017 0.71 Lower limit of 95% CI 1.75
1.53 0.862 1.50 1.53 0.656 1.54 1.55 0.555 Upper limit of 95% CI
8.30 6.53 3.69 7.46 6.53 2.79 8.04 6.77 2.37 OR Quartile 4 6.67
6.13 1.34 5.42 6.13 1.12 4.97 5.68 0.913 p Value 0.0028 0.0013 0.49
0.0080 0.0013 0.79 0.012 0.0021 0.83 Lower limit of 95% CI 1.92
2.03 0.584 1.55 2.03 0.485 1.42 1.87 0.396 Upper limit of 95% CI
23.2 18.6 3.07 18.9 18.6 2.57 17.4 17.2 2.10
TABLE-US-00044 TABLE 12.5 Comparison of marker levels and the area
under the ROC curve (AUC) in urine samples for the "recovered" and
"non-recovered" cohorts where recovery starts within 7 days after
sample collection and renal status is assessed by serum creatinine
(sCr) only, urine output (UO) only, or serum creatinine or urine
output RIFLE criteria. Recovery Period Duration (hr) 24 48 72
Recovered Non-recovered Recovered Non-recovered Recovered
Non-recovered Cohort Cohort Cohort Cohort Cohort Cohort sCr or UO
Median 44.2 117 40.8 118 40.8 118 Average 206 382 207 379 207 379
Stdev 393 675 396 670 396 670 p (t-test) 0.047 0.052 0.052 Min
0.259 2.91 0.259 2.91 0.259 2.91 Max 2160 3600 2160 3600 2160 3600
n (Patient) 86 63 85 64 85 64 sCr only Median 36.8 123 36.8 119
36.8 119 Average 137 412 140 402 140 402 Stdev 322 649 326 644 326
644 p (t-test) 0.0015 0.0026 0.0026 Min 0.259 0.723 0.259 0.723
0.259 0.723 Max 2160 3600 2160 3600 2160 3600 n (Patient) 71 78 69
80 69 80 UO only Median 58.9 113 58.9 113 58.9 113 Average 214 408
217 396 216 391 Stdev 380 733 383 722 386 711 p (t-test) 0.035
0.051 0.054 Min 0.259 3.02 0.259 2.91 0.259 2.91 Max 2160 3600 2160
3600 2160 3600 n (Patient) 96 52 94 54 92 56 Recovery Period
Duration (hr) 24 48 72 sCr or UO sCr only UO only sCr or UO sCr
only UO only sCr or UO sCr only UO only AUC 0.65 0.72 0.62 0.66
0.71 0.61 0.66 0.71 0.61 SE 0.046 0.041 0.049 0.046 0.042 0.049
0.046 0.042 0.049 p Value 8.2E-4 8.6E-8 0.019 5.5E-4 4.6E-7 0.031
5.5E-4 4.6E-7 0.028 nCohort Recovered 86 71 96 85 69 94 85 69 92
nCohort Non-recovered 63 78 52 64 80 54 64 80 56 Cutoff Quartile 2
17.2 17.2 17.6 17.2 17.2 17.6 17.2 17.2 17.6 Sensitivity 84% 86%
83% 84% 85% 81% 84% 85% 80% Specificity 31% 37% 29% 32% 36% 29% 32%
36% 28% Cutoff Quartile 3 78.3 78.3 80.9 78.3 78.3 80.9 78.3 78.3
80.9 Sensitivity 65% 67% 62% 66% 65% 61% 66% 65% 61% Specificity
60% 68% 56% 61% 67% 56% 61% 67% 57% Cutoff Quartile 4 331 331 331
331 331 331 331 331 331 Sensitivity 33% 38% 31% 33% 38% 30% 33% 38%
30% Specificity 80% 89% 78% 80% 88% 78% 80% 88% 78% OR Quartile 2
2.43 3.52 1.97 2.51 3.22 1.77 2.51 3.22 1.61 p Value 0.033 0.0020
0.12 0.027 0.0035 0.17 0.027 0.0035 0.24 Lower limit of 95% CI 1.07
1.58 0.847 1.11 1.47 0.782 1.11 1.47 0.724 Upper limit of 95% CI
5.48 7.83 4.57 5.68 7.07 4.02 5.68 7.07 3.59 OR Quartile 3 2.85
4.17 2.06 3.01 3.71 2.03 3.01 3.71 2.01 p Value 0.0023 4.3E-5 0.040
0.0014 1.5E-4 0.042 0.0014 1.5E-4 0.043 Lower limit of 95% CI 1.45
2.10 1.03 1.53 1.88 1.03 1.53 1.88 1.02 Upper limit of 95% CI 5.60
8.28 4.10 5.91 7.33 4.02 5.91 7.33 3.95 OR Quartile 4 2.03 4.92
1.59 1.95 4.58 1.46 1.95 4.58 1.57 p Value 0.063 3.1E-4 0.23 0.078
5.7E-4 0.33 0.078 5.7E-4 0.24 Lower limit of 95% CI 0.963 2.07
0.741 0.928 1.93 0.685 0.928 1.93 0.738 Upper limit of 95% CI 4.28
11.7 3.40 4.11 10.9 3.13 4.11 10.9 3.34
Example 13. Use of Insulin-Like Growth Factor-Binding Protein 6 for
Evaluating Renal Status in Patients Admitted to the ICU: Recovery
to RIFLE 0 and R from RIFLE I and F
[0151] Patients from the intensive care unit (ICU) with RIFLE stage
of injury (I) or failure (F) are enrolled in the following study.
EDTA anti-coagulated blood samples (10 mL) and urine samples (50
mL) are collected from each patient at enrollment, and at every 12
hours up to day 3, and then every 24 hours thereafter up to day 7
while the subject is hospitalized. Insulin-like growth
factor-binding protein 6 is measured in the enrollment samples by
standard immunoassay methods using commercially available assay
reagents.
[0152] Kidney status is assessed by RIFLE criteria based on serum
creatinine, urine output, or both serum creatinine and urine output
during a period starting at 12, 24, 48, or 72 hours after sample
collection or at any time within 7 days after sample collection.
Two cohorts are defined to represent a "recovered" and a
"non-recovered" population. "Recovered" indicates those patients
whose maximum RIFLE stage during a period of 24, 48 or 72 hours is
non-injury (RIFLE 0) or risk of injury (R). "Non-recovered"
indicates those patients whose maximum RIFLE stage during a period
of 24, 48 or 72 hours is injury (I) or failure (F). If a patient
dies or is placed on renal replacement therapy (RRT) at any time
from sample collection to 12, 24, 48, or 72 hours after sample
collection or at any time within 7 days after sample collection,
the patient is considered "non-recovered".
[0153] The ability to distinguish the "recovered" and
"non-recovered" cohorts is determined using receiver operating
characteristic (ROC) analysis.
TABLE-US-00045 TABLE 13.1 Comparison of marker levels and the area
under the ROC curve (AUC) in urine samples for the "recovered" and
"non-recovered" cohorts where recovery starts at 12 hours after
sample collection and renal status is assessed by serum creatinine
(sCr) only, urine output (UO) only, or serum creatinine or urine
output RIFLE criteria. Recovery Period Duration (hr) 24 48 72
Recovered Non-recovered Recovered Non-recovered Recovered
Non-recovered Cohort Cohort Cohort Cohort Cohort Cohort sCr or UO
Median 20.6 98.7 17.2 97.0 18.9 95.7 Average 125 332 131 327 135
324 Stdev 368 573 378 569 383 568 p (t-test) 0.042 0.059 0.070 Min
0.259 0.723 0.259 0.723 0.259 0.723 Max 2160 3600 2160 3600 2160
3600 n (Patient) 37 112 35 114 34 115 sCr only Median 21.0 106 21.0
106 21.6 103 Average 121 359 121 359 124 355 Stdev 328 599 328 599
331 597 p (t-test) 0.011 0.011 0.013 Min 0.259 0.723 0.259 0.723
0.259 0.723 Max 2160 3600 2160 3600 2160 3600 n (Patient) 49 100 49
100 48 101 UO only Median 58.5 121 58.9 104 58.8 108 Average 212
405 223 369 206 386 Stdev 405 699 416 672 384 682 p (t-test) 0.034
0.11 0.043 Min 0.259 2.91 0.259 2.91 0.259 2.91 Max 2160 3600 2160
3600 2160 3600 n (Patient) 94 54 88 60 85 63 Recovery Period
Duration (hr) 24 48 72 sCr or UO sCr only UO only sCr or UO sCr
only UO only sCr or UO sCr only UO only AUC 0.73 0.72 0.65 0.72
0.72 0.62 0.71 0.72 0.63 SE 0.044 0.042 0.048 0.045 0.042 0.048
0.046 0.042 0.047 p Value 1.9E-7 6.5E-8 0.0022 5.0E-7 6.5E-8 0.015
2.8E-6 3.6E-7 0.0065 nCohort Recovered 37 49 94 35 49 88 34 48 85
nCohort Non-recovered 112 100 54 114 100 60 115 101 63 Cutoff
Quartile 2 17.2 17.2 17.6 17.2 17.2 17.6 17.2 17.2 17.6 Sensitivity
82% 84% 85% 82% 84% 85% 82% 83% 86% Specificity 46% 43% 31% 49% 43%
32% 47% 42% 33% Cutoff Quartile 3 78.3 78.3 80.9 78.3 78.3 80.9
78.3 78.3 80.9 Sensitivity 59% 61% 65% 58% 61% 60% 57% 60% 60%
Specificity 76% 71% 59% 74% 71% 57% 74% 71% 58% Cutoff Quartile 4
331 331 331 331 331 331 331 331 331 Sensitivity 31% 34% 35% 31% 34%
32% 30% 34% 32% Specificity 92% 92% 81% 91% 92% 80% 91% 92% 80% OR
Quartile 2 3.91 3.94 2.57 4.44 3.94 2.64 3.98 3.53 2.95 p Value
9.3E-4 5.6E-4 0.034 3.7E-4 5.6E-4 0.023 0.0010 0.0014 0.011 Lower
limit of 95% CI 1.74 1.81 1.08 1.96 1.81 1.14 1.75 1.63 1.27 Upper
limit of 95% CI 8.77 8.58 6.12 10.1 8.58 6.12 9.06 7.66 6.81 OR
Quartile 3 4.46 3.91 2.60 3.97 3.91 1.97 3.74 3.70 2.07 p Value
4.8E-4 3.0E-4 0.0069 0.0014 3.0E-4 0.046 0.0023 5.2E-4 0.032 Lower
limit of 95% CI 1.93 1.87 1.30 1.71 1.87 1.01 1.60 1.77 1.07 Upper
limit of 95% CI 10.3 8.18 5.20 9.24 8.18 3.84 8.73 7.76 4.02 OR
Quartile 4 5.15 5.80 2.29 4.73 5.80 1.80 4.52 5.58 1.86 p Value
0.0099 0.0018 0.032 0.015 0.0018 0.12 0.018 0.0023 0.11 Lower limit
of 95% CI 1.48 1.92 1.07 1.36 1.92 0.850 1.30 1.85 0.878 Upper
limit of 95% CI 17.9 17.5 4.90 16.5 17.5 3.82 15.8 16.8 3.94
TABLE-US-00046 TABLE 13.2 Comparison of marker levels and the area
under the ROC curve (AUC) in urine samples for the "recovered" and
"non-recovered" cohorts where recovery starts at 24 hours after
sample collection and renal status is assessed by serum creatinine
(sCr) only, urine output (UO) only, or serum creatinine or urine
output RIFLE criteria. Recovery Period Duration (hr) 24 48 72
Recovered Non-recovered Recovered Non-recovered Recovered
Non-recovered Cohort Cohort Cohort Cohort Cohort Cohort sCr or UO
Median 26.8 110 26.8 109 26.8 109 Average 121 363 125 357 125 357
Stdev 323 603 329 599 329 599 p (t-test) 0.0084 0.013 0.013 Min
0.259 0.723 0.259 0.723 0.259 0.723 Max 2160 3600 2160 3600 2160
3600 n (Patient) 51 98 49 100 49 100 sCr only Median 28.9 111 30.9
110 30.9 110 Average 125 382 127 378 127 378 Stdev 314 621 316 618
316 618 p (t-test) 0.0047 0.0060 0.0060 Min 0.259 0.723 0.259 0.723
0.259 0.723 Max 2160 3600 2160 3600 2160 3600 n (Patient) 56 91 55
92 55 92 UO only Median 58.5 114 58.8 109 58.8 109 Average 217 414
204 417 204 417 Stdev 405 724 377 722 377 722 p (t-test) 0.038
0.022 0.022 Min 0.259 2.91 0.259 2.91 0.259 2.91 Max 2160 3600 2160
3600 2160 3600 n (Patient) 94 50 89 55 89 55 Recovery Period
Duration (hr) 24 48 72 sCr or UO sCr only UO only sCr or UO sCr
only UO only sCr or UO sCr only UO only AUC 0.72 0.72 0.64 0.71
0.71 0.64 0.71 0.71 0.64 SE 0.042 0.042 0.050 0.043 0.042 0.048
0.043 0.042 0.048 p Value 1.7E-7 2.4E-7 0.0040 1.2E-6 1.2E-6 0.0036
1.2E-6 1.2E-6 0.0036 nCohort Recovered 51 56 94 49 55 89 49 55 89
nCohort Non-recovered 98 91 50 100 92 55 100 92 55 Cutoff Quartile
2 17.2 17.5 16.5 17.2 17.5 16.5 17.2 17.5 16.5 Sensitivity 84% 85%
86% 83% 84% 87% 83% 84% 87% Specificity 41% 41% 31% 41% 40% 33% 41%
40% 33% Cutoff Quartile 3 78.3 83.5 80.9 78.3 83.5 80.9 78.3 83.5
80.9 Sensitivity 62% 63% 64% 61% 62% 62% 61% 62% 62% Specificity
73% 70% 57% 71% 69% 57% 71% 69% 57% Cutoff Quartile 4 331 332 331
331 332 331 331 332 331 Sensitivity 35% 35% 34% 34% 35% 33% 34% 35%
33% Specificity 92% 91% 80% 92% 91% 80% 92% 91% 80% OR Quartile 2
3.59 3.83 2.74 3.37 3.42 3.31 3.37 3.42 3.31 p Value 0.0012 7.3E-4
0.030 0.0021 0.0018 0.0097 0.0021 0.0018 0.0097 Lower limit of 95%
CI 1.66 1.76 1.10 1.56 1.58 1.34 1.56 1.58 1.34 Upper limit of 95%
CI 7.77 8.36 6.81 7.29 7.41 8.22 7.29 7.41 8.22 OR Quartile 3 4.36
3.85 2.40 3.91 3.64 2.17 3.91 3.64 2.17 p Value 9.3E-5 2.0E-4 0.015
3.0E-4 3.6E-4 0.027 3.0E-4 3.6E-4 0.027 Lower limit of 95% CI 2.08
1.89 1.18 1.87 1.79 1.09 1.87 1.79 1.09 Upper limit of 95% CI 9.12
7.83 4.87 8.18 7.41 4.32 8.18 7.41 4.32 OR Quartile 4 6.24 5.53
2.03 5.80 5.33 1.92 5.80 5.33 1.92 p Value 0.0011 9.5E-4 0.072
0.0018 0.0012 0.095 0.0018 0.0012 0.095 Lower limit of 95% CI 2.07
2.01 0.940 1.92 1.93 0.893 1.92 1.93 0.893 Upper limit of 95% CI
18.8 15.3 4.40 17.5 14.7 4.12 17.5 14.7 4.12
TABLE-US-00047 TABLE 13.3 Comparison of marker levels and the area
under the ROC curve (AUC) in urine samples for the "recovered" and
"non-recovered" cohorts where recovery starts at 48 hours after
sample collection and renal status is assessed by serum creatinine
(sCr) only, urine output (UO) only, or serum creatinine or urine
output RIFLE criteria. Recovery Period Duration (hr) 24 48 72
Recovered Non-recovered Recovered Non-recovered Recovered
Non-recovered Cohort Cohort Cohort Cohort Cohort Cohort sCr or UO
Median 31.3 111 31.3 111 31.3 111 Average 154 380 154 380 153 376
Stdev 345 636 345 636 349 629 p (t-test) 0.012 0.012 0.014 Min
0.259 0.723 0.259 0.723 0.259 0.723 Max 2160 3600 2160 3600 2160
3600 n (Patient) 63 83 63 83 61 85 sCr only Median 32.9 110 32.9
110 32.1 111 Average 157 394 157 394 154 393 Stdev 339 652 339 652
340 648 p (t-test) 0.0082 0.0082 0.0075 Min 0.259 0.723 0.259 0.723
0.259 0.723 Max 2160 3600 2160 3600 2160 3600 n (Patient) 67 78 67
78 66 79 UO only Median 61.7 121 61.7 121 63.7 119 Average 231 446
231 446 238 423 Stdev 398 762 398 762 404 745 p (t-test) 0.039
0.039 0.072 Min 0.259 3.55 0.259 3.55 0.259 2.91 Max 2160 3600 2160
3600 2160 3600 n (Patient) 80 48 80 48 77 51 Recovery Period
Duration (hr) 24 48 72 sCr or UO sCr only UO only sCr or UO sCr
only UO only sCr or UO sCr only UO only AUC 0.69 0.69 0.64 0.69
0.69 0.64 0.69 0.69 0.61 SE 0.043 0.044 0.052 0.043 0.044 0.052
0.043 0.043 0.051 p Value 7.6E-6 2.0E-5 0.0079 7.6E-6 2.0E-5 0.0079
7.6E-6 7.0E-6 0.027 nCohort Recovered 63 67 80 63 67 80 61 66 77
nCohort Non-recovered 83 78 48 83 78 48 85 79 51 Cutoff Quartile 2
17.4 17.2 20.7 17.4 17.2 20.7 17.4 17.2 20.7 Sensitivity 84% 85%
85% 84% 85% 85% 84% 85% 82% Specificity 38% 36% 31% 38% 36% 31% 38%
36% 30% Cutoff Quartile 3 80.9 83.5 87.1 80.9 83.5 87.1 80.9 83.5
87.1 Sensitivity 64% 64% 60% 64% 64% 60% 64% 65% 59% Specificity
68% 66% 56% 68% 66% 56% 69% 67% 56% Cutoff Quartile 4 325 331 369
325 331 369 325 331 369 Sensitivity 34% 35% 31% 34% 35% 31% 34% 35%
29% Specificity 86% 85% 79% 86% 85% 79% 87% 86% 78% OR Quartile 2
3.31 3.07 2.66 3.31 3.07 2.66 3.07 3.19 1.99 p Value 0.0026 0.0055
0.039 0.0026 0.0055 0.039 0.0044 0.0041 0.12 Lower limit of 95% CI
1.52 1.39 1.05 1.52 1.39 1.05 1.42 1.44 0.833 Upper limit of 95% CI
7.23 6.78 6.75 7.23 6.78 6.75 6.65 7.05 4.74 OR Quartile 3 3.80
3.42 1.96 3.80 3.42 1.96 3.85 3.64 1.81 p Value 1.6E-4 4.3E-4 0.069
1.6E-4 4.3E-4 0.069 1.6E-4 2.3E-4 0.11 Lower limit of 95% CI 1.90
1.72 0.948 1.90 1.72 0.948 1.91 1.83 0.883 Upper limit of 95% CI
7.60 6.77 4.06 7.60 6.77 4.06 7.75 7.25 3.70 OR Quartile 4 3.05
3.02 1.68 3.05 3.02 1.68 3.43 3.48 1.47 p Value 0.0091 0.0081 0.21
0.0091 0.0081 0.21 0.0054 0.0037 0.35 Lower limit of 95% CI 1.32
1.33 0.748 1.32 1.33 0.748 1.44 1.50 0.656 Upper limit of 95% CI
7.07 6.84 3.79 7.07 6.84 3.79 8.17 8.06 3.30
TABLE-US-00048 TABLE 13.4 Comparison of marker levels and the area
under the ROC curve (AUC) in urine samples for the "recovered" and
"non-recovered" cohorts where recovery starts at 72 hours after
sample collection and renal status is assessed by serum creatinine
(sCr) only, urine output (UO) only, or serum creatinine or urine
output RIFLE criteria. Recovery Period Duration (hr) 24 48 72
Recovered Non-recovered Recovered Non-recovered Recovered
Non-recovered Cohort Cohort Cohort Cohort Cohort Cohort sCr or UO
Median 33.8 119 33.8 119 32.1 123 Average 144 432 145 416 136 413
Stdev 327 673 334 659 335 649 p (t-test) 0.0015 0.0029 0.0024 Min
0.259 0.723 0.259 0.723 0.259 0.723 Max 2160 3600 2160 3600 2160
3600 n (Patient) 71 71 67 75 64 78 sCr only Median 36.8 119 35.3
123 33.8 126 Average 148 437 145 436 138 439 Stdev 325 681 327 677
323 672 p (t-test) 0.0015 0.0014 8.8E-4 Min 0.259 0.723 0.259 0.723
0.259 0.723 Max 2160 3600 2160 3600 2160 3600 n (Patient) 73 69 72
70 71 71 UO only Median 72.2 109 72.2 109 75.9 109 Average 259 422
249 415 258 406 Stdev 447 757 422 746 427 733 p (t-test) 0.14 0.13
0.17 Min 0.259 5.59 0.259 2.91 0.259 2.91 Max 2160 3600 2160 3600
2160 3600 n (Patient) 74 45 68 51 67 53 Recovery Period Duration
(hr) 24 48 72 sCr or UO sCr only UO only sCr or UO sCr only UO only
sCr or UO sCr only UO only AUC 0.72 0.71 0.62 0.71 0.72 0.61 0.72
0.73 0.60 SE 0.043 0.043 0.054 0.043 0.043 0.053 0.042 0.042 0.052
p Value 3.4E-7 9.8E-7 0.032 1.0E-6 3.0E-7 0.046 8.3E-8 4.5E-8 0.061
nCohort Recovered 71 73 74 67 72 68 64 71 67 nCohort Non-recovered
71 69 45 75 70 51 78 71 53 Cutoff Quartile 2 17.4 17.4 25.6 17.4
17.4 25.6 17.4 17.4 25.8 Sensitivity 87% 87% 84% 85% 87% 82% 86%
87% 83% Specificity 38% 37% 31% 37% 38% 31% 39% 38% 31% Cutoff
Quartile 3 80.9 80.9 87.9 80.9 80.9 87.9 80.9 80.9 90.6 Sensitivity
66% 67% 58% 65% 67% 57% 65% 68% 57% Specificity 66% 66% 54% 67% 67%
54% 69% 68% 55% Cutoff Quartile 4 332 332 364 332 332 364 332 332
369 Sensitivity 38% 38% 29% 37% 39% 27% 37% 39% 26% Specificity 87%
86% 77% 88% 88% 76% 89% 89% 76% OR Quartile 2 4.23 3.91 2.45 3.46
4.07 2.09 3.90 4.23 2.23 p Value 8.6E-4 0.0016 0.063 0.0026 0.0012
0.10 0.0010 8.6E-4 0.075 Lower limit of 95% CI 1.81 1.68 0.952 1.54
1.74 0.861 1.73 1.81 0.922 Upper limit of 95% CI 9.87 9.12 6.30
7.78 9.49 5.05 8.79 9.87 5.40 OR Quartile 3 3.84 3.84 1.61 3.85
4.09 1.57 4.16 4.36 1.61 p Value 1.5E-4 1.5E-4 0.21 1.5E-4 7.9E-5
0.22 7.5E-5 4.1E-5 0.20 Lower limit of 95% CI 1.91 1.91 0.762 1.92
2.03 0.757 2.05 2.16 0.778 Upper limit of 95% CI 7.69 7.70 3.40
7.74 8.22 3.27 8.41 8.80 3.32 OR Quartile 4 4.23 3.81 1.36 4.39
4.40 1.23 4.82 5.13 1.14 p Value 8.6E-4 0.0015 0.47 9.0E-4 6.2E-4
0.63 7.0E-4 2.6E-4 0.75 Lower limit of 95% CI 1.81 1.67 0.587 1.83
1.88 0.535 1.94 2.14 0.499 Upper limit of 95% CI 9.87 8.70 3.16
10.5 10.3 2.83 12.0 12.3 2.62
TABLE-US-00049 TABLE 13.5 Comparison of marker levels and the area
under the ROC curve (AUC) in urine samples for the "recovered" and
"non-recovered" cohorts where recovery starts within 7 days after
sample collection and renal status is assessed by serum creatinine
(sCr) only, urine output (UO) only, or serum creatinine or urine
output RIFLE criteria. Recovery Period Duration (hr) 24 48 72
Recovered Non-recovered Recovered Non-recovered Recovered
Non-recovered Cohort Cohort Cohort Cohort Cohort Cohort sCr or UO
Median 40.8 118 44.2 117 40.8 118 Average 203 409 205 402 206 398
Stdev 383 708 384 703 386 698 p (t-test) 0.022 0.029 0.032 Min
0.259 5.59 0.259 2.91 0.259 2.91 Max 2160 3600 2160 3600 2160 3600
n (Patient) 93 56 92 57 91 58 sCr only Median 38.1 123 38.1 123
38.1 123 Average 149 446 149 446 149 446 Stdev 312 694 312 694 312
694 p (t-test) 6.5E-4 6.5E-4 6.5E-4 Min 0.259 0.723 0.259 0.723
0.259 0.723 Max 2160 3600 2160 3600 2160 3600 n (Patient) 83 66 83
66 83 66 UO only Median 58.9 118 58.9 118 58.9 118 Average 208 437
208 437 211 423 Stdev 373 757 373 757 377 745 p (t-test) 0.014
0.014 0.022 Min 0.259 3.55 0.259 3.55 0.259 2.91 Max 2160 3600 2160
3600 2160 3600 n (Patient) 100 48 100 48 98 50 Recovery Period
Duration (hr) 24 48 72 sCr or UO sCr only UO only sCr or UO sCr
only UO only sCr or UO sCr only UO only AUC 0.67 0.72 0.64 0.66
0.72 0.64 0.66 0.72 0.63 SE 0.047 0.043 0.050 0.047 0.043 0.050
0.047 0.043 0.050 p Value 2.1E-4 4.0E-7 0.0065 6.7E-4 4.0E-7 0.0065
4.5E-4 4.0E-7 0.012 nCohort Recovered 93 83 100 92 83 100 91 83 98
nCohort Non-recovered 56 66 48 57 66 48 58 66 50 Cutoff Quartile 2
17.2 17.2 17.6 17.2 17.2 17.6 17.2 17.2 17.6 Sensitivity 88% 88%
85% 86% 88% 85% 86% 88% 84% Specificity 32% 35% 30% 32% 35% 30% 32%
35% 30% Cutoff Quartile 3 78.3 78.3 80.9 78.3 78.3 80.9 78.3 78.3
80.9 Sensitivity 68% 68% 62% 67% 68% 62% 67% 68% 62% Specificity
60% 64% 56% 60% 64% 56% 60% 64% 56% Cutoff Quartile 4 331 331 331
331 331 331 331 331 331 Sensitivity 34% 39% 33% 33% 39% 33% 33% 39%
32% Specificity 80% 86% 79% 79% 86% 79% 79% 86% 79% OR Quartile 2
3.33 3.89 2.51 2.82 3.89 2.51 2.92 3.89 2.21 p Value 0.0090 0.0021
0.047 0.019 0.0021 0.047 0.015 0.0021 0.075 Lower limit of 95% CI
1.35 1.64 1.01 1.18 1.64 1.01 1.23 1.64 0.923 Upper limit of 95% CI
8.23 9.26 6.23 6.71 9.26 6.23 6.96 9.26 5.28 OR Quartile 3 3.20
3.79 2.12 2.97 3.79 2.12 3.14 3.79 2.09 p Value 0.0011 1.4E-4 0.037
0.0020 1.4E-4 0.037 0.0012 1.4E-4 0.038 Lower limit of 95% CI 1.59
1.91 1.05 1.49 1.91 1.05 1.57 1.91 1.04 Upper limit of 95% CI 6.42
7.51 4.29 5.93 7.51 4.29 6.26 7.51 4.19 OR Quartile 4 2.00 3.85
1.88 1.92 3.85 1.88 1.85 3.85 1.73 p Value 0.069 7.8E-4 0.11 0.087
7.8E-4 0.11 0.11 7.8E-4 0.16 Lower limit of 95% CI 0.946 1.75 0.872
0.910 1.75 0.872 0.876 1.75 0.803 Upper limit of 95% CI 4.23 8.44
4.06 4.05 8.44 4.06 3.89 8.44 3.71
Example 14. Use of Insulin-Like Growth Factor-Binding Protein 2 for
Evaluating Renal Status in Patients Admitted to the ICU: Persistent
at RIFLE F
[0154] Patients from the intensive care unit (ICU) with RIFLE stage
of injury (I) or failure (F) are enrolled in the following study.
EDTA anti-coagulated blood samples (10 mL) and urine samples (50
mL) are collected from each patient at enrollment, and at every 12
hours up to day 3, and then every 24 hours thereafter up to day 7
while the subject is hospitalized. Insulin-like growth
factor-binding protein 2 is measured in the enrollment samples by
standard immunoassay methods using commercially available assay
reagents.
[0155] Kidney status is assessed by RIFLE criteria based on serum
creatinine, urine output, or both serum creatinine and urine
output. Two cohorts are defined to represent a "persistent" and a
"non-persistent" population. "Persistent" indicates those patients
whose minimum RIFLE stage during a period of 24, 48 or 72 hours is
failure (F) where the persistence period can start from the time of
sample collection to 24, 48, 72, 96 or 168 hours after sample
collection. "Non-persistent" indicates those patients who are not
persistent at failure (F) and whose minimum RIFLE stage during a
period of 24, 48 or 72 hours is non-injury (RIFLE 0), risk of
injury (R), or injury (I) where the persistence period can start
from the time of sample collection to 24, 48, 72, 96 or 168 hours
after sample collection. If a patient dies after failure (F) or is
placed on renal replacement therapy (RRT) at any time from sample
collection to 24, 48, 72, 96 or 168 hours after sample collection,
the patient is considered "persistent".
[0156] The ability to distinguish the "persistent" and
"non-persistent" cohorts is determined using receiver operating
characteristic (ROC) analysis.
TABLE-US-00050 TABLE 14.1 Comparison of marker levels and the area
under the ROC curve (AUC) in urine samples for the "persistent" and
"non-persistent" cohorts where persistence starts within 24 hours
after sample collection and renal status is assessed by serum
creatinine (sCr) only, urine output (UO) only, or serum creatinine
or urine output RIFLE criteria. Persistence Period Duration (hr) 24
48 72 Non-persistent Persistent Non-persistent Persistent
Non-persistent Persistent Cohort Cohort Cohort Cohort Cohort Cohort
sCr or UO Median 3.47 15.6 3.49 15.6 3.53 11.3 Average 12.3 25.4
12.9 26.3 14.9 22.7 Stdev 21.5 31.8 22.2 32.4 25.0 29.1 p (t-test)
0.0033 0.0043 0.12 Min 3.16E-5 0.0645 3.16E-5 0.0645 3.16E-5 0.0645
Max 111 112 111 112 111 112 n (Patient) 98 51 106 43 113 36 sCr
only Median 3.47 14.5 3.52 15.6 3.55 11.3 Average 12.4 24.9 12.9
26.3 15.0 22.0 Stdev 21.6 31.7 22.2 32.4 25.2 28.6 p (t-test)
0.0049 0.0042 0.16 Min 3.16E-5 0.0645 3.16E-5 0.0645 3.16E-5 0.0645
Max 111 112 111 112 111 112 n (Patient) 97 52 106 43 111 38 UO only
Median 3.75 17.2 3.55 21.0 3.55 21.0 Average 15.9 23.7 15.8 24.9
15.8 24.9 Stdev 26.1 26.8 26.0 27.1 26.0 27.1 p (t-test) 0.24 0.18
0.18 Min 3.16E-5 0.0645 3.16E-5 0.0645 3.16E-5 0.0645 Max 111 112
111 112 111 112 n (Patient) 130 18 131 17 131 17 Persistence Period
Duration (hr) 24 48 72 sCr or UO sCr only UO only sCr or UO sCr
only UO only sCr or UO sCr only UO only AUC 0.64 0.62 0.68 0.65
0.63 0.70 0.61 0.59 0.70 SE 0.049 0.049 0.073 0.052 0.052 0.074
0.056 0.055 0.074 p Value 0.0050 0.012 0.012 0.0045 0.011 0.0078
0.044 0.098 0.0078 nCohort Non-persistent 98 97 130 106 106 131 113
111 131 nCohort Persistent 51 52 18 43 43 17 36 38 17 Cutoff
Quartile 2 1.89 1.89 1.93 1.89 1.89 1.93 1.89 1.89 1.93 Sensitivity
76% 75% 94% 79% 77% 94% 78% 74% 94% Specificity 26% 25% 28% 26% 25%
27% 26% 24% 27% Cutoff Quartile 3 4.13 4.13 4.52 4.13 4.13 4.52
4.13 4.13 4.52 Sensitivity 65% 63% 78% 65% 63% 82% 64% 61% 82%
Specificity 57% 57% 54% 56% 55% 54% 54% 53% 54% Cutoff Quartile 4
20.0 20.0 20.2 20.0 20.0 20.2 20.0 20.0 20.2 Sensitivity 43% 42%
50% 44% 47% 53% 42% 42% 53% Specificity 84% 84% 78% 82% 83% 79% 80%
80% 79% OR Quartile 2 1.11 0.986 6.51 1.36 1.13 6.06 1.21 0.900
6.06 p Value 0.79 0.97 0.074 0.48 0.78 0.086 0.68 0.81 0.086 Lower
limit of 95% CI 0.505 0.453 0.836 0.578 0.491 0.776 0.495 0.388
0.776 Upper limit of 95% CI 2.45 2.15 50.7 3.18 2.59 47.4 2.95 2.09
47.4 OR Quartile 3 2.44 2.27 4.08 2.34 2.04 5.52 2.08 1.74 5.52 p
Value 0.012 0.020 0.018 0.023 0.055 0.0096 0.065 0.15 0.0096 Lower
limit of 95% CI 1.21 1.14 1.28 1.12 0.986 1.51 0.957 0.822 1.51
Upper limit of 95% CI 4.92 4.55 13.1 4.89 4.22 20.1 4.50 3.68 20.1
OR Quartile 4 3.89 3.71 3.64 3.62 4.25 4.14 2.80 2.94 4.14 p Value
5.5E-4 8.2E-4 0.012 0.0012 3.0E-4 0.0074 0.012 0.0078 0.0074 Lower
limit of 95% CI 1.80 1.72 1.32 1.66 1.94 1.46 1.25 1.33 1.46 Upper
limit of 95% CI 8.40 8.00 10.0 7.91 9.32 11.7 6.25 6.52 11.7
TABLE-US-00051 TABLE 14.2 Comparison of marker levels and the area
under the ROC curve (AUC) in urine samples for the "persistent" and
"non-persistent" cohorts where persistence starts within 48 hours
after sample collection and renal status is assessed by serum
creatinine (sCr) only, urine output (UO) only, or serum creatinine
or urine output RIFLE criteria. Persistence Period Duration (hr) 24
48 72 Non-persistent Persistent Non-persistent Persistent
Non-persistent Persistent Cohort Cohort Cohort Cohort Cohort Cohort
sCr or UO Median 3.15 10.8 3.19 13.4 3.47 10.2 Average 12.5 23.4
12.9 24.2 15.1 20.7 Stdev 22.2 30.4 22.9 30.3 25.8 26.9 p (t-test)
0.013 0.012 0.23 Min 3.16E-5 0.0532 3.16E-5 0.0645 3.16E-5 0.0645
Max 111 112 111 112 111 112 n (Patient) 91 58 98 51 105 44 sCr only
Median 3.24 10.8 3.24 12.4 3.47 9.73 Average 12.6 23.3 13.0 23.8
15.3 19.9 Stdev 22.2 30.5 23.0 30.2 26.0 26.5 p (t-test) 0.014
0.016 0.32 Min 3.16E-5 0.0532 3.16E-5 0.0645 3.16E-5 0.0645 Max 111
112 111 112 111 112 n (Patient) 91 58 97 52 103 46 UO only Median
3.55 11.3 3.53 12.4 3.53 12.4 Average 16.3 19.8 16.2 20.5 16.2 20.5
Stdev 26.7 23.9 26.6 24.2 26.6 24.2 p (t-test) 0.54 0.46 0.46 Min
3.16E-5 0.0645 3.16E-5 0.0645 3.16E-5 0.0645 Max 111 112 111 112
111 112 n (Patient) 123 25 124 24 124 24 Persistence Period
Duration (hr) 24 48 72 sCr or UO sCr only UO only sCr or UO sCr
only UO only sCr or UO sCr only UO only AUC 0.63 0.62 0.64 0.65
0.64 0.65 0.62 0.60 0.65 SE 0.047 0.048 0.064 0.049 0.049 0.065
0.052 0.051 0.065 p Value 0.0049 0.013 0.029 0.0014 0.0035 0.023
0.022 0.064 0.023 nCohort Non-persistent 91 91 123 98 97 124 105
103 124 nCohort Persistent 58 58 25 51 52 24 44 46 24 Cutoff
Quartile 2 1.89 1.89 1.93 1.89 1.89 1.93 1.89 1.89 1.93 Sensitivity
78% 76% 88% 80% 79% 88% 80% 76% 88% Specificity 26% 25% 28% 28% 27%
27% 27% 25% 27% Cutoff Quartile 3 4.13 4.13 4.52 4.13 4.13 4.52
4.13 4.13 4.52 Sensitivity 66% 64% 72% 67% 65% 75% 66% 63% 75%
Specificity 59% 58% 54% 58% 58% 55% 56% 55% 55% Cutoff Quartile 4
20.0 20.0 20.2 20.0 20.0 20.2 20.0 20.0 20.2 Sensitivity 40% 40%
40% 43% 42% 42% 39% 37% 42% Specificity 84% 84% 78% 84% 84% 78% 80%
80% 78% OR Quartile 2 1.24 1.06 2.80 1.56 1.36 2.64 1.41 1.07 2.64
p Value 0.59 0.88 0.11 0.29 0.45 0.13 0.42 0.86 0.13 Lower limit of
95% CI 0.572 0.495 0.787 0.686 0.611 0.741 0.604 0.478 0.741 Upper
limit of 95% CI 2.69 2.28 9.97 3.54 3.05 9.44 3.31 2.42 9.44 OR
Quartile 3 2.77 2.46 3.08 2.78 2.58 3.64 2.48 2.11 3.64 p Value
0.0035 0.0094 0.019 0.0046 0.0079 0.010 0.015 0.040 0.010 Lower
limit of 95% CI 1.40 1.25 1.20 1.37 1.28 1.35 1.19 1.04 1.35 Upper
limit of 95% CI 5.50 4.84 7.89 5.64 5.19 9.80 5.16 4.32 9.80 OR
Quartile 4 3.33 3.33 2.37 3.89 3.71 2.57 2.52 2.29 2.57 p Value
0.0020 0.0020 0.062 5.5E-4 8.2E-4 0.044 0.019 0.034 0.044 Lower
limit of 95% CI 1.55 1.55 0.957 1.80 1.72 1.03 1.16 1.06 1.03 Upper
limit of 95% CI 7.15 7.15 5.87 8.40 8.00 6.42 5.45 4.93 6.42
TABLE-US-00052 TABLE 14.3 Comparison of marker levels and the area
under the ROC curve (AUC) in urine samples for the "persistent" and
"non-persistent" cohorts where persistence starts within 72 hours
after sample collection and renal status is assessed by serum
creatinine (sCr) only, urine output (UO) only, or serum creatinine
or urine output RIFLE criteria. Persistence Period Duration (hr) 24
48 72 Non-persistent Persistent Non-persistent Persistent
Non-persistent Persistent Cohort Cohort Cohort Cohort Cohort Cohort
sCr or UO Median 3.09 10.3 2.97 13.4 3.19 10.3 Average 11.6 23.8
11.1 25.3 14.6 21.0 Stdev 20.2 31.4 19.9 31.9 25.4 27.4 p (t-test)
0.0044 0.0010 0.16 Min 3.16E-5 0.0532 3.16E-5 0.0645 3.16E-5 0.0645
Max 111 112 111 112 111 112 n (Patient) 86 63 90 59 98 51 sCr only
Median 3.15 9.73 3.09 11.3 3.47 8.85 Average 11.7 23.5 11.4 25.0
14.9 20.1 Stdev 20.3 31.3 19.9 32.0 25.4 27.4 p (t-test) 0.0062
0.0017 0.25 Min 3.16E-5 0.0532 3.16E-5 0.0645 3.16E-5 0.0645 Max
111 112 111 112 111 112 n (Patient) 85 64 90 59 97 52 UO only
Median 3.49 12.4 3.50 13.4 3.50 13.4 Average 15.7 21.2 15.6 21.8
15.6 21.8 Stdev 26.4 25.7 26.3 25.9 26.3 25.9 p (t-test) 0.29 0.24
0.24 Min 3.16E-5 0.0645 3.16E-5 0.0645 3.16E-5 0.0645 Max 111 112
111 112 111 112 n (Patient) 116 32 117 31 117 31 Persistence Period
Duration (hr) 24 48 72 sCr or UO sCr only UO only sCr or UO sCr
only UO only sCr or UO sCr only UO only AUC 0.64 0.63 0.65 0.68
0.66 0.66 0.63 0.60 0.66 SE 0.046 0.047 0.058 0.046 0.047 0.058
0.049 0.050 0.058 p Value 0.0027 0.0067 0.0089 1.1E-4 7.7E-4 0.0070
0.0087 0.047 0.0070 nCohort Non-persistent 86 85 116 90 90 117 98
97 117 nCohort Persistent 63 64 32 59 59 31 51 52 31 Cutoff
Quartile 2 1.89 1.89 1.93 1.89 1.89 1.93 1.89 1.89 1.93 Sensitivity
76% 75% 84% 80% 78% 84% 78% 75% 84% Specificity 26% 25% 28% 28% 27%
27% 27% 25% 27% Cutoff Quartile 3 4.13 4.13 4.52 4.13 4.13 4.52
4.13 4.13 4.52 Sensitivity 65% 64% 72% 68% 66% 74% 67% 63% 74%
Specificity 60% 60% 56% 61% 60% 56% 58% 57% 56% Cutoff Quartile 4
20.0 20.0 20.2 20.0 20.0 20.2 20.0 20.0 20.2 Sensitivity 40% 39%
41% 42% 41% 42% 37% 35% 42% Specificity 85% 85% 79% 86% 84% 79% 81%
79% 79% OR Quartile 2 1.10 0.984 2.06 1.51 1.29 1.96 1.31 0.986
1.96 p Value 0.80 0.97 0.17 0.31 0.52 0.21 0.51 0.97 0.21 Lower
limit of 95% CI 0.517 0.465 0.729 0.688 0.594 0.692 0.588 0.453
0.692 Upper limit of 95% CI 2.34 2.08 5.81 3.30 2.79 5.54 2.93 2.15
5.54 OR Quartile 3 2.85 2.67 3.26 3.31 2.92 3.72 2.78 2.27 3.72 p
Value 0.0023 0.0040 0.0067 6.9E-4 0.0021 0.0036 0.0046 0.020 0.0036
Lower limit of 95% CI 1.45 1.37 1.39 1.66 1.48 1.54 1.37 1.14 1.54
Upper limit of 95% CI 5.60 5.23 7.65 6.60 5.80 9.00 5.64 4.55 9.00
OR Quartile 4 3.69 3.55 2.62 4.36 3.72 2.80 2.47 2.04 2.80 p Value
9.7E-4 0.0014 0.024 2.3E-4 8.4E-4 0.017 0.019 0.064 0.017 Lower
limit of 95% CI 1.70 1.64 1.14 1.99 1.72 1.20 1.16 0.959 1.20 Upper
limit of 95% CI 8.03 7.71 6.05 9.52 8.05 6.50 5.26 4.33 6.50
TABLE-US-00053 TABLE 14.4 Comparison of marker levels and the area
under the ROC curve (AUC) in urine samples for the "persistent" and
"non-persistent" cohorts where persistence starts within 96 hours
after sample collection and renal status is assessed by serum
creatinine (sCr) only, urine output (UO) only, or serum creatinine
or urine output RIFLE criteria. Persistence Period Duration (hr) 24
48 72 Non-persistent Persistent Non-persistent Persistent
Non-persistent Persistent Cohort Cohort Cohort Cohort Cohort Cohort
sCr or UO Median 3.03 10.8 2.97 13.4 3.19 10.3 Average 11.2 24.2
11.1 25.3 14.1 21.6 Stdev 20.0 31.3 19.9 31.9 24.9 27.9 p (t-test)
0.0024 0.0010 0.094 Min 3.16E-5 0.0532 3.16E-5 0.0645 3.16E-5
0.0645 Max 111 112 111 112 111 112 n (Patient) 85 64 90 59 96 53
sCr only Median 3.15 9.73 3.03 12.4 3.24 9.73 Average 11.7 23.5
11.3 24.9 14.2 21.2 Stdev 20.3 31.3 20.0 31.8 25.0 27.8 p (t-test)
0.0062 0.0015 0.12 Min 3.16E-5 0.0532 3.16E-5 0.0645 3.16E-5 0.0645
Max 111 112 111 112 111 112 n (Patient) 85 64 89 60 95 54 UO only
Median 3.35 12.4 3.47 12.4 3.47 12.4 Average 14.8 23.3 15.0 23.2
15.0 23.2 Stdev 25.3 28.4 25.3 28.7 25.3 28.7 p (t-test) 0.090 0.11
0.11 Min 3.16E-5 0.0645 3.16E-5 0.0645 3.16E-5 0.0645 Max 111 112
111 112 111 112 n (Patient) 112 36 114 34 114 34 Persistence Period
Duration (hr) 24 48 72 sCr or UO sCr only UO only sCr or UO sCr
only UO only sCr or UO sCr only UO only AUC 0.65 0.63 0.67 0.68
0.66 0.67 0.63 0.62 0.67 SE 0.046 0.047 0.054 0.046 0.046 0.056
0.049 0.049 0.056 p Value 0.0011 0.0067 0.0017 1.1E-4 3.8E-4 0.0031
0.0067 0.016 0.0031 nCohort Non-persistent 85 85 112 90 89 114 96
95 114 nCohort Persistent 64 64 36 59 60 34 53 54 34 Cutoff
Quartile 2 1.89 1.89 1.93 1.89 1.89 1.93 1.89 1.89 1.93 Sensitivity
77% 75% 86% 80% 78% 85% 77% 76% 85% Specificity 26% 25% 29% 28% 27%
28% 26% 25% 28% Cutoff Quartile 3 4.13 4.13 4.52 4.13 4.13 4.52
4.13 4.13 4.52 Sensitivity 66% 64% 72% 68% 67% 74% 66% 65% 74%
Specificity 61% 60% 57% 61% 61% 57% 58% 58% 57% Cutoff Quartile 4
20.0 20.0 20.2 20.0 20.0 20.2 20.0 20.0 20.2 Sensitivity 41% 39%
42% 42% 42% 41% 38% 37% 41% Specificity 86% 85% 80% 86% 85% 80% 81%
81% 80% OR Quartile 2 1.14 0.984 2.48 1.51 1.33 2.26 1.20 1.07 2.26
p Value 0.73 0.97 0.084 0.31 0.46 0.12 0.65 0.87 0.12 Lower limit
of 95% CI 0.536 0.465 0.886 0.688 0.617 0.805 0.547 0.490 0.805
Upper limit of 95% CI 2.43 2.08 6.94 3.30 2.89 6.36 2.65 2.32 6.36
OR Quartile 3 3.01 2.67 3.47 3.31 3.09 3.68 2.72 2.53 3.68 p Value
0.0014 0.0040 0.0030 6.9E-4 0.0013 0.0026 0.0049 0.0084 0.0026
Lower limit of 95% CI 1.53 1.37 1.53 1.66 1.56 1.58 1.35 1.27 1.58
Upper limit of 95% CI 5.91 5.23 7.87 6.60 6.12 8.60 5.47 5.06 8.60
OR Quartile 4 4.16 3.55 2.92 4.36 4.18 2.77 2.63 2.52 2.77 p Value
3.9E-4 0.0014 0.0095 2.3E-4 3.3E-4 0.015 0.012 0.016 0.015 Lower
limit of 95% CI 1.89 1.64 1.30 1.99 1.91 1.22 1.23 1.18 1.22 Upper
limit of 95% CI 9.16 7.71 6.57 9.52 9.12 6.30 5.59 5.35 6.30
TABLE-US-00054 TABLE 14.5 Comparison of marker levels and the area
under the ROC curve (AUC) in urine samples for the "persistent" and
"non-persistent" cohorts where persistence starts within 168 hours
after sample collection and renal status is assessed by serum
creatinine (sCr) only, urine output (UO) only, or serum creatinine
or urine output RIFLE criteria. Persistence Period Duration (hr) 24
48 72 Non-persistent Persistent Non-persistent Persistent
Non-persistent Persistent Cohort Cohort Cohort Cohort Cohort Cohort
sCr or UO Median 2.97 11.3 2.85 15.6 3.15 10.8 Average 10.3 24.7
9.85 26.2 13.9 21.6 Stdev 18.3 31.8 17.9 32.2 25.0 27.5 p (t-test)
6.6E-4 1.2E-4 0.081 Min 3.16E-5 0.0532 3.16E-5 0.0645 3.16E-5
0.0645 Max 111 112 111 112 111 112 n (Patient) 82 67 86 63 93 56
sCr only Median 3.03 10.8 2.91 14.5 3.15 10.8 Average 10.7 24.4
10.3 25.9 13.4 22.4 Stdev 18.6 31.9 18.2 32.4 23.9 28.9 p (t-test)
0.0013 2.6E-4 0.042 Min 3.16E-5 0.0532 3.16E-5 0.0645 3.16E-5
0.0645 Max 111 112 111 112 111 112 n (Patient) 83 66 87 62 93 56 UO
only Median 3.24 13.4 3.35 14.5 3.35 14.5 Average 14.7 23.2 14.6
23.8 14.6 23.8 Stdev 25.4 28.0 25.3 28.2 25.3 28.2 p (t-test) 0.089
0.069 0.069 Min 3.16E-5 0.0645 3.16E-5 0.0645 3.16E-5 0.0645 Max
111 112 111 112 111 112 n (Patient) 111 37 112 36 112 36
Persistence Period Duration (hr) 24 48 72 sCr or UO sCr only UO
only sCr or UO sCr only UO only sCr or UO sCr only UO only AUC 0.65
0.64 0.68 0.69 0.68 0.68 0.63 0.64 0.68 SE 0.045 0.046 0.054 0.045
0.045 0.054 0.048 0.048 0.054 p Value 6.8E-4 0.0017 9.7E-4 1.8E-5
6.2E-5 7.3E-4 0.0052 0.0047 7.3E-4 nCohort Non-persistent 82 83 111
86 87 112 9.3 93 112 nCohort Persistent 67 66 37 63 62 36 56 56 36
Cutoff Quartile 2 1.89 1.89 1.93 1.89 1.89 1.93 1.89 1.89 1.93
Sensitivity 76% 76% 86% 79% 79% 86% 77% 77% 86% Specificity 26% 25%
29% 28% 28% 29% 26% 26% 29% Cutoff Quartile 3 4.13 4.13 4.52 4.13
4.13 4.52 4.13 4.13 4.52 Sensitivity 66% 65% 73% 68% 68% 75% 66%
66% 75% Specificity 62% 61% 58% 63% 62% 58% 59% 59% 58% Cutoff
Quartile 4 20.0 20.0 20.2 20.0 20.0 20.2 20.0 20.0 20.2 Sensitivity
40% 39% 41% 43% 42% 42% 38% 38% 42% Specificity 87% 86% 80% 87% 86%
80% 82% 82% 80% OR Quartile 2 1.10 1.06 2.59 1.49 1.44 2.48 1.15
1.15 2.48 p Value 0.81 0.88 0.069 0.31 0.36 0.084 0.72 0.72 0.084
Lower limit of 95% CI 0.519 0.500 0.927 0.689 0.664 0.886 0.530
0.530 0.886 Upper limit of 95% CI 2.32 2.24 7.25 3.22 3.11 6.94
2.50 2.50 6.94 OR Quartile 3 3.15 2.98 3.68 3.63 3.44 4.15 2.82
2.82 4.15 p Value 8.5E-4 0.0015 0.0018 2.4E-4 4.2E-4 9.3E-4 0.0033
0.0033 9.3E-4 Lower limit of 95% CI 1.60 1.52 1.62 1.82 1.73 1.79
1.41 1.41 1.79 Upper limit of 95% CI 6.17 5.84 8.33 7.22 6.83 9.64
5.62 5.62 9.64 OR Quartile 4 4.36 3.85 2.76 5.11 4.51 2.92 2.68
2.68 2.92 p Value 3.2E-4 7.8E-4 0.014 7.2E-5 1.9E-4 0.0095 0.010
0.010 0.0095 Lower limit of 95% CI 1.96 1.75 1.23 2.28 2.05 1.30
1.26 1.26 1.30 Upper limit of 95% CI 9.71 8.44 6.17 11.4 9.96 6.57
5.70 5.70 6.57
Example 15. Use of Insulin-Like Growth Factor-Binding Protein 2 for
Evaluating Renal Status in Patients Admitted to the ICU: Persistent
at RIFLE I or F
[0157] Patients from the intensive care unit (ICU) with RIFLE stage
of injury (I) or failure (F) are enrolled in the following study.
EDTA anti-coagulated blood samples (10 mL) and urine samples (50
mL) are collected from each patient at enrollment, and at every 12
hours up to day 3, and then every 24 hours thereafter up to day 7
while the subject is hospitalized. Insulin-like growth
factor-binding protein 2 is measured in the enrollment samples by
standard immunoassay methods using commercially available assay
reagents.
[0158] Kidney status is assessed by RIFLE criteria based on serum
creatinine, urine output, or both serum creatinine and urine
output. Two cohorts are defined to represent a "persistent" and a
"non-persistent" population. "Persistent" indicates those patients
whose minimum RIFLE stage during a period of 24, 48 or 72 hours is
injury (I) or failure (F) where the persistence period can start
from the time of sample collection to 24, 48, 72, 96 or 168 hours
after sample collection. "Non-persistent" indicates those patients
who are not persistent at injury (I) or failure (F) and whose
minimum RIFLE stage during a period of 24, 48 or 72 hours is
non-injury (RIFLE 0) or risk of injury (R) where the persistence
period can start from the time of sample collection to 24, 48, 72,
96 or 168 hours after sample collection. If a patient dies after
injury (I) or failure (F) or is placed on renal replacement therapy
(RRT) at any time from sample collection to 24, 48, 72, 96 or 168
hours after sample collection, the patient is considered
"persistent".
[0159] The ability to distinguish the "persistent" and
"non-persistent" cohorts is determined using receiver operating
characteristic (ROC) analysis.
TABLE-US-00055 TABLE 15.1 Comparison of marker levels and the area
under the ROC curve (AUC) in urine samples for the "persistent" and
"non-persistent" cohorts where persistence starts within 24 hours
after sample collection and renal status is assessed by serum
creatinine (sCr) only, urine output (UO) only, or serum creatinine
or urine output RIFLE criteria. Persistence Period Duration (hr) 24
48 72 Non-persistent Persistent Non-persistent Persistent
Non-persistent Persistent Cohort Cohort Cohort Cohort Cohort Cohort
sCr or UO Median 2.31 9.57 2.97 7.04 2.97 11.3 Average 6.67 22.7
9.93 24.3 9.33 27.5 Stdev 12.6 30.0 14.8 33.1 14.1 34.7 D (t-test)
2.5E-4 7.0E-4 1.9E-5 Min 3.16E-5 0.0532 3.16E-5 0.0532 3.16E-5
0.0532 Max 78.7 112 78.7 112 78.7 112 n (Patient) 55 94 78 71 88 61
sCr only Median 2.35 9.57 2.97 7.04 3.03 10.8 Average 7.38 22.6
10.3 23.5 9.80 27.1 Stdev 13.4 30.2 15.4 32.7 14.6 34.9 p (t-test)
4.7E-4 0.0019 5.2E-5 Min 3.16E-5 0.0532 3.16E-5 0.0532 3.16E-5
0.0532 Max 78.7 112 78.7 112 78.7 112 n (Patient) 57 92 76 73 89 60
UO only Median 3.75 6.98 3.96 13.4 3.53 22.0 Average 15.1 22.7 14.7
26.4 14.3 30.6 Stdev 24.7 30.4 24.2 32.6 23.9 33.7 p (t-test) 0.14
0.037 0.0060 Min 3.16E-5 0.0645 3.16E-5 0.0645 3.16E-5 0.0645 Max
109 112 109 112 109 112 n (Patient) 114 34 121 27 125 23
Persistence Period Duration (hr) 24 48 72 sCr or UO sCr only UO
only sCr or UO sCr only UO only sCr or UO sCr only UO only AUC 0.71
0.69 0.61 0.63 0.62 0.64 0.66 0.65 0.71 SE 0.042 0.043 0.057 0.046
0.046 0.062 0.046 0.047 0.064 p Value 5.6E-7 1.7E-5 0.050 0.0050
0.0092 0.020 4.7E-4 0.0013 0.0014 nCohort Non-persistent 55 57 114
78 76 121 88 89 125 nCohort Persistent 94 92 34 71 73 27 61 60 23
Cutoff Quartile 2 1.89 1.89 1.93 1.89 1.89 1.93 1.89 1.89 1.93
Sensitivity 81% 79% 82% 77% 77% 81% 79% 78% 87% Specificity 35% 32%
27% 27% 26% 26% 27% 27% 27% Cutoff Quartile 3 4.13 4.13 4.52 4.13
4.13 4.52 4.13 4.13 4.52 Sensitivity 63% 62% 62% 59% 60% 67% 64%
65% 78% Specificity 71% 68% 54% 58% 59% 54% 59% 60% 55% Cutoff
Quartile 4 20.0 20.0 20.2 20.0 20.0 20.2 20.0 20.0 20.2 Sensitivity
37% 37% 41% 37% 36% 48% 43% 42% 57% Specificity 95% 93% 80% 85% 84%
80% 86% 85% 81% OR Quartile 2 2.23 1.77 1.74 1.27 1.18 1.58 1.38
1.33 2.49 p Value 0.038 0.14 0.26 0.54 0.67 0.39 0.41 0.46 0.16
Lower limit of 95% CI 1.05 0.835 0.658 0.599 0.558 0.553 0.640
0.617 0.695 Upper limit of 95% CI 4.75 3.76 4.61 2.68 2.48 4.53
3.00 2.89 8.92 OR Quartile 3 4.11 3.53 1.86 1.97 2.20 2.32 2.56
2.73 4.44 p Value 1.1E-4 4.1E-4 0.12 0.041 0.018 0.060 0.0062
0.0037 0.0055 Lower limit of 95% CI 2.01 1.75 0.849 1.03 1.14 0.966
1.31 1.39 1.55 Upper limit of 95% CI 8.41 7.10 4.07 3.79 4.24 5.58
5.02 5.39 12.7 OR Quartile 4 10.3 7.77 2.77 3.18 2.95 3.75 4.70
4.18 5.47 p Value 2.2E-4 2.6E-4 0.015 0.0038 0.0066 0.0031 1.3E-4
3.3E-4 3.8E-4 Lower limit of 95% CI 2.99 2.58 1.22 1.45 1.35 1.56
2.13 1.91 2.14 Upper limit of 95% CI 35.4 23.4 6.30 6.95 6.44 9.02
10.4 9.12 14.0
TABLE-US-00056 TABLE 15.2 Comparison of marker levels and the area
under the ROC curve (AUC) in urine samples for the "persistent" and
"non-persistent" cohorts where persistence starts within 48 hours
after sample collection and renal status is assessed by serum
creatinine (sCr) only, urine output (UO) only, or serum creatinine
or urine output RIFLE criteria. Persistence Period Duration (hr) 24
48 72 Non-persistent Persistent Non-persistent Persistent
Non-persistent Persistent Cohort Cohort Cohort Cohort Cohort Cohort
sCr or UO Median 2.30 9.12 2.65 8.16 2.61 11.3 Average 6.65 22.5
9.62 23.6 8.94 26.3 Stdev 12.7 29.9 15.1 32.2 14.4 33.3 p (t-test)
3.0E-4 9.4E-4 3.6E-5 Min 3.16E-5 0.0532 3.16E-5 0.0532 3.16E-5
0.0532 Max 78.7 112 78.7 112 78.7 112 n (Patient) 54 95 73 76 82 67
sCr only Median 2.35 9.12 2.79 7.39 2.72 10.3 Average 7.37 22.4
10.3 2.3.0 9.59 25.5 Stdev 13.6 30.1 15.7 32.2 15.0 33.4 p (t-test)
5.6E-4 0.0026 1.6E-4 Min 3.16E-5 0.0532 3.16E-5 0.0532 3.16E-5
0.0532 Max 78.7 112 78.7 112 78.7 112 n (Patient) 56 93 73 76 82 67
UO only Median 3.49 7.04 3.51 13.4 3.47 21.0 Average 14.5 23.0 14.1
25.9 13.7 28.9 Stdev 24.0 30.5 23.5 32.3 23.2 33.1 p (t-test) 0.075
0.020 0.0038 Min 3.16E-5 0.0645 3.16E-5 0.0645 3.16E-5 0.0645 Max
109 112 109 112 109 112 n (Patient) 106 42 113 35 117 31
Persistence Period Duration (hr) 24 48 72 sCr or UO sCr only UO
only sCr or UO sCr only UO only sCr or UO sCr only UO only AUC 0.71
0.69 0.63 0.65 0.63 0.66 0.69 0.66 0.71 SE 0.042 0.043 0.052 0.045
0.045 0.055 0.044 0.045 0.057 p Value 2.8E-7 1.1E-5 0.012 7.2E-4
0.0048 0.0044 2.5E-5 3.9E-4 2.7E-4 nCohort Non-persistent 54 56 106
73 73 113 82 82 117 nCohort Persistent 95 93 42 76 76 35 67 67 31
Cutoff Quartile 2 1.89 1.89 1.93 1.89 1.89 1.93 1.89 1.89 1.93
Sensitivity 81% 80% 83% 79% 78% 83% 81% 79% 87% Specificity 35% 32%
28% 29% 27% 27% 29% 28% 28% Cutoff Quartile 3 4.13 4.13 4.52 4.13
4.13 4.52 4.13 4.13 4.52 Sensitivity 63% 62% 64% 62% 61% 69% 67%
66% 77% Specificity 72% 70% 56% 62% 60% 56% 63% 62% 57% Cutoff
Quartile 4 20.0 20.0 20.2 20.0 20.0 20.2 20.0 20.0 20.2 Sensitivity
37% 37% 40% 37% 36% 46% 42% 40% 52% Specificity 94% 93% 81% 86% 85%
81% 88% 87% 82% OR Quartile 2 2.32 1.84 1.97 1.51 1.31 1.83 1.72
1.48 2.65 p Value 0.029 0.11 0.15 0.28 0.48 0.22 0.17 0.32 0.089
Lower limit of 95% CI 1.09 0.868 0.791 0.716 0.621 0.692 0.796
0.690 0.861 Upper limit of 95% CI 4.96 3.92 4.93 3.20 2.76 4.83
3.71 3.16 8.17 OR Quartile 3 4.46 3.80 2.26 2.60 2.33 2.75 3.55
3.15 4.59 p Value 5.6E-5 2.2E-4 0.030 0.0045 0.012 0.014 2.6E-4
8.5E-4 0.0011 Lower limit of 95% CI 2.15 1.87 1.08 1.35 1.21 1.23
1.80 1.60 1.83 Upper limit of 95% CI 9.22 7.71 4.73 5.04 4.49 6.15
7.00 6.17 11.5 OR Quartile 4 9.92 7.49 2.92 3.68 3.11 3.69 5.17
4.36 4.88 p Value 2.8E-4 3.4E-4 0.0074 0.0017 0.0052 0.0017 8.7E-5
3.2E-4 2.5E-4 Lower limit of 95% CI 2.88 2.49 1.33 1.63 1.40 1.63
2.28 1.96 2.09 Upper limit of 95% CI 34.2 22.5 6.41 8.29 6.88 8.35
11.7 9.71 11.4
TABLE-US-00057 TABLE 15.3 Comparison of marker levels and the area
under the ROC curve (AUC) in urine samples for the "persistent" and
"non-persistent" cohorts where persistence starts within 72 hours
after sample collection and renal status is assessed by serum
creatinine (sCr) only, urine output (UO) only, or serum creatinine
or urine output RIFLE criteria. Persistence Period Duration (hr) 24
48 72 Non-persistent Persistent Non-persistent Persistent
Non-persistent Persistent Cohort Cohort Cohort Cohort Cohort Cohort
sCr or UO Median 2.30 9.12 2.72 7.74 2.72 10.3 Average 6.65 22.5
9.72 23.3 9.19 25.1 Stdev 12.7 29.9 15.2 32.0 14.7 32.8 p (t-test)
3.0E-4 0.0013 1.6E-4 Min 3.16E-5 0.0532 3.16E-5 0.0532 3.16E-5
0.0532 Max 78.7 112 78.7 112 78.7 112 n (Patient) 54 95 72 77 78 71
sCr only Median 2.35 9.12 2.85 7.04 2.85 9.12 Average 7.37 22.4
10.4 22.7 9.79 24.4 Stdev 13.6 30.1 15.7 32.0 15.3 32.8 p (t-test)
5.6E-4 0.0036 5.3E-4 Min 3.16E-5 0.0532 3.16E-5 0.0532 3.16E-5
0.0532 Max 78.7 112 78.7 112 78.7 112 n (Patient) 56 93 72 77 78 71
UO only Median 3.49 7.04 3.49 10.8 3.47 14.5 Average 14.9 20.9 14.3
23.4 13.8 25.6 Stdev 24.6 29.1 24.1 30.3 23.7 31.1 p (t-test) 0.19
0.056 0.016 Min 3.16E-5 0.0645 3.16E-5 0.0645 3.16E-5 0.0645 Max
109 112 109 112 109 112 n (Patient) 100 48 106 42 110 38
Persistence Period Duration (hr) 24 48 72 sCr or UO sCr only UO
only sCr or UO sCr only UO only sCr or UO sCr only UO only AUC 0.71
0.69 0.61 0.65 0.62 0.64 0.67 0.64 0.68 SE 0.042 0.043 0.051 0.045
0.046 0.052 0.044 0.045 0.053 p Value 2.8E-7 1.1E-5 0.031 0.0011
0.0069 0.0083 1.6E-4 0.0014 9.3E-4 nCohort Non-persistent 54 56 100
72 72 106 78 78 110 nCohort Persistent 95 93 48 77 77 42 71 71 38
Cutoff Quartile 2 1.89 1.89 1.93 1.89 1.89 1.93 1.89 1.89 1.93
Sensitivity 81% 80% 79% 79% 78% 79% 79% 77% 82% Specificity 35% 32%
27% 29% 28% 26% 28% 27% 27% Cutoff Quartile 3 4.13 4.13 4.52 4.13
4.13 4.52 4.13 4.13 4.52 Sensitivity 63% 62% 62% 61% 60% 67% 65%
63% 74% Specificity 72% 70% 56% 61% 60% 57% 63% 62% 58% Cutoff
Quartile 4 20.0 20.0 20.2 20.0 20.0 20.2 20.0 20.0 20.2 Sensitivity
37% 37% 35% 36% 35% 40% 39% 38% 45% Specificity 94% 93% 80% 86% 85%
81% 87% 86% 82% OR Quartile 2 2.32 1.84 1.41 1.57 1.36 1.32 1.47
1.27 1.66 p Value 0.029 0.11 0.42 0.24 0.42 0.53 0.32 0.54 0.28
Lower limit of 95% CI 1.09 0.868 0.616 0.742 0.644 0.560 0.690
0.599 0.661 Upper limit of 95% CI 4.96 3.92 3.21 3.32 2.86 3.09
3.12 2.68 4.17 OR Quartile 3 4.46 3.80 2.12 2.46 2.20 2.61 3.11
2.77 3.90 p Value 5.6E-5 2.2E-4 0.037 0.0074 0.018 0.012 9.0E-4
0.0027 0.0011 Lower limit of 95% CI 2.15 1.87 1.05 1.27 1.14 1.24
1.59 1.43 1.72 Upper limit of 95% CI 9.22 7.71 4.29 4.76 4.24 5.51
6.07 5.38 8.80 OR Quartile 4 9.92 7.49 2.19 3.54 2.99 2.92 4.43
3.74 3.64 p Value 2.8E-4 3.4E-4 0.045 0.0023 0.0068 0.0074 3.6E-4
0.0012 0.0016 Lower limit of 95% CI 2.88 2.49 1.02 1.57 1.35 1.33
1.96 1.68 1.63 Upper limit of 95% CI 34.2 22.5 4.73 7.99 6.63 6.41
10.0 8.30 8.13
TABLE-US-00058 TABLE 15.4 Comparison of marker levels and the area
under the ROC curve (AUC) in urine samples for the "persistent" and
"non-persistent" cohorts where persistence starts within 96 hours
after sample collection and renal status is assessed by serum
creatinine (sCr) only, urine output (UO) only, or serum creatinine
or urine output RIFLE criteria. Persistence Period Duration (hr) 24
48 72 Non-persistent Persistent Non-persistent Persistent
Non-persistent Persistent Cohort Cohort Cohort Cohort Cohort Cohort
sCr or UO Median 2.30 9.12 2.72 7.74 2.72 10.3 Average 6.65 22.5
9.72 23.3 9.19 25.1 Stdev 12.7 29.9 15.2 32.0 14.7 32.8 p (t-test)
3.0E-4 0.0013 1.6E-4 Min 3.16E-5 0.0532 3.16E-5 0.0532 3.16E-5
0.0532 Max 78.7 112 78.7 112 78.7 112 n (Patient) 54 95 72 77 78 71
sCr only Median 2.35 9.12 2.85 7.04 2.85 9.12 Average 7.37 22.4
10.4 22.7 9.79 24.4 Stdev 13.6 30.1 15.7 32.0 15.3 32.8 p (t-test)
5.6E-4 0.0036 5.3E-4 Min 3.16E-5 0.0532 3.16E-5 0.05.32 3.16E-5
0.0532 Max 78.7 112 78.7 112 78.7 112 n (Patient) 56 93 72 77 78 71
UO only Median 3.49 6.98 3.47 8.58 3.47 11.3 Average 15.1 20.3 14.6
22.1 14.1 24.0 Stdev 24.8 28.7 24.4 29.7 24.0 30.4 p (t-test) 0.26
0.11 0.039 Min 3.16E-5 0.0645 3.16E-5 0.0645 3.16E-5 0.0645 Max 109
112 109 112 109 112 n (Patient) 98 50 103 45 107 41 Persistence
Period Duration (hr) 24 48 72 sCr or UO sCr only UO only sCr or UO
sCr only UO only sCr or UO sCr only UO only AUC 0.71 0.69 0.60 0.65
0.62 0.62 0.67 0.64 0.66 SE 0.042 0.043 0.050 0.045 0.046 0.051
0.044 0.045 0.052 p Value 2.8E-7 1.1E-5 0.047 0.0011 0.0069 0.016
1.6E-4 0.0014 0.0023 nCohort Non-persistent 54 56 98 72 72 103 78
78 107 nCohort Persistent 95 93 50 77 77 45 71 71 41 Cutoff
Quartile 2 1.89 1.89 1.93 1.89 1.89 1.93 1.89 1.89 1.93 Sensitivity
81% 80% 78% 79% 78% 78% 79% 77% 80% Specificity 35% 32% 27% 29% 28%
26% 28% 27% 27% Cutoff Quartile 3 4.13 4.13 4.52 4.13 4.13 4.52
4.13 4.13 4.52 Sensitivity 63% 62% 62% 61% 60% 64% 65% 63% 71%
Specificity 72% 70% 56% 61% 60% 56% 63% 62% 58% Cutoff Quartile 4
20.0 20.0 20.2 20.0 20.0 20.2 20.0 20.0 20.2 Sensitivity 37% 37%
34% 36% 35% 38% 39% 38% 41% Specificity 94% 93% 80% 86% 85% 81% 87%
86% 81% OR Quartile 2 2.32 1.84 1.28 1.57 1.36 1.24 1.47 1.27 1.53
p Value 0.029 0.11 0.55 0.24 0.42 0.61 0.32 0.54 0.34 Lower limit
of 95% CI 1.09 0.868 0.572 0.742 0.644 0.543 0.690 0.599 0.635
Upper limit of 95% CI 4.96 3.92 2.87 3.32 2.86 2.85 3.12 2.68 3.71
OR Quartile 3 4.46 3.80 2.09 2.46 2.20 2.34 3.11 2.77 3.33 p Value
5.6E-5 2.2E-4 0.038 0.0074 0.018 0.022 9.0E-4 0.0027 0.0023 Lower
limit of 95% CI 2.15 1.87 1.04 1.27 1.14 1.13 1.59 1.43 1.53 Upper
limit of 95% CI 9.22 7.71 4.19 4.76 4.24 4.82 6.07 5.38 7.22 OR
Quartile 4 9.92 7.49 2.01 3.54 2.99 2.52 4.43 3.74 3.08 p Value
2.8E-4 3.4E-4 0.073 0.0023 0.0068 0.020 3.6E-4 0.0012 0.0052 Lower
limit of 95% CI 2.88 2.49 0.936 1.57 1.35 1.16 1.96 1.68 1.40 Upper
limit of 95% CI 34.2 22.5 4.31 7.99 6.63 5.47 10.0 8.30 6.78
TABLE-US-00059 TABLE 15.5 Comparison of marker levels and the area
under the ROC curve (AUC) in urine samples for the "persistent" and
"non-persistent" cohorts where persistence starts within 168 hours
after sample collection and renal status is assessed by serum
creatinine (sCr) only, urine output (UO) only, or serum creatinine
or urine output RIFLE criteria. Persistence Period Duration (hr) 24
48 72 Non-persistent Persistent Non-persistent Persistent
Non-persistent Persistent Cohort Cohort Cohort Cohort Cohort Cohort
sCr or UO Median 2.30 9.12 2.65 7.39 2.72 9.12 Average 6.53 22.2
9.85 22.7 9.38 24.0 Stdev 12.8 29.7 15.4 31.6 15.0 32.2 p (t-test)
3.8E-4 0.0025 5.1E-4 Mill 3.16E-5 0.0532 3.16E-5 0.0532 3.16E-5
0.0532 Max 78.7 112 78.7 112 78.7 112 n (Patient) 52 97 69 80 74 75
sCr only Median 2.34 9.57 2.72 7.74 2.72 10.3 Average 7.17 22.4
10.1 22.6 9.57 24.2 Stdev 13.6 29.9 15.9 31.6 15.4 32.4 p (t-test)
5.1E-4 0.0034 5.1E-4 Min 3.16E-5 0.0532 3.16E-5 0.0532 3.16E-5
0.0532 Max 78.7 112 78.7 112 78.7 112 n (Patient) 55 94 70 79 76 73
UO only Median 3.47 7.04 3.47 8.58 3.47 10.8 Average 15.1 20.2 14.7
21.2 14.4 22.4 Stdev 25.1 28.1 24.8 28.7 24.5 29.2 p (t-test) 0.26
0.16 0.084 Min 3.16E-5 0.0645 3.16E-5 0.0645 3.16E-5 0.0645 Max 109
112 109 112 109 112 n (Patient) 96 52 99 49 102 46 Persistence
Period Duration (hr) 24 48 72 sCr or UO sCr only UO only sCr or UO
sCr only UO only sCr or UO sCr only UO only AUC 0.71 0.70 0.61 0.64
0.64 0.63 0.65 0.66 0.65 SE 0.042 0.043 0.049 0.045 0.045 0.050
0.045 0.045 0.050 p Value 4.8E-7 3.4E-6 0.024 0.0022 0.0026 0.012
5.3E-4 4.3E-4 0.0025 nCohort Non-persistent 52 55 96 69 70 99 74 76
102 nCohort Persistent 97 94 52 80 79 49 75 73 46 Cutoff Quartile 2
1.89 1.89 1.93 1.89 1.89 1.93 1.89 1.89 1.93 Sensitivity 80% 80%
79% 79% 78% 80% 79% 78% 83% Specificity 35% 33% 27% 29% 29% 27% 28%
28% 28% Cutoff Quartile 3 4.13 4.13 4.52 4.13 4.13 4.52 4.13 4.13
4.52 Sensitivity 63% 63% 63% 60% 61% 63% 63% 64% 67% Specificity
73% 71% 57% 61% 61% 57% 62% 63% 58% Cutoff Quartile 4 20.0 20.0
20.2 20.0 20.0 20.2 20.0 20.0 20.2 Sensitivity 36% 36% 33% 35% 34%
35% 37% 37% 37% Specificity 94% 93% 79% 86% 84% 80% 86% 86% 80% OR
Quartile 2 2.17 1.92 1.38 1.51 1.46 1.46 1.46 1.36 1.89 p Value
0.045 0.090 0.43 0.28 0.32 0.37 0.32 0.42 0.16 Lower limit of 95%
CI 1.02 0.902 0.620 0.717 0.692 0.642 0.691 0.643 0.786 Upper limit
of 95% CI 4.65 4.09 3.09 3.19 3.08 3.33 3.09 2.88 4.53 OR Quartile
3 4.60 4.11 2.33 2.33 2.47 2.24 2.76 3.10 2.84 p Value 5.1E-5
1.1E-4 0.017 0.012 0.0074 0.024 0.0027 9.1E-4 0.0052 Lower limit of
95% CI 2.20 2.01 1.16 1.21 1.27 1.11 1.42 1.59 1.37 Upper limit of
95% CI 9.62 8.41 4.67 4.51 4.77 4.53 5.35 6.05 5.89 OR Quartile 4
9.22 7.22 1.85 3.18 2.78 2.10 3.81 3.47 2.40 p Value 4.3E-4 4.3E-4
0.11 0.0053 0.011 0.058 0.0013 0.0022 0.026 Lower limit of 95% CI
2.68 2.40 0.863 1.41 1.26 0.976 1.69 1.56 1.11 Upper limit of 95%
CI 31.8 21.7 3.95 7.16 6.16 4.51 8.61 7.69 5.21
Example 16. Use of Insulin-Like Growth Factor-Binding Protein 3 for
Evaluating Renal Status in Patients Admitted to the ICU: Persistent
at RIFLE F
[0160] Patients from the intensive care unit (ICU) with RIFLE stage
of injury (I) or failure (F) are enrolled in the following study.
EDTA anti-coagulated blood samples (10 mL) and urine samples (50
mL) are collected from each patient at enrollment, and at every 12
hours up to day 3, and then every 24 hours thereafter up to day 7
while the subject is hospitalized. Insulin-like growth
factor-binding protein 3 is measured in the enrollment samples by
standard immunoassay methods using commercially available assay
reagents.
[0161] Kidney status is assessed by RIFLE criteria based on serum
creatinine, urine output, or both serum creatinine and urine
output. Two cohorts are defined to represent a "persistent" and a
"non-persistent" population. "Persistent" indicates those patients
whose minimum RIFLE stage during a period of 24, 48 or 72 hours is
failure (F) where the persistence period can start from the time of
sample collection to 24, 48, 72, 96 or 168 hours after sample
collection. "Non-persistent" indicates those patients who are not
persistent at failure (F) and whose minimum RIFLE stage during a
period of 24, 48 or 72 hours is non-injury (RIFLE 0), risk of
injury (R), or injury (I) where the persistence period can start
from the time of sample collection to 24, 48, 72, 96 or 168 hours
after sample collection. If a patient dies after failure (F) or is
placed on renal replacement therapy (RRT) at any time from sample
collection to 24, 48, 72, 96 or 168 hours after sample collection,
the patient is considered "persistent".
[0162] The ability to distinguish the "persistent" and
"non-persistent" cohorts is determined using receiver operating
characteristic (ROC) analysis.
TABLE-US-00060 TABLE 16.1 Comparison of marker levels and the area
under the ROC curve (AUC) in urine samples for the "persistent" and
"non-persistent" cohorts where persistence starts within 24 hours
after sample collection and renal status is assessed by serum
creatinine (sCr) only, urine output (UO) only, or serum creatinine
or urine output RIFLE criteria. Persistence Period Duration (hr) 24
48 72 Non-persistent Persistent Non-persistent Persistent
Non-persistent Persistent Cohort Cohort Cohort Cohort Cohort Cohort
sCr or UO Median 637 1250 637 1350 702 1160 Average 1820 4620 1960
4820 2360 4100 Stdev 3970 6250 4060 6480 4660 5940 p (t-test)
0.0011 0.0015 0.072 Min 20.6 158 20.6 158 20.6 158 Max 18800 18800
18800 18800 18800 18800 n (Patient) 98 51 106 43 113 36 sCr only
Median 640 1210 641 1400 702 1160 Average 1840 4540 1840 5110 2280
4250 Stdev 3990 6220 3880 6620 4560 6050 p (t-test) 0.0016 2.6E-4
0.037 Min 20.6 158 20.6 158 20.6 158 Max 18800 18800 18800 18800
18800 18800 n (Patient) 97 52 106 43 111 38 UO only Median 747
1.380 766 1400 766 1400 Average 2440 5410 2430 5670 2430 5670 Stdev
4550 7420 4530 7560 4530 7560 p (t-test) 0.019 0.012 0.012 Min 20.6
322 20.6 322 20.6 322 Max 18800 18800 18800 18800 18800 18800 n
(Patient) 130 18 131 17 131 17 Persistence Period Duration (hr) 24
48 72 sCr or UO sCr only UO only sCr or UO sCr only UO only sCr or
UO sCr only UO only AUC 0.68 0.67 0.70 0.70 0.69 0.70 0.65 0.64
0.70 SE 0.048 0.048 0.072 0.050 0.050 0.074 0.055 0.054 0.074 p
Value 1.3E-4 4.6E-4 0.0058 7.9E-5 1.1E-4 0.0057 0.0048 0.0098
0.0057 nCohort Non-persistent 98 97 130 106 106 131 113 111 131
nCohort Persistent 51 52 18 43 43 17 36 38 17 Cutoff Quartile 2 401
401 410 401 401 410 401 401 410 Sensitivity 84% 83% 89% 86% 84% 88%
86% 82% 88% Specificity 30% 29% 27% 29% 28% 27% 28% 27% 27% Cutoff
Quartile 3 794 794 801 794 794 801 794 794 801 Sensitivity 67% 65%
78% 72% 72% 76% 69% 68% 76% Specificity 58% 58% 54% 58% 58% 53% 56%
56% 53% Cutoff Quartile 4 1830 1830 1840 1830 1830 1840 1830 1830
1840 Sensitivity 41% 40% 33% 42% 44% 35% 36% 37% 35% Specificity
83% 82% 76% 81% 82% 76% 78% 78% 76% OR Quartile 2 2.26 1.94 2.95
2.55 2.03 2.73 2.45 1.64 2.73 p Value 0.067 0.12 0.16 0.056 0.13
0.20 0.088 0.29 0.20 Lower limit of 95% CI 0.946 0.835 0.644 0.977
0.814 0.595 0.875 0.653 0.595 Upper limit of 95% CI 5.39 4.50 13.5
6.65 5.06 12.6 6.86 4.12 12.6 OR Quartile 3 2.78 2.58 4.08 3.64
3.64 3.73 2.86 2.74 3.73 p Value 0.0046 0.0079 0.018 0.0010 0.0010
0.028 0.0100 0.011 0.028 Lower limit of 95% CI 1.37 1.28 1.28 1.68
1.68 1.16 1.29 1.26 1.16 Upper limit of 95% CI 5.64 5.19 13.1 7.86
7.86 12.0 6.38 5.98 12.0 OR Quartile 4 3.34 3.19 1.60 3.10 3.62
1.76 1.99 2.11 1.76 p Value 0.0020 0.0029 0.39 0.0044 0.0012 0.30
0.097 0.066 0.30 Lower limit of 95% CI 1.55 1.49 0.553 1.42 1.66
0.602 0.883 0.951 0.602 Upper limit of 95% CI 7.16 6.83 4.61 6.73
7.91 5.15 4.48 4.70 5.15
TABLE-US-00061 TABLE 16.2 Comparison of marker levels and the area
under the ROC curve (AUC) in urine samples for the "persistent" and
"non-persistent" cohorts where persistence starts within 48 hours
after sample collection and renal status is assessed by serum
creatinine (sCr) only, urine output (UO) only, or serum creatinine
or urine output RIFLE criteria. Persistence Period Duration (hr) 24
48 72 Non-persistent Persistent Non-persistent Persistent
Non-persistent Persistent Cohort Cohort Cohort Cohort Cohort Cohort
sCr or UO Median 626 1210 624 1400 640 1210 Average 1880 4200 1850
4570 2310 3920 Stdev 4110 5970 4030 6210 4680 5690 p (t-test)
0.0055 0.0015 0.074 Min 21.1 20.6 20.6 158 20.6 158 Max 18800 18800
18800 18800 18800 18800 n (Patient) 91 58 98 51 105 44 sCr only
Median 634 1120 626 1300 642 1070 Average 1900 4170 1880 4470 2360
3740 Stdev 4110 5990 4040 6190 4710 5630 p (t-test) 0.0067 0.0025
0.12 Min 21.1 20.6 20.6 158 20.6 158 Max 18800 18800 18800 18800
18800 18800 n (Patient) 91 58 97 52 103 46 UO only Median 718 1350
724 1380 724 1380 Average 2490 4330 2480 4470 2480 4470 Stdev 4660
6520 4640 6630 4640 6630 p (t-test) 0.097 0.076 0.076 Min 20.6 322
20.6 322 20.6 322 Max 18800 18800 18800 18800 18800 18800 n
(Patient) 193 25 124 24 124 24 Persistence Period Duration (hr) 24
48 72 sCr or UO sCr only UO only sCr or UO sCr only UO only sCr or
UO sCr only UO only AUC 0.68 0.66 0.68 0.71 0.70 0.69 0.67 0.64
0.69 SE 0.046 0.047 0.063 0.046 0.047 0.064 0.051 0.051 0.064 p
Value 1.2E-4 7.6E-4 0.0036 3.7E-6 3.0E-5 0.0037 8.3E-4 0.0069
0.0037 nCohort Non-persistent 91 91 123 98 97 124 105 103 124
nCohort Persistent 58 58 25 51 52 24 44 46 24 Cutoff Quartile 2 401
401 410 401 401 410 401 401 410 Sensitivity 84% 83% 92% 88% 87% 92%
89% 85% 92% Specificity 31% 30% 28% 32% 31% 28% 30% 29% 28% Cutoff
Quartile 3 794 794 801 794 794 801 794 794 801 Sensitivity 66% 64%
76% 71% 69% 75% 68% 65% 75% Specificity 59% 58% 55% 60% 60% 55% 57%
56% 55% Cutoff Quartile 4 1830 1830 1840 1830 1830 1840 1830 1830
1840 Sensitivity 40% 38% 32% 43% 40% 33% 36% 33% 33% Specificity
84% 82% 76% 84% 82% 77% 79% 78% 77% OR Quartile 2 2.42 2.02 4.57
3.47 2.88 4.33 3.42 2.29 4.33 p Value 0.039 0.090 0.047 0.010 0.022
0.056 0.018 0.074 0.056 Lower limit of 95% CI 1.05 0.895 1.02 1.34
1.16 0.966 1.23 0.922 0.966 Upper limit of 95% CI 5.60 4.58 20.4
8.99 7.12 19.4 9.48 5.69 19.4 OR Quartile 3 2.77 2.46 3.92 3.63
3.35 3.64 2.86 2.42 3.64 p Value 0.0035 0.0094 0.0066 5.0E-4 9.3E-4
0.010 0.0056 0.016 0.010 Lower limit of 95% CI 1.40 1.25 1.46 1.76
1.64 1.35 1.36 1.18 1.35 Upper limit of 95% CI 5.50 4.84 10.5 7.50
6.84 9.80 6.01 4.97 9.80 OR Quartile 4 3.33 2.86 1.53 3.89 3.19
1.64 2.16 1.68 1.64 p Value 0.0020 0.0064 0.38 5.5E-4 0.0029 0.31
0.052 0.19 0.31 Lower limit of 95% CI 1.55 1.34 0.597 1.80 1.49
0.6.37 0.995 0.778 0.6.37 Upper limit of 95% CI 7.15 6.11 3.90 8.40
6.83 4.21 4.67 3.64 4.21
TABLE-US-00062 TABLE 16.3 Comparison of marker levels and the area
under the ROC curve (AUC) in urine samples for the "persistent" and
"non-persistent" cohorts where persistence starts within 72 hours
after sample collection and renal status is assessed by serum
creatinine (sCr) only, urine output (UO) only, or serum creatinine
or urine output RIFLE criteria. Persistence Period Duration (hr) 24
48 72 Non-persistent Persistent Non-persistent Persistent
Non-persistent Persistent Cohort Cohort Cohort Cohort Cohort Cohort
sCr or UO Median 624 1070 608 1250 630 1070 Average 1750 4190 1680
4460 2290 3720 Stdev 3830 6070 3760 6180 4690 5570 p (t-test)
0.0031 8.3E-4 0.099 Min 21.1 20.6 20.6 158 20.6 158 Max 18800 18800
18800 18800 18800 18800 n (Patient) 86 63 90 59 98 51 sCr only
Median 626 1070 619 1250 642 1070 Average 1770 4130 1690 4450 2320
3650 Stdev 3850 6040 3750 6190 4700 5540 p (t-test) 0.0042 9.1E-4
0.13 Min 21.1 20.6 20.6 158 20.6 158 Max 18800 18800 18800 18800
18800 18800 n (Patient) 85 64 90 59 97 52 UO only Median 724 1210
729 1250 729 1250 Average 2450 4070 2430 4170 2430 4170 Stdev 4660
6160 4640 6240 4640 6240 p (t-test) 0.11 0.088 0.088 Min 20.6 233
20.6 233 20.6 233 Max 18800 18800 18800 18800 18800 18800 n
(Patient) 116 32 117 31 117 31 Persistence Period Duration (hr) 24
48 72 sCr or UO sCr only UO only sCr or UO sCr only UO only sCr or
UO sCr only UO only AUC 0.67 0.66 0.65 0.71 0.70 0.66 0.65 0.63
0.66 SE 0.045 0.046 0.058 0.044 0.045 0.058 0.049 0.049 0.058 p
Value 2.2E-4 6.9E-4 0.0071 2.4E-6 1.3E-5 0.0077 0.0018 0.0093
0.0077 nCohort Non-persistent 86 85 116 90 90 117 98 97 117 nCohort
Persistent 63 64 32 59 59 31 51 52 31 Cutoff Quartile 2 401 401 410
401 401 410 401 401 410 Sensitivity 84% 83% 91% 88% 86% 90% 88% 85%
90% Specificity 31% 31% 29% 33% 32% 29% 32% 30% 29% Cutoff Quartile
3 794 794 801 794 794 801 794 794 801 Sensitivity 63% 62% 69% 68%
66% 68% 65% 62% 68% Specificity 59% 59% 55% 61% 60% 55% 57% 56% 55%
Cutoff Quartile 4 1830 1830 1840 1830 1830 1840 1830 1830 1840
Sensitivity 38% 38% 31% 41% 41% 32% 33% 33% 32% Specificity 84% 84%
77% 84% 84% 77% 79% 78% 77% OR Quartile 2 2.43 2.12 4.01 3.71 3.03
3.82 3.47 2.35 3.82 p Value 0.033 0.064 0.030 0.0044 0.012 0.036
0.010 0.055 0.036 Lower limit of 95% CI 1.07 0.957 1.14 1.51 1.27
1.09 1.34 0.983 1.09 Upper limit of 95% CI 5.48 4.71 14.0 9.16 7.21
13.4 8.99 5.60 13.4 OR Quartile 3 2.53 2.38 2.71 3.31 2.92 2.54
2.44 2.01 2.54 p Value 0.0065 0.011 0.019 6.9E-4 0.0021 0.029 0.012
0.047 0.029 Lower limit of 95% CI 1.30 1.22 1.18 1.66 1.48 1.10
1.21 1.01 1.10 Upper limit of 95% Cl 4.95 4.63 6.22 6.60 5.80 5.85
4.92 4.00 5.85 OR Quartile 4 3.16 3.04 1.50 3.72 3.72 1.59 1.83
1.76 1.59 p Value 0.0032 0.0043 0.36 8.4E-4 8.4E-4 0.30 0.12 0.14
0.30 Lower limit of 95% CI 1.47 1.42 0.632 1.72 1.72 0.667 0.861
0.827 0.667 Upper limit of 95% CI 6.81 6.54 3.55 8.05 8.05 3.78
3.91 3.74 3.78
TABLE-US-00063 TABLE 16.4 Comparison of marker levels and the area
under the ROC curve (AUC) in urine samples for the "persistent" and
"non-persistent" cohorts where persistence starts within 96 hours
after sample collection and renal status is assessed by serum
creatinine (sCr) only, urine output (UO) only, or serum creatinine
or urine output RIFLE criteria. Persistence Period Duration (hr) 24
48 72 Non-persistent Persistent Non-persistent Persistent
Non-persistent Persistent Cohort Cohort Cohort Cohort Cohort Cohort
sCr or UO Median 622 1120 605 1250 630 1070 Average 1550 4420 1680
4460 2140 3940 Stdev 3370 6290 3760 6180 4420 5860 p (t-test)
4.6E-4 8.3E-4 0.0.36 Min 21.1 20.6 20.6 158 20.6 158 Max 18800
18800 18800 18800 18800 18800 n (Patient) 85 64 90 59 96 53 sCr
only Median 626 1070 615 1210 634 1070 Average 1770 4130 1700 4390
2160 3870 Stdev 3850 6040 3770 6150 4430 5830 p (t-test) 0.0042
0.0012 0.046 Min 21.1 20.6 20.6 158 20.6 158 Max 18800 18800 18800
18800 18800 18800 n (Patient) 85 64 89 60 95 54 UO only Median 724
1210 747 1210 747 1210 Average 2220 4590 2360 4280 2360 4280 Stdev
4.310 6610 4540 6310 4540 6310 p (t-test) 0.014 0.050 0.050 Min
20.6 233 20.6 233 20.6 233 Max 18800 18800 18800 18800 18800 18800
n (Patient) 112 36 114 34 114 34 Persistence Period Duration (hr)
24 48 72 sCr or UO sCr only UO only sCr or UO sCr only UO only sCr
or UO sCr only UO only AUG 0.68 0.66 0.66 0.71 0.70 0.65 0.65 0.64
0.65 SE 0.045 0.046 0.055 0.044 0.045 0.056 0.048 0.048 0.056 p
Value 5.9E-5 6.9E-4 0.0026 2.4E-6 1.2E-5 0.0076 0.0013 0.0036
0.0076 nCohort Non-persistent 85 85 112 90 89 114 96 95 114 nCohort
Persistent 64 64 36 59 60 34 53 54 34 Cutoff Quartile 2 401 401 410
401 401 410 401 401 410 Sensitivity 84% 83% 92% 88% 87% 91% 87% 85%
91% Specificity 32% 31% 30% 33% 33% 30% 31% 31% 30% Cutoff Quartile
3 794 794 801 794 794 801 794 794 801 Sensitivity 64% 62% 67% 68%
67% 65% 64% 63% 65% Specificity 60% 59% 55% 61% 61% 54% 57% 57% 54%
Cutoff Quartile 4 1830 1830 1840 1830 1830 1840 1830 1830 1840
Sensitivity 39% 38% 33% 41% 40% 32% 34% 33% 32% Specificity 85% 84%
78% 84% 84% 77% 79% 79% 77% OR Quartile 2 2.51 2.12 4.79 3.71 3.14
4.39 2.99 2.53 4.39 p Value 0.027 0.064 0.014 0.0044 0.0096 0.020
0.018 0.036 0.020 Lower limit of 95% Cl 1.11 0.957 1.38 1.51 1.32
1.26 1.21 1.06 1.26 Upper limit of 95% CI 5.68 4.71 16.7 9.16 7.47
15.3 7.38 6.02 15.3 OR Quartile 3 2.67 2.38 2.48 3.31 3.09 2.19
2.40 2.24 2.19 p Value 0.0040 0.011 0.024 6.9E-4 0.0013 0.054 0.013
0.021 0.054 Lower limit of 95% CI 1.37 1.22 1.13 1.66 1.56 0.988
1.20 1.13 0.988 Upper limit of 95% CI 5.23 4.63 5.45 6.60 6.12 4.84
4.80 4.44 4.84 OR Quartile 4 3.55 3.04 1.74 3.72 3.57 1.62 1.95
1.88 1.62 p Value 0.0014 0.0043 0.19 8.4E-4 0.0012 0.26 0.081 0.10
0.26 Lower limit of 95% Cl 1.64 1.42 0.764 1.72 1.65 0.698 0.921
0.885 0.698 Upper limit of 95% CI 7.71 6.54 3.96 8.05 7.71 3.75
4.15 3.97 3.75
TABLE-US-00064 TABLE 16.5 Comparison of marker levels and the area
under the ROC curve (AUC) in urine samples for the "persistent" and
"non-persistent" cohorts where persistence starts within 168 hours
after sample collection and renal status is assessed by serum
creatinine (sCr) only, urine output (UO) only, or serum creatinine
or urine output RIFLE criteria. Persistence Period Duration (hr) 24
48 72 Non-persistent Persistent Non-persistent Persistent
Non-persistent Persistent Cohort Cohort Cohort Cohort Cohort Cohort
sCr or UO Median 611 1180 592 1350 626 1070 Average 1220 4690 1180
4970 1870 4290 Stdev 2550 6480 2500 6590 3980 6160 p (t-test)
1.7E-5 2.6E-6 0.0041 Min 21.1 20.6 20.6 158 20.6 158 Max 16600
18800 16600 18800 18800 18800 n (Patient) 82 67 86 63 93 56 sCr
only Median 622 1120 601 1300 626 1070 Average 1430 4480 1380 4750
1870 4290 Stdev 3190 6290 3120 6400 3980 6160 p (t-test) 1.8E-4
3.6E-5 0.0041 Min 21.1 20.6 20.6 158 20.6 158 Max 18800 18800 18800
18800 18800 18800 n (Patient) 83 66 87 62 93 56 UO only Median 718
1180 724 1210 724 1210 Average 2230 4500 2220 4600 2220 4600 Stdev
4320 6540 4310 6610 4310 6610 p (t-test) 0.018 0.014 0.014 Min 20.6
233 20.6 233 20.6 233 Max 18800 18800 18800 18800 18800 18800 n
(Patient) 111 37 112 36 112 36 Persistence Period Duration (hr) 24
48 72 sCr or UO sCr only UO only sCr or UO sCr only UO only sCr or
UO sCr only UO only AUC 0.69 0.68 0.67 0.73 0.72 0.67 0.66 0.66
0.67 SE 0.044 0.045 0.054 0.043 0.043 0.055 0.047 0.047 0.055 p
Value 1.5E-5 6.5E-5 0.0021 5.9E-8 4.6E-7 0.0023 5.1E-4 5.1E-4
0.0023 nCohort Non-persistent 82 83 111 86 87 112 93 93 112 nCohort
Persistent 67 66 37 63 62 36 56 56 36 Cutoff Quartile 2 401 401 410
401 401 410 401 401 410 Sensitivity 84% 83% 92% 87% 87% 92% 86% 86%
92% Specificity 32% 31% 31% 34% 33% 30% 31% 31% 30% Cutoff Quartile
3 794 794 801 794 794 801 794 794 801 Sensitivity 64% 64% 68% 68%
68% 67% 64% 64% 67% Specificity 61% 60% 56% 63% 62% 55% 58% 58% 55%
Cutoff Quartile 4 1830 1830 1840 1830 1830 1840 1830 1830 1840
Sensitivity 40% 39% 32% 43% 42% 33% 36% 36% 33% Specificity 87% 86%
77% 87% 86% 78% 81% 81% 78% OR Quartile 2 2.36 2.28 5.00 3.50 3.38
4.79 2.72 2.72 4.79 p Value 0.034 0.042 0.011 0.0046 0.0059 0.014
0.024 0.024 0.014 Lower limit of 95% CI 1.07 1.03 1.44 1.47 1.42
1.38 1.14 1.14 1.38 Upper limit of 95% CI 5.24 5.06 17.4 8.32 8.02
16.7 6.47 6.47 16.7 OR Quartile 3 2.80 2.65 2.64 3.63 3.44 2.48
2.49 2.49 2.48 p Value 0.0025 0.0042 0.015 2.4E-4 4.2E-4 0.024
0.0089 0.0089 0.024 Lower limit of 95% CI 1.44 1.36 1.20 1.82 1.73
1.13 1.26 1.26 1.13 Upper limit of 95% CI 5.46 5.17 5.77 7.22 6.83
5.45 4.94 4.94 5.45 OR Quartile 4 4.36 3.85 1.65 5.11 4.51 1.74
2.31 2.31 1.74 p Value 3.2E-4 7.8E-4 0.23 7.2E-5 1.9E-4 0.19 0.028
0.028 0.19 Lower limit of 95% CI 1.96 1.75 0.727 2.28 2.05 0.764
1.09 1.09 0.764 Upper limit of 95% CI 9.71 8.44 3.75 11.4 9.96 3.96
4.90 4.90 3.96
Example 17. Use of Insulin-Like Growth Factor-Binding Protein 3 for
Evaluating Renal Status in Patients Admitted to the ICU: Persistent
at RIFLE I or F
[0163] Patients from the intensive care unit (ICU) with RIFLE stage
of injury (I) or failure (F) are enrolled in the following study.
EDTA anti-coagulated blood samples (10 mL) and urine samples (50
mL) are collected from each patient at enrollment, and at every 12
hours up to day 3, and then every 24 hours thereafter up to day 7
while the subject is hospitalized. Insulin-like growth
factor-binding protein 3 is measured in the enrollment samples by
standard immunoassay methods using commercially available assay
reagents.
[0164] Kidney status is assessed by RIFLE criteria based on serum
creatinine, urine output, or both serum creatinine and urine
output. Two cohorts are defined to represent a "persistent" and a
"non-persistent" population. "Persistent" indicates those patients
whose minimum RIFLE stage during a period of 24, 48 or 72 hours is
injury (I) or failure (F) where the persistence period can start
from the time of sample collection to 24, 48, 72, 96 or 168 hours
after sample collection. "Non-persistent" indicates those patients
who are not persistent at injury (I) or failure (F) and whose
minimum RIFLE stage during a period of 24, 48 or 72 hours is
non-injury (RIFLE 0) or risk of injury (R) where the persistence
period can start from the time of sample collection to 24, 48, 72,
96 or 168 hours after sample collection. If a patient dies after
injury (I) or failure (F) or is placed on renal replacement therapy
(RRT) at any time from sample collection to 24, 48, 72, 96 or 168
hours after sample collection, the patient is considered
"persistent".
[0165] The ability to distinguish the "persistent" and
"non-persistent" cohorts is determined using receiver operating
characteristic (ROC) analysis.
TABLE-US-00065 TABLE 17.1 Comparison of marker levels and the area
under the ROC curve (AUC) in urine samples for the "persistent" and
"non-persistent" cohorts where persistence starts within 24 hours
after sample collection and renal status is assessed by serum
creatinine (sCr) only, urine output (UO) only, or serum creatinine
or urine output RIFLE criteria. Persistence Period Duration (hr) 24
48 72 Non-persistent Persistent Non-persistent Persistent
Non-persistent Persistent Cohort Cohort Cohort Cohort Cohort Cohort
sCr or UO Median 553 1070 630 983 624 1070 Average 1240 3690 1580
4110 1470 4670 Stdev 3000 5730 3240 6210 3070 6530 p (t-test)
0.0038 0.0019 9.6E-5 Min 30.5 20.6 21.1 20.6 21.1 20.6 Max 16600
18800 16600 18800 16600 18800 n (Patient) 55 94 78 71 88 61 sCr
only Median 583 1020 624 1070 622 1300 Average 1560 3540 1630 3980
1530 4640 Stdev 3740 5570 3550 6010 3310 6420 p (t-test) 0.019
0.0042 1.6E-4 Min 30.5 20.6 21.1 20.6 21.1 20.6 Max 18800 18800
18800 18800 18800 18800 n (Patient) 57 92 76 73 89 60 UO only
Median 672 1240 715 1350 718 1400 Average 2310 4450 2290 5070 2250
5780 Stdev 4440 6510 4340 7110 4270 7490 p (t-test) 0.029 0.0091
0.0018 Mill 20.6 172 20.6 194 20.6 194 Max 18800 18800 18800 18800
18800 18800 n (Patient) 114 34 121 27 125 23 Persistence Period
Duration (hr) 24 48 72 sCr or UO sCr only UO only sCr or UO sCr
only UO only sCr or UO sCr only UO only AUC 0.68 0.64 0.66 0.64
0.64 0.68 0.68 0.69 0.70 SE 0.044 0.045 0.056 0.046 0.045 0.061
0.045 0.045 0.065 p Value 4.1E-5 0.0015 0.0037 0.0027 0.0018 0.0031
5.1E-5 2.4E-5 0.0018 nCohort Non-persistent 55 57 114 78 76 121 88
89 125 nCohort Persistent 94 92 34 71 73 27 61 60 23 Cutoff
Quartile 2 401 401 410 401 401 410 401 401 410 Sensitivity 80% 78%
85% 80% 79% 85% 85% 83% 87% Specificity 33% 30% 28% 29% 29% 27% 32%
30% 27% Cutoff Quartile 3 794 794 801 794 794 801 794 794 801
Sensitivity 61% 59% 74% 59% 60% 78% 62% 67% 78% Specificity 67% 63%
57% 58% 59% 56% 58% 61% 55% Cutoff Quartile 4 1830 1830 1840 1830
1830 1840 1830 1830 1840 Sensitivity 35% 35% 32% 37% 37% 33% 41%
42% 39% Specificity 91% 89% 77% 85% 86% 77% 85% 85% 78% OR Quartile
2 1.92 1.53 2.26 1.70 1.58 2.16 2.70 2.18 2.49 p Value 0.090 0.27
0.12 0.17 0.24 0.18 0.020 0.061 0.16 Lower limit of 95% CI 0.902
0.720 0.805 0.796 0.741 0.693 1.17 0.963 0.695 Upper limit of 95%
CI 4.09 3.25 6.36 3.64 3.35 6.71 6.23 4.92 8.92 OR Quartile 3 3.17
2.44 3.68 1.97 2.20 4.49 2.28 3.09 4.44 p Value 0.0012 0.010 0.0026
0.041 0.018 0.0026 0.016 0.0013 0.0055 Lower limit of 95% CI 1.57
1.23 1.58 1.03 1.14 1.69 1.17 1.56 1.55 Upper limit of 95% CI 6.37
4.81 8.60 3.79 4.24 11.9 4.45 6.12 12.7 OR Quartile 4 5.41 4.53
1.62 3.18 3.47 1.66 4.01 4.18 2.23 p Value 0.0011 0.0018 0.26
0.0038 0.0022 0.27 4.8E-4 3.3E-4 0.094 Lower limit of 95% CI 1.97
1.76 0.698 1.45 1.56 0.672 1.84 1.91 0.873 Upper limit of 95% CI
14.9 11.7 3.75 6.95 7.69 4.10 8.73 9.12 5.68
TABLE-US-00066 TABLE 17.2 Comparison of marker levels and the area
under the ROC curve (AUC) in urine samples for the "persistent" and
"non-persistent" cohorts where persistence starts within 48 hours
after sample collection and renal status is assessed by serum
creatinine (sCr) only, urine output (UO) only, or serum creatinine
or urine output RIFLE criteria. Persistence Period Duration (hr) 24
48 72 Non-persistent Persistent Non-persistent Persistent
Non-persistent Persistent Cohort Cohort Cohort Cohort Cohort Cohort
sCr or UO Median 547 1070 601 1070 576 1250 Average 1250 3660 1400
4110 1310 4580 Stdev 3020 5710 3000 6140 2840 6400 p (t-test)
0.0046 8.7E-4 5.5E-5 Min 30.5 20.6 21.1 20.6 21.1 20.6 Max 16600
18800 16600 18800 16600 18800 n (Patient) 54 95 73 76 82 67 sCr
only Median 576 983 622 1020 592 1180 Average 1570 3510 1650 3870
1530 4310 Stdev 3770 5550 3610 5920 3430 6170 p (t-test) 0.022
0.0069 6.8E-4 Min 30.5 20.6 21.1 20.6 21.1 20.6 Max 18800 18800
18800 18800 18800 18800 n (Patient) 56 93 73 76 82 67 UO only
Median 637 1300 642 1400 702 1440 Average 2110 4540 2110 5040 2070
5560 Stdev 4260 6370 4160 6810 4090 7080 p (t-test) 0.0079 0.0024
5.0E-4 Min 20.6 172 20.6 194 20.6 194 Max 18800 18800 18800 18800
18800 18800 n (Patient) 106 42 113 35 117 31 Persistence Period
Duration (hr) 24 48 72 sCr or UO sCr only UO only sCr or UO sCr
only UO only sCr or UO sCr only UO only AUC 0.68 0.64 0.69 0.67
0.64 0.70 0.71 0.69 0.72 SE 0.044 0.045 0.051 0.044 0.045 0.054
0.043 0.044 0.056 p Value 4.1E-5 0.0015 1.8E-4 1.5E-4 0.0015 1.5E-4
5.7E-7 8.6E-6 8.5E-5 nCohort Non-persistent 54 56 106 73 73 113 82
82 117 nCohort Persistent 95 93 42 76 76 35 67 67 31 Cutoff
Quartile 2 401 401 410 401 401 410 401 401 410 Sensitivity 80% 78%
88% 82% 80% 89% 87% 85% 90% Specificity 33% 30% 30% 32% 30% 29% 34%
33% 29% Cutoff Quartile 3 794 794 801 794 794 801 794 794 801
Sensitivity 60% 58% 74% 61% 59% 77% 64% 64% 77% Specificity 67% 62%
59% 60% 59% 58% 61% 61% 57% Cutoff Quartile 4 1830 1830 1840 1830
1830 1840 1830 1830 1840 Sensitivity 35% 34% 36% 38% 37% 37% 42%
40% 42% Specificity 91% 89% 79% 88% 86% 79% 88% 87% 79% OR Quartile
2 2.00 1.59 3.20 2.04 1.75 3.20 3.34 2.80 3.82 p Value 0.073 0.23
0.026 0.067 0.14 0.042 0.0048 0.013 0.036 Lower limit of 95% CI
0.938 0.748 1.15 0.951 0.825 1.05 1.45 1.24 1.09 Upper limit of 95%
CI 4.26 3.38 8.89 4.36 3.73 9.77 7.72 6.32 13.4 OR Quartile 3 3.00
2.31 4.13 2.33 2.08 4.74 2.80 2.80 4.59 p Value 0.0021 0.016 4.3E-4
0.012 0.028 4.8E-4 0.0025 0.0025 0.0011 Lower limit of 95% CI 1.49
1.17 1.87 1.21 1.08 1.98 1.44 1.44 1.83 Upper limit of 95% CI 6.04
4.55 9.09 4.49 4.00 11.3 5.46 5.46 11.5 OR Quartile 4 5.22 4.37
2.12 4.39 3.68 2.19 5.17 4.36 2.80 p Value 0.0014 0.0023 0.061
5.4E-4 0.0017 0.061 8.7E-5 3.2E-4 0.017 Lower limit of 95% CI 1.90
1.69 0.966 1.90 1.63 0.965 2.28 1.96 1.20 Upper limit of 95% CI
14.4 11.3 4.66 10.1 8.29 4.98 11.7 9.71 6.50
TABLE-US-00067 TABLE 17.3 Comparison of marker levels and the area
under the ROC curve (AUC) in urine samples for the "persistent" and
"non-persistent" cohorts where persistence starts within 72 hours
after sample collection and renal status is assessed by serum
creatinine (sCr) only, urine output (UO) only, or serum creatinine
or urine output RIFLE criteria. Persistence Period Duration (hr) 24
48 72 Non-persistent Persistent Non-persistent Persistent
Non-persistent Persistent Cohort Cohort Cohort Cohort Cohort Cohort
sCr or UO Median 547 1070 611 1070 592 1070 Average 1250 3660 1420
4060 1360 4350 Stdev 3020 5710 3010 6120 2910 6280 p (t-test)
0.0046 0.0012 2.2E-4 Min 30.5 20.6 21.1 20.6 21.1 20.6 Max 16600
18800 16600 18800 16600 18800 n (Patient) 54 95 72 77 78 71 sCr
only Median 576 983 624 983 611 1070 Average 1570 3510 1680 3820
1590 4090 Stdev 3770 5550 3640 5890 3510 6060 p (L-test) 0.022
0.0090 0.0022 Min 30.5 20.6 21.1 20.6 21.1 20.6 Max 18800 18800
18800 18800 18800 18800 n (Patient) 56 93 72 77 78 71 UO only
Median 638 1120 679 1210 717 1300 Average 2200 4040 2160 4420 2110
4780 Stdev 4370 6090 4260 6400 4190 6630 p (t-test) 0.037 0.013
0.0046 Min 20.6 172 20.6 194 20.6 194 Max 18800 18800 18800 18800
18800 18800 n (Patient) 100 48 106 42 110 38 Persistence Period
Duration (hr) 24 48 72 sCr or UO sCr only UO only sCr or UO sCr
only UO only sCr or UO sCr only UO only AUC 0.68 0.64 0.65 0.66
0.63 0.67 0.69 0.66 0.68 SE 0.044 0.045 0.050 0.045 0.045 0.052
0.044 0.045 0.053 p Value 4.1E-5 0.0015 0.0022 4.9E-4 0.0039 0.0012
1.6E-5 2.4E-4 9.5E-4 nCohort Non-persistent 54 56 100 72 72 106 78
78 110 nCohort Persistent 95 93 48 77 77 42 71 71 38 Cutoff
Quartile 2 401 401 410 401 401 410 401 401 410 Sensitivity 80% 78%
88% 81% 79% 88% 85% 83% 89% Specificity 33% 30% 31% 31% 29% 30% 33%
32% 30% Cutoff Quartile 3 794 794 801 794 794 801 794 794 801
Sensitivity 60% 58% 67% 60% 58% 69% 62% 61% 68% Specificity 67% 62%
58% 60% 58% 58% 60% 59% 56% Cutoff Quartile 4 1830 1830 1840 1830
1830 1840 1830 1830 1840 Sensitivity 35% 34% 31% 38% 36% 33% 39%
38% 37% Specificity 91% 89% 78% 88% 86% 78% 87% 86% 79% OR Quartile
2 2.00 1.59 3.14 1.82 1.57 3.20 2.73 2.32 3.64 p Value 0.073 0.23
0.019 0.12 0.24 0.026 0.014 0.035 0.023 Lower limit of 95% CI 0.938
0.748 1.21 0.855 0.742 1.15 1.23 1.06 1.20 Upper limit of 95% CI
4.26 3.38 8.17 3.87 3.32 8.89 6.05 5.07 11.1 OR Quartile 3 3.00
2.31 2.76 2.20 1.97 3.02 2.47 2.21 2.80 p Value 0.0021 0.016 0.0057
0.018 0.042 0.0043 0.0072 0.018 0.0098 Lower limit of 95% CI 1.49
1.17 1.34 1.14 1.03 1.42 1.28 1.15 1.28 Upper limit of 95% CI 6.04
4.55 5.67 4.24 3.78 6.46 4.78 4.25 6.11 OR Quartile 4 5.22 4.37
1.61 4.23 3.54 1.80 4.43 3.74 2.21 p Value 0.0014 0.0023 0.23
7.3E-4 0.0023 0.14 3.6E-4 0.0012 0.054 Lower limit of 95% CI 1.90
1.69 0.744 1.83 1.57 0.818 1.96 1.68 0.988 Upper limit of 95% CI
14.4 11.3 3.49 9.77 7.99 3.98 10.0 8.30 4.93
TABLE-US-00068 TABLE 17.4 Comparison of marker levels and the area
under the ROC curve (AUC) in urine samples for the "persistent" and
"non-persistent" cohorts where persistence starts within 96 hours
after sample collection and renal status is assessed by serum
creatinine (sCr) only, urine output (UO) only, or serum creatinine
or urine output RIFLE criteria. Persistence Period Duration (hr) 24
48 72 Non-persistent Persistent Non-persistent Persistent
Non-persistent Persistent Cohort Cohort Cohort Cohort Cohort Cohort
sCr or UO Median 547 1070 611 1070 592 1070 Average 1250 3660 1420
4060 1360 4350 Stdev 3020 5710 3010 6120 2910 6280 p (t-test)
0.0046 0.0012 2.2E-4 Min 30.5 20.6 21.1 20.6 21.1 20.6 Max 16600
18800 16600 18800 16600 18800 n (Patient) 54 95 72 77 78 71 sCr
only Median 576 983 624 983 611 1070 Average 1570 3510 1680 3820
1590 4090 Stdev 3770 5550 3640 5890 3510 6060 p (t-test) 0.022
0.0090 0.0022 Min 30.5 20.6 21.1 20.6 21.1 20.6 Max 18800 18800
18800 18800 18800 18800 n (Patient) 56 93 72 77 78 71 UO only
Median 638 1070 718 1070 729 1180 Average 2240 3900 2210 4160 2160
4460 Stdev 4400 6010 4310 6260 4240 6480 p (t-test) 0.057 0.030
0.012 Min 20.6 172 20.6 194 20.6 194 Max 18800 18800 18800 18800
18800 18800 n (Patient) 98 50 103 45 107 41 Persistence Period
Duration (hr) 24 48 72 sCr or UO sCr only UO only sCr or UO sCr
only UO only sCr or UO sCr only UO only AUC 0.68 0.64 0.64 0.66
0.63 0.64 0.69 0.66 0.65 SE 0.044 0.045 0.049 0.045 0.045 0.051
0.044 0.045 0.053 p Value 4.1E-5 0.0015 0.0052 4.9E-4 0.0039 0.0056
1.6E-5 2.4E-4 0.0051 nCohort Non-persistent 54 56 98 72 72 103 78
78 107 nCohort Persistent 95 93 50 77 77 45 71 71 41 Cutoff
Quartile 2 401 401 410 401 401 410 401 401 410 Sensitivity 80% 78%
86% 81% 79% 87% 85% 83% 88% Specificity 33% 30% 31% 31% 29% 30% 33%
32% 30% Cutoff Quartile 3 794 794 801 794 794 801 794 794 801
Sensitivity 60% 58% 64% 60% 58% 64% 62% 61% 63% Specificity 67% 62%
57% 60% 58% 56% 60% 59% 55% Cutoff Quartile 4 1830 1830 1840 1830
1830 1840 1830 1830 1840 Sensitivity 35% 34% 30% 38% 36% 31% 39%
38% 34% Specificity 91% 89% 78% 88% 86% 78% 87% 86% 79% OR Quartile
2 2.00 1.59 2.71 1.82 1.57 2.80 2.73 2.32 3.07 p Value 0.073 0.23
0.031 0.12 0.24 0.035 0.014 0.035 0.032 Lower limit of 95% CI 0.938
0.748 1.09 0.855 0.742 1.07 1.23 1.06 1.10 Upper limit of 95% CI
4.26 3.38 6.71 3.87 3.32 7.29 6.05 5.07 8.54 OR Quartile 3 3.00
2.31 2.37 2.20 1.97 2.34 2.47 2.21 2.13 p Value 0.0021 0.016 0.016
0.018 0.042 0.022 0.0072 0.018 0.045 Lower limit of 95% CI 1.49
1.17 1.17 1.14 1.03 1.13 1.28 1.15 1.02 Upper limit of 95% CI 6.04
4.55 4.79 4.24 3.78 4.82 4.78 4.25 4.47 OR Quartile 4 5.22 4.37
1.48 4.23 3.54 1.57 4.43 3.74 1.89 p Value 0.0014 0.0023 0.32
7.3E-4 0.0023 0.26 3.6E-4 0.0012 0.11 Lower limit of 95% CI 1.90
1.69 0.686 1.83 1.57 0.718 1.96 1.68 0.857 Upper limit of 95% CI
14.4 11.3 3.19 9.77 7.99 3.44 10.0 8.30 4.19
TABLE-US-00069 TABLE 17.5 Comparison of marker levels and the area
under the ROC curve (AUC) in urine samples for the "persistent" and
"non-persistent" cohorts where persistence starts within 168 hours
after sample collection and renal status is assessed by serum
creatinine (sCr) only, urine output (UO) only, or serum creatinine
or urine output RTFLE criteria. Persistence Period Duration (hr) 24
48 72 Non-persistent Persistent Non-persistent Persistent
Non-persistent Persistent Cohort Cohort Cohort Cohort Cohort Cohort
sCr or UO Median 547 1070 601 1070 592 1070 Average 1250 3600 1280
4080 1240 4310 Stdev 3080 5660 2760 6100 2670 6230 p (t-test)
0.0060 5.8E-4 1.5E-4 Min 30.5 20.6 21.1 20.6 21.1 20.6 Max 16600
18800 16600 18800 16600 18800 n (Patient) 52 97 69 80 74 75 sCr
only Median 569 1020 611 1070 592 1070 Average 1560 3500 1510 3910
1440 4180 Stdev 3810 5520 3440 5900 3320 6060 p (t-test) 0.023
0.0034 7.7E-4 Min 30.5 20.6 21.1 20.6 21.1 20.6 Max 18800 18800
18800 18800 18800 18800 n (Patient) 55 94 70 79 76 73 UO only
Median 630 1070 642 1070 680 1200 Average 2140 4010 2140 4120 2100
4340 Stdev 4320 6020 4270 6170 4210 6310 p (t-test) 0.031 0.024
0.012 Min 20.6 172 20.6 172 20.6 172 Max 18800 18800 18800 18800
18800 18800 n (Patient) 96 52 99 49 102 46 Persistence Period
Duration (hr) 24 48 72 sCr or UO sCr only UO only sCr or UO sCr
only UO only sCr or UO sCr only UO only AUC 0.68 0.65 0.65 0.66
0.65 0.64 0.68 0.68 0.65 SE 0.044 0.045 0.048 0.044 0.045 0.050
0.044 0.044 0.050 p Value 5.2E-5 6.9E-4 0.0018 3.1E-4 8.1E-4 0.0040
3.8E-5 3.2E-5 0.0023 nCohort Non-persistent 52 55 96 69 70 99 74 76
102 nCohort Persistent 97 94 52 80 79 49 75 73 46 Cutoff Quartile 2
401 401 410 401 401 410 401 401 410 Sensitivity 79% 79% 87% 80% 80%
86% 83% 84% 87% Specificity 33% 31% 31% 30% 30% 30% 32% 33% 30%
Cutoff Quartile 3 794 794 801 794 794 801 794 794 801 Sensitivity
60% 59% 65% 60% 59% 65% 61% 62% 65% Specificity 67% 64% 58% 61% 60%
58% 61% 61% 57% Cutoff Quartile 4 1830 1830 1840 1830 1830 1840
1830 1830 1840 Sensitivity 35% 35% 31% 38% 38% 31% 39% 40% 33%
Specificity 92% 91% 78% 88% 89% 78% 88% 88% 78% OR Quartile 2 1.87
1.66 2.92 1.75 1.69 2.61 2.29 2.49 2.91 p Value 0.11 0.19 0.020
0.14 0.17 0.038 0.035 0.022 0.029 Lower limit of 95% CI 0.874 0.777
1.18 0.826 0.797 1.05 1.06 1.14 1.12 Upper limit of 95% CI 4.00
3.52 7.23 3.71 3.57 6.47 4.95 5.45 7.57 OR Quartile 3 3.06 2.47
2.64 2.33 2.20 2.55 2.46 2.46 2.47 p Value 0.0019 0.0098 0.0065
0.012 0.018 0.0097 0.0074 0.0073 0.014 Lower limit of 95% CI 1.51
1.24 1.31 1.21 1.14 1.26 1.27 1.28 1.20 Upper limit of 95% CI 6.21
4.90 5.33 4.51 4.25 5.20 4.76 4.76 5.09 OR Quartile 4 6.48 5.41
1.59 4.58 4.74 1.54 4.55 4.91 1.76 p Value 8.9E-4 0.0011 0.23
5.7E-4 4.2E-4 0.27 3.9E-4 2.0E-4 0.15 Lower limit of 95% CI 2.15
1.97 0.741 1.93 2.00 0.715 1.97 2.12 0.810 Upper limit of 95% CI
19.5 14.9 3.40 10.9 11.3 3.34 10.5 11.4 3.82
Example 18. Use of Insulin-Like Growth Factor-Binding Protein 4 for
Evaluating Renal Status in Patients Admitted to the ICU: Persistent
at RIFLE F
[0166] Patients from the intensive care unit (ICU) with RIFLE stage
of injury (I) or failure (F) are enrolled in the following study.
EDTA anti-coagulated blood samples (10 mL) and urine samples (50
mL) are collected from each patient at enrollment, and at every 12
hours up to day 3, and then every 24 hours thereafter up to day 7
while the subject is hospitalized. Insulin-like growth
factor-binding protein 4 is measured in the enrollment samples by
standard immunoassay methods using commercially available assay
reagents.
[0167] Kidney status is assessed by RIFLE criteria based on serum
creatinine, urine output, or both serum creatinine and urine
output. Two cohorts are defined to represent a "persistent" and a
"non-persistent" population. "Persistent" indicates those patients
whose minimum RIFLE stage during a period of 24, 48 or 72 hours is
failure (F) where the persistence period can start from the time of
sample collection to 24, 48, 72, 96 or 168 hours after sample
collection. "Non-persistent" indicates those patients who are not
persistent at failure (F) and whose minimum RIFLE stage during a
period of 24, 48 or 72 hours is non-injury (RIFLE 0), risk of
injury (R), or injury (I) where the persistence period can start
from the time of sample collection to 24, 48, 72, 96 or 168 hours
after sample collection. If a patient dies after failure (F) or is
placed on renal replacement therapy (RRT) at any time from sample
collection to 24, 48, 72, 96 or 168 hours after sample collection,
the patient is considered "persistent".
[0168] The ability to distinguish the "persistent" and
"non-persistent" cohorts is determined using receiver operating
characteristic (ROC) analysis.
TABLE-US-00070 TABLE 18.1 Comparison of marker levels and the area
under the ROC curve (AUC) in urine samples for the "persistent" and
"non-persistent" cohorts where persistence starts within 24 hours
after sample collection and renal status is assessed by serum
creatinine (sCr) only, urine output (UO) only, or serum creatinine
or urine output RIFLE criteria. Persistence Period Duration (hr) 24
48 72 Non-persistent Persistent Non-persistent Persistent
Non-persistent Persistent Cohort Cohort Cohort Cohort Cohort Cohort
sCr or UO Median 0.0669 1.14 0.0851 1.75 0.0895 1.36 Average 4.30
14.0 4.43 15.5 5.82 13.2 Stdev 16.9 21.1 16.5 22.2 18.3 20.0 p
(t-test) 0.0028 0.0011 0.040 Min 0.000212 0.000212 0.000212
0.000212 0.000212 0.000212 Max 120 73.0 120 73.0 120 61.5 n
(Patient) 98 51 106 43 113 36 sCr only Median 0.0851 1.13 0.0851
1.75 0.118 1.36 Average 4.35 13.7 4.36 15.6 5.81 12.9 Stdev 17.0
21.0 16.5 22.1 18.5 19.6 p (L-Lest) 0.0037 8.2E-4 0.046 Min
0.000212 0.000212 0.000212 0.000212 0.000212 0.000212 Max 120 73.0
120 73.0 120 61.5 n (Patient) 97 52 106 43 111 38 UO only Median
0.146 1.03 0.126 1.14 0.126 1.14 Average 6.99 12.6 6.94 13.3 6.94
13.3 Stdev 19.0 18.8 18.9 19.1 18.9 19.1 p (t-test) 0.24 0.20 0.20
Min 0.000212 0.000339 0.000212 0.000339 0.000212 0.000339 Max 120
50.9 120 50.9 120 50.9 n (Patient) 130 18 131 17 131 17 Persistence
Period Duration (hr) 24 48 72 sCr or UO sCr only UO only sCr or UO
sCr only UO only sCr or UO sCr only UO only AUC 0.68 0.67 0.66 0.69
0.68 0.67 0.65 0.63 0.67 SE 0.048 0.048 0.074 0.050 0.051 0.075
0.055 0.054 0.075 p Value 1.9E-4 5.2E-4 0.033 1.4E-4 3.0E-4 0.027
0.0063 0.013 0.027 nCohort Non-persistent 98 97 130 106 106 131 113
111 131 nCohort Persistent 51 52 18 43 43 17 36 38 17 Cutoff
Quartile 2 0.000339 0.000339 0.000339 0.000339 0.000339 0.000339
0.000339 0.000339 0.000339 Sensitivity 88% 87% 100% 86% 84% 100%
86% 82% 100% Specificity 22% 22% 21% 21% 20% 21% 20% 19% 21% Cutoff
Quartile 3 0.170 0.170 0.205 0.170 0.170 0.205 0.170 0.170 0.205
Sensitivity 63% 62% 61% 67% 67% 65% 64% 63% 65% Specificity 56% 56%
52% 57% 57% 52% 54% 54% 52% Cutoff Quartile 4 2.99 2.99 3.01 2.99
2.99 3.01 2.99 2.99 3.01 Sensitivity 43% 42% 39% 47% 47% 41% 42%
42% 41% Specificity 84% 84% 77% 83% 83% 77% 80% 80% 77% OR Quartile
2 2.17 1.78 9.83 1.62 1.27 9.21 1.58 1.03 9.21 p Value 0.12 0.23
0.11 0.34 0.62 0.13 0.39 0.95 0.13 Lower limit of 95% CI 0.819
0.700 0.574 0.605 0.496 0.537 0.555 0.401 0.537 Upper limit of 95%
CI 5.76 4.51 168 4.31 3.25 158 4.53 2.67 158 OR Quartile 3 2.15
2.01 1.67 2.70 2.70 1.98 2.08 2.02 1.98 p Value 0.030 0.047 0.32
0.0089 0.0089 0.20 0.065 0.070 0.20 Lower limit of 95% CI 1.08 1.01
0.610 1.28 1.28 0.691 0.957 0.946 0.691 Upper limit of 95% CI 4.31
4.00 4.58 5.69 5.69 5.67 4.50 4.30 5.67 OR Quartile 4 3.89 3.71
2.12 4.25 4.25 2.36 2.80 2.94 2.36 p Value 5.5E-4 8.2E-4 0.15
3.0E-4 3.0E-4 0.11 0.012 0.0078 0.11 Lower limit of 95% CI 1.80
1.72 0.756 1.94 1.94 0.826 1.25 1.33 0.826 Upper limit of 95% CI
8.40 8.00 5.95 9.32 9.32 6.72 6.25 6.52 6.72
TABLE-US-00071 TABLE 18.2 Comparison of marker levels and the area
under the ROC curve (AUC) in urine samples for the "persistent" and
"non-persistent" cohorts where persistence starts within 48 hours
after sample collection and renal status is assessed by serum
creatinine (sCr) only, urine output (UO) only, or serum creatinine
or urine output RIFLE criteria. Persistence Period Duration (hr) 24
48 72 Non-persistent Persistent Non-persistent Persistent
Non-persistent Persistent Cohort Cohort Cohort Cohort Cohort Cohort
sCr or UO Median 0.0328 1.17 0.0328 1.58 0.0851 1.17 Average 4.50
12.5 4.55 13.5 6.01 11.4 Stdev 17.5 20.2 17.2 20.9 18.9 18.6 p
(t-test) 0.011 0.0058 0.11 Min 0.000212 0.000212 0.000212 0.000212
0.000212 0.000212 Max 120 73.0 120 73.0 120 61.5 n (Patient) 91 58
98 51 105 44 sCr only Median 0.0487 1.13 0.0328 1.67 0.0851 1.13
Average 4.51 12.5 4.57 13.3 6.10 11.0 Stdev 17.5 20.2 17.2 20.7
19.1 18.3 p (t-test) 0.012 0.0070 0.15 Min 0.000212 0.000212
0.000212 0.000212 0.000212 0.000212 Max 120 73.0 120 73.0 120 61.5
n (Patient) 91 58 97 52 103 46 UO only Median 0.126 1.13 0.126 1.13
0.126 1.13 Average 7.28 9.57 7.22 9.96 7.22 9.96 Stdev 19.5 16.6
19.4 16.9 19.4 16.9 p (t-test) 0.58 0.52 0.52 Min 0.000212 0.000339
0.000212 0.000339 0.000212 0.000339 Max 120 50.9 120 50.9 120 50.9
n (Patient) 123 25 124 24 124 24 Persistence Period Duration (hr)
24 48 72 sCr or UO sCr only UO only sCr or UO sCr only UO only sCr
or UO sCr only UO only AUC 0.69 0.67 0.65 0.70 0.69 0.65 0.66 0.64
0.65 SE 0.046 0.046 0.064 0.047 0.047 0.065 0.051 0.051 0.065 p
Value 4.2E-5 2.0E-4 0.021 1.6E-5 4.1E-5 0.018 0.0012 0.0049 0.018
nCohort Non-persistent 91 91 123 98 97 124 105 103 124 nCohort
Persistent 58 58 25 51 52 24 44 46 24 Cutoff Quartile 2 0.000339
0.000339 0.000339 0.000339 0.000339 0.000339 0.000339 0.000339
0.000339 Sensitivity 90% 88% 100% 88% 87% 100% 89% 85% 100%
Specificity 24% 23% 22% 22% 22% 22% 22% 20% 22% Cutoff Quartile 3
0.170 0.170 0.205 0.170 0.170 0.205 0.170 0.170 0.205 Sensitivity
62% 60% 60% 67% 65% 62% 64% 61% 62% Specificity 57% 56% 52% 58% 58%
52% 55% 54% 52% Cutoff Quartile 4 2.99 2.99 3.01 2.99 2.99 3.01
2.99 2.99 3.01 Sensitivity 41% 41% 36% 43% 44% 38% 41% 41% 38%
Specificity 85% 85% 77% 84% 85% 77% 81% 82% 77% OR Quartile 2 2.76
2.19 14.5 2.17 1.78 13.8 2.19 1.43 13.8 p Value 0.040 0.099 0.064
0.12 0.23 0.069 0.14 0.46 0.069 Lower limit of 95% CI 1.05 0.864
0.857 0.819 0.700 0.814 0.774 0.559 0.814 Upper limit of 95% CI
7.30 5.53 246 5.76 4.51 235 6.19 3.64 235 OR Quartile 3 2.18 1.94
1.63 2.78 2.58 1.84 2.16 1.85 1.84 p Value 0.023 0.052 0.28 0.0046
0.0079 0.18 0.037 0.088 0.18 Lower limit of 95% CI 1.11 0.993 0.678
1.37 1.28 0.748 1.05 0.913 0.748 Upper limit of 95% CI 4.28 3.79
3.90 5.64 5.19 4.51 4.46 3.76 4.51 OR Quartile 4 3.88 3.88 1.91
3.89 4.34 2.06 2.94 3.11 2.06 p Value 5.8E-4 5.8E-4 0.17 5.5E-4
2.1E-4 0.13 0.0063 0.0038 0.13 Lower limit of 95% CI 1.79 1.79
0.761 1.80 2.00 0.814 1.36 1.44 0.814 Upper limit of 95% CI 8.41
8.41 4.78 8.40 9.42 5.20 6.38 6.72 5.20
TABLE-US-00072 TABLE 18.3 Comparison of marker levels and the area
under the ROC curve (AUC) in urine samples for the "persistent" and
"non-persistent" cohorts where persistence starts within 72 hours
after sample collection and renal status is assessed by serum
creatinine (sCr) only, urine output (UO) only, or serum creatinine
or urine output RIFLE criteria. Persistence Period Duration (hr) 24
48 72 Non-persistent Persistent Non-persistent Persistent
Non-persistent Persistent Cohort Cohort Cohort Cohort Cohort Cohort
sCr or UO Median 0.0328 1.21 0.0328 1.46 0.0407 1.21 Average 4.49
11.9 4.29 12.7 5.99 10.7 Stdev 17.9 19.6 17.5 20.0 19.3 17.9 p
(t-test) 0.018 0.0077 0.15 Min 0.000212 0.000212 0.000212 0.000212
0.000212 0.000212 Max 120 73.0 120 73.0 120 61.5 n (Patient) 86 63
90 59 98 51 sCr only Median 0.0328 1.17 0.0328 1.46 0.0851 1.13
Average 4.55 11.7 4.31 12.7 6.06 10.5 Stdev 18.0 19.5 17.5 20.0
19.4 17.8 p (t-test) 0.022 0.0080 0.17 Min 0.000212 0.000212
0.000212 0.000212 0.000212 0.000212 Max 120 73.0 120 73.0 120 61.5
n (Patient) 85 64 90 59 97 52 UO only Median 0.122 1.13 0.126 1.14
0.126 1.14 Average 7.21 9.31 7.15 9.61 7.15 9.61 Stdev 19.8 15.9
19.7 16.1 19.7 16.1 p (t-test) 0.58 0.52 0.52 Mill 0.000212
0.000312 0.000212 0.000312 0.000212 0.000312 Max 120 50.9 120 50.9
120 50.9 n (Patient) 116 32 117 31 117 31 Persistence Period
Duration (hr) 24 48 72 sCr or UO sCr only UO only sCr or UO sCr
only UO only sCr or UO sCr only UO only AUC 0.69 0.68 0.64 0.71
0.70 0.65 0.66 0.64 0.65 SE 0.045 0.045 0.058 0.044 0.045 0.059
0.048 0.049 0.059 p Value 3.0E-5 9.1E-5 0.014 1.7E-6 1.2E-5 0.012
6.5E-4 0.0048 0.012 nCohort Non-persistent 86 85 116 90 90 117 98
97 117 nCohort Persistent 63 64 32 59 59 31 51 52 31 Cutoff
Quartile 2 0.000339 0.000339 0.000339 0.000339 0.000339 0.000339
0.000339 0.000339 0.000339 Sensitivity 89% 88% 97% 88% 86% 97% 88%
85% 97% Specificity 24% 24% 22% 23% 22% 22% 22% 21% 22% Cutoff
Quartile 3 0.170 0.170 0.205 0.170 0.170 0.205 0.170 0.170 0.205
Sensitivity 62% 61% 59% 66% 64% 61% 63% 60% 61% Specificity 58% 58%
53% 60% 59% 53% 56% 55% 53% Cutoff Quartile 4 2.99 2.99 3.01 2.99
2.99 3.01 2.99 2.99 3.01 Sensitivity 40% 39% 34% 42% 42% 35% 39%
38% 35% Specificity 85% 85% 78% 86% 86% 78% 82% 81% 78% OR Quartile
2 2.58 2.15 8.96 2.26 1.82 8.57 2.17 1.43 8.57 p Value 0.045 0.093
0.035 0.085 0.19 0.039 0.12 0.44 0.039 Lower limit of 95% CI 1.02
0.881 1.17 0.894 0.744 1.12 0.819 0.581 1.12 Upper limit of 95% CI
6.53 5.27 68.8 5.72 4.46 65.9 5.76 3.51 65.9 OR Quartile 3 2.26
2.12 1.62 2.92 2.59 1.78 2.15 1.78 1.78 p Value 0.016 0.026 0.23
0.0021 0.0059 0.16 0.030 0.099 0.16 Lower limit of 95% CI 1.16 1.10
0.733 1.48 1.32 0.795 1.08 0.898 0.795 Upper limit of 95% CI 4.39
4.11 3.59 5.80 5.11 4.01 4.31 3.52 4.01 OR Quartile 4 3.69 3.55
1.81 4.36 4.36 1.92 2.87 2.74 1.92 p Value 9.7E-4 0.0014 0.17
2.3E-4 2.3E-4 0.13 0.0066 0.0091 0.13 Lower limit of 95% CI 1.70
1.64 0.775 1.99 1.99 0.819 1.34 1.29 0.819 Upper limit of 95% CI
8.03 7.71 4.24 9.52 9.52 4.53 6.13 5.85 4.53
TABLE-US-00073 TABLE 18.4 Comparison of marker levels and the area
under the ROC curve (AUC) in urine samples for the "persistent" and
"non-persistent" cohorts where persistence starts within 96 hours
after sample collection and renal status is assessed by serum
creatinine (sCr) only, urine output (UO) only, or serum creatinine
or urine output RIFLE criteria. Persistence Period Duration (hr) 24
48 72 Non-persistent Persistent Non-persistent Persistent
Non-persistent Persistent Cohort Cohort Cohort Cohort Cohort Cohort
sCr or UO Median 0.0328 1.28 0.0328 1.46 0.0407 1.21 Average 4.40
11.9 4.29 12.7 5.35 11.7 Stdev 18.0 19.4 17.5 20.0 18.2 19.6 p
(t-test) 0.016 0.0077 0.049 Min 0.000212 0.000212 0.000212 0.000212
0.000212 0.000212 Max 120 73.0 120 73.0 120 73.0 n (Patient) 85 64
90 59 96 53 sCr only Median 0.0328 1.17 0.0328 1.40 0.0487 1.17
Average 4.55 11.7 4.34 12.5 5.41 11.5 Stdev 18.0 19.5 17.6 19.9
18.3 19.5 p (t-test) 0.022 0,0097 0.059 Min 0.000212 0.000212
0.000212 0.000212 0.000212 0.000212 Max 120 73.0 120 73.0 120 73.0
n (Patient) 85 64 89 60 95 54 UO only Median 0.0873 1.13 0.104 1.13
0.104 1.13 Average 6.98 9.79 6.97 9.98 6.97 9.98 Stdev 19.9 16.1
19.7 16.4 19.7 16.4 p (t-test) 0.44 0.42 0.42 Min 0.000212 0.000312
0.000212 0.000312 0.000212 0.000312 Max 120 50.9 120 50.9 120 50.9
n (Patient) 112 36 114 34 114 34 Persistence Period Duration (hr)
24 48 72 sCr or UO sCr only UO only sCr or UO sCr only UO only sCr
or UO sCr only UO only AUC 0.70 0.68 0.66 0.71 0.70 0.66 0.67 0.65
0.66 SE 0.044 0.045 0.055 0.044 0.045 0.056 0.048 0.048 0.056 p
Value 9.7E-6 9.1E-5 0.0029 1.7E-6 6.6E-6 0.0049 4.8E-4 0.0012
0.0049 nCohort Non-persistent 85 85 112 90 89 114 96 95 114 nCohort
Persistent 64 64 36 59 60 34 53 54 34 Cutoff Quartile 2 0.000339
0.000339 0.000339 0.000339 0.000339 0.000339 0.000339 0.000339
0.000339 Sensitivity 89% 88% 97% 88% 87% 97% 87% 85% 97%
Specificity 25% 24% 23% 23% 22% 23% 22% 21% 23% Cutoff Quartile 3
0.170 0.170 0.205 0.170 0.170 0.205 0.170 0.170 0.205 Sensitivity
62% 61% 61% 66% 65% 62% 62% 61% 62% Specificity 59% 58% 54% 60% 60%
54% 56% 56% 54% Cutoff Quartile 4 2.99 2.99 3.01 2.99 2.99 3.01
2.99 2.99 3.01 Sensitivity 41% 39% 36% 42% 42% 35% 40% 39% 35%
Specificity 86% 85% 79% 86% 85% 78% 82% 82% 78% OR Quartile 2 2.67
2.15 10.6 2.26 1.88 9.75 1.84 1.53 9.75 p Value 0.038 0.093 0.023
0.085 0.17 0.028 0.20 0.35 0.028 Lower limit of 95% CI 1.06 0.881
1.38 0.894 0.769 1.27 0.725 0.624 1.27 Upper limit of 95% CI 6.75
5.27 81.0 5.72 4.61 74.8 4.67 3.77 74.8 OR Quartile 3 2.38 2.12
1.81 2.92 2.73 1.86 2.12 1.98 1.86 p Value 0.011 0.026 0.13 0.0021
0.0037 0.12 0.032 0.049 0.12 Lower limit of 95% CI 1.22 1.10 0.843
1.48 1.39 0.849 1.07 1.00 0.849 Upper limit of 95% CI 4.63 4.11
3.90 5.80 5.39 4.07 4.21 3.92 4.07 OR Quartile 4 4.16 3.55 2.07
4.36 4.18 1.94 3.05 2.92 1.94 p Value 3.9E-4 0.0014 0.080 2.3E-4
3.3E-4 0.12 0.0040 0.0056 0.12 Lower limit of 95% CI 1.89 1.64
0.916 1.99 1.91 0.845 1.43 1.37 0.845 Upper limit of 95% CI 9.16
7.71 4.69 9.52 9.12 4.46 6.52 6.23 4.46
TABLE-US-00074 TABLE 18.5 Comparison of marker levels and the area
under the ROC curve (AUC) in urine samples for the "persistent" and
"non-persistent" cohorts where persistence starts within 168 hours
after sample collection and renal status is assessed by serum
creatinine (sCr) only, urine output (UO) only, or serum creatinine
or urine output RIFLE criteria. Persistence Period Duration (hr) 24
48 72 Non-persistent Persistent Non-persistent Persistent
Non-persistent Persistent Cohort Cohort Cohort Cohort Cohort Cohort
sCr or UO Median 0.0328 1.35 0.0169 1.58 0.0328 1.28 Average 2.93
13.3 2.79 14.2 5.25 11.5 Stdev 12.9 23.2 12.6 23.7 18.5 19.2 p
(t-test) 7.0E-4 2.2E-4 0.049 Min 0.000212 0.000212 0.000212
0.000212 0.000212 0.000212 Max 110 120 110 120 120 73.0 n (Patient)
82 67 86 63 93 56 sCr only Median 0.0328 1.28 0.0328 1.52 0.0328
1.28 Average 3.05 13.4 2.91 14.2 4.09 13.5 Stdev 12.9 23.4 12.6
23.9 14.1 24.0 p (t-test) 8.1E-4 2.5E-4 0.0031 Min 0.000212
0.000212 0.000212 0.000212 0.000212 0.000212 Max 110 120 110 120
110 120 n (Patient) 83 66 87 62 93 56 UO only Median 0.0851 1.14
0.0873 1.17 0.0873 1.17 Average 6.64 10.7 6.58 11.0 6.58 11.0 Stdev
19.6 16.9 19.5 17.0 19.5 17.0 p (t-test) 0.26 0.22 0.22 Min
0.000212 0.000312 0.000212 0.000312 0.000212 0.000312 Max 120 50.9
120 50.9 120 50.9 n (Patient) 111 37 112 36 112 36 Persistence
Period Duration (hr) 24 48 72 sCr or UO sCr only UO only sCr or UO
sCr only UO only sCr or UO sCr only UO only AUC 0.71 0.70 0.68 0.73
0.72 0.68 0.67 0.68 0.68 SE 0.043 0.044 0.054 0.043 0.043 0.054
0.047 0.047 0.054 p Value 1.6E-6 5.9E-6 0.0011 5.4E-8 2.5E-7 8.7E-4
2.2E-4 1.4E-4 8.7E-4 nCohort Non-persistent 82 83 111 86 87 112 93
93 112 nCohort Persistent 67 66 37 63 62 36 56 56 36 Cutoff
Quartile 2 0.000339 0.000339 0.000339 0.000339 0.000339 0.000339
0.000339 0.000339 0.000339 Sensitivity 88% 88% 97% 87% 87% 97% 86%
86% 97% Specificity 24% 24% 23% 23% 23% 23% 22% 22% 23% Cutoff
Quartile 3 0.170 0.170 0.205 0.170 0.170 0.205 0.170 0.170 0.205
Sensitivity 63% 62% 62% 67% 66% 64% 62% 62% 64% Specificity 60% 59%
54% 62% 61% 54% 57% 57% 54% Cutoff Quartile 4 2.99 2.99 3.01 2.99
2.99 3.01 2.99 2.99 3.01 Sensitivity 42% 41% 38% 44% 44% 39% 41%
41% 39% Specificity 88% 87% 79% 88% 87% 79% 84% 84% 79% OR Quartile
2 2.38 2.30 11.0 2.08 2.01 10.6 1.64 1.64 10.6 p Value 0.057 0.068
0.021 0.11 0.12 0.023 0.28 0.28 0.023 Lower limit of 95% CI 0.973
0.941 1.44 0.852 0.823 1.38 0.670 0.670 1.38 Upper limit of 95% CI
5.82 5.63 84.3 5.10 4.93 81.0 4.03 4.03 81.0 OR Quartile 3 2.49
2.36 1.93 3.21 3.04 2.12 2.21 2.21 2.12 p Value 0.0069 0.011 0.090
7.8E-4 0.0013 0.058 0.022 0.022 0.058 Lower limit of 95% CI 1.29
1.22 0.902 1.63 1.54 0.975 1.12 1.12 0.975 Upper limit of 95% CI
4.84 4.58 4.14 6.34 6.01 4.59 4.36 4.36 4.59 OR Quartile 4 5.17
4.53 2.33 6.08 5.33 2.46 3.62 3.62 2.46 p Value 8.7E-5 2.2E-4 0.040
1.8E-5 4.9E-5 0.030 0.0010 0.0010 0.030 Lower limit of 95% CI 2.28
2.03 1.04 2.66 2.38 1.09 1.68 1.68 1.09 Upper limit of 95% CI 11.7
10.1 5.22 13.9 11.9 5.55 7.81 7.81 5.55
Example 19. Use of Insulin-Like Growth Factor-Binding Protein 4 for
Evaluating Renal Status in Patients Admitted to the ICU: Persistent
at RIFLE I or F
[0169] Patients from the intensive care unit (ICU) with RIFLE stage
of injury (I) or failure (F) are enrolled in the following study.
EDTA anti-coagulated blood samples (10 mL) and urine samples (50
mL) are collected from each patient at enrollment, and at every 12
hours up to day 3, and then every 24 hours thereafter up to day 7
while the subject is hospitalized. Insulin-like growth
factor-binding protein 4 is measured in the enrollment samples by
standard immunoassay methods using commercially available assay
reagents.
[0170] Kidney status is assessed by RIFLE criteria based on serum
creatinine, urine output, or both serum creatinine and urine
output. Two cohorts are defined to represent a "persistent" and a
"non-persistent" population. "Persistent" indicates those patients
whose minimum RIFLE stage during a period of 24, 48 or 72 hours is
injury (I) or failure (F) where the persistence period can start
from the time of sample collection to 24, 48, 72, 96 or 168 hours
after sample collection. "Non-persistent" indicates those patients
who are not persistent at injury (I) or failure (F) and whose
minimum RIFLE stage during a period of 24, 48 or 72 hours is
non-injury (RIFLE 0) or risk of injury (R) where the persistence
period can start from the time of sample collection to 24, 48, 72,
96 or 168 hours after sample collection. If a patient dies after
injury (I) or failure (F) or is placed on renal replacement therapy
(RRT) at any time from sample collection to 24, 48, 72, 96 or 168
hours after sample collection, the patient is considered
"persistent".
[0171] The ability to distinguish the "persistent" and
"non-persistent" cohorts is determined using receiver operating
characteristic (ROC) analysis.
TABLE-US-00075 TABLE 19.1 Comparison of marker levels and the area
under the ROC curve (AUC) in urine samples for the "persistent" and
"non-persistent" cohorts where persistence starts within 24 hours
after sample collection and renal status is assessed by serum
creatinine (sCr) only, urine output (UO) only, or serum creatinine
or urine output RIFLE criteria. Persistence Period Duration (hr) 24
48 72 Non-persistent Persistent Non-persistent Persistent
Non-persistent Persistent Cohort Cohort Cohort Cohort Cohort Cohort
sCr or UO Median 0.000473 0.899 0.0669 0.866 0.0328 1.13 Average
2.51 10.6 3.39 12.3 3.11 14.1 Stdev 14.9 20.4 13.3 22.8 12.6 24.1 p
(t-test) 0.011 0.0039 4.0E-4 Min 0.000212 0.000212 0.000212
0.000212 0.000212 0.000212 Max 110 120 110 120 110 120 n (Patient)
55 94 78 71 88 61 sCr only Median 0.000473 0.899 0.0407 0.872
0.0328 1.40 Average 2.65 10.7 3.38 12.0 2.97 14.5 Stdev 14.7 20.6
13.5 22.6 12.5 24.2 p (t-test) 0.011 0.0049 2.0E-4 Mill 0.000212
0.000212 0.000212 0.000212 0.000212 0.000212 Max 110 120 110 120
110 120 n (Patient) 57 92 76 73 89 60 UO only Median 0.146 0.869
0.126 0.927 0.126 1.35 Average 7.17 9.31 6.99 10.7 6.77 12.5 Stdev
19.9 15.6 19.4 16.9 19.1 17.7 p (t-test) 0.57 0.36 0.18 Min
0.000212 0.000286 0.000212 0.000286 0.000212 0.000301 Max 120 50.9
120 50.9 120 50.9 n (Patient) 114 34 121 27 125 23 Persistence
Period Duration (hr) 24 48 72 sCr or UO sCr only UO only sCr or UO
sCr only UO only sCr or UO sCr only UO only AUC 0.74 0.73 0.59 0.64
0.65 0.62 0.68 0.69 0.67 SE 0.040 0.041 0.057 0.045 0.045 0.062
0.046 0.045 0.066 p Value 5.1E-9 2.8E-8 0.12 0.0022 0.0012 0.055
1.1E-4 2.4E-5 0.0084 nCohort Non-persistent 55 57 114 78 76 121 88
89 125 nCohort Persistent 94 92 34 71 73 27 61 60 23 Cutoff
Quartile 2 0.000339 0.000339 0.000339 0.000339 0.000339 0.000339
0.000339 0.000339 0.000339 Sensitivity 86% 86% 85% 85% 84% 89% 85%
83% 96% Specificity 27% 26% 19% 22% 21% 20% 22% 20% 21% Cutoff
Quartile 3 0.170 0.170 0.205 0.170 0.170 0.205 0.170 0.170 0.205
Sensitivity 63% 63% 56% 58% 59% 59% 62% 67% 65% Specificity 71% 70%
52% 56% 58% 52% 58% 61% 53% Cutoff Quartile 4 2.99 2.99 3.01 2.99
2.99 3.01 2.99 2.99 3.01 Sensitivity 38% 38% 35% 37% 37% 37% 39%
43% 43% Specificity 96% 95% 78% 85% 86% 78% 84% 87% 78% OR Quartile
2 2.34 2.17 1.39 1.52 1.36 1.98 1.59 1.27 5.78 p Value 0.046 0.068
0.54 0.33 0.47 0.30 0.30 0.59 0.094 Lower limit of 95% CI 1.02
0.945 0.482 0.658 0.592 0.550 0.666 0.540 0.744 Upper limit of 95%
CI 5.38 4.99 3.99 3.51 3.11 7.12 3.80 2.98 44.9 OR Quartile 3 4.11
4.01 1.36 1.77 1.97 1.58 2.28 3.09 2.10 p Value 1.1E-4 1.2E-4 0.44
0.085 0.041 0.29 0.016 0.0013 0.12 Lower limit of 95% CI 2.01 1.98
0.629 0.924 1.03 0.678 1.17 1.56 0.830 Upper limit of 95% CI 8.41
8.15 2.94 3.39 3.78 3.68 4.45 6.12 5.30 OR Quartile 4 16.4 11.1
1.94 3.18 3.47 2.05 3.43 4.91 2.79 p Value 1.9E-4 1.4E-4 0.12
0.0038 0.0022 0.11 0.0017 8.7E-5 0.030 Lower limit of 95% CI 3.78
3.21 0.845 1.45 1.56 0.840 1.59 2.22 1.10 Upper limit of 95% CI
71.7 38.1 4.46 6.95 7.69 4.99 7.39 10.9 7.06
TABLE-US-00076 TABLE 19.2 Comparison of marker levels and the area
under the ROC curve (AUC) in urine samples for the "persistent" and
"non-persistent" cohorts where persistence starts within 48 hours
after sample collection and renal status is assessed by serum
creatinine (sCr) only, urine output (UO) only, or serum creatinine
or urine output RIFLE criteria. Persistence Period Duration (hr) 24
48 72 Non-persistent Persistent Non-persistent Persistent
Non-persistent Persistent Cohort Cohort Cohort Cohort Cohort Cohort
sCr or UO Median 0.000472 0.927 0.0328 1.03 0.000747 1.35 Average
2.53 10.5 3.29 11.8 2.98 13.3 Stdev 15.0 20.3 13.7 22.2 13.0 23.2 p
(t-test) 0.013 0.0059 8.0E-4 Min 0.000212 0.000212 0.000212
0.000212 0.000212 0.000212 Max 110 120 110 120 110 120 n (Patient)
54 95 73 76 82 67 sCr only Median 0.000473 0.927 0.0328 0.899
0.0169 1.35 Average 2.66 10.6 3.46 11.6 3.09 13.1 Stdev 14.8 20.5
13.8 22.2 13.0 23.2 p (t-test) 0.013 0.0082 0.0011 Min 0.000212
0.000212 0.000212 0.000212 0.000212 0.000212 Max 110 120 110 120
110 120 n (Patient) 56 93 73 76 82 67 UO only Median 0.118 1.03
0.118 1.14 0.118 1.35 Average 7.08 9.15 6.89 10.2 6.66 11.5 Stdev
20.4 15.1 19.8 16.1 19.5 16.7 p (t-test) 0.55 0.37 0.21 Min
0.000212 0.000286 0.000212 0.000286 0.000212 0.000301 Max 120 50.9
120 50.9 120 50.9 n (Patient ) 106 42 113 35 117 31 Persistence
Period Duration (hr) 24 48 72 sCr or UO sCr only UO only sCr or UO
sCr only UO only sCr or UO sCr only UO only AUC 0.74 0.73 0.63 0.67
0.65 0.65 0.71 0.70 0.70 SE 0.040 0.040 0.053 0.044 0.045 0.056
0.043 0.043 0.057 p Value 1.0E-9 6.8E-9 0.017 8.6E-5 6.0E-4 0.0059
6.9E-7 3.3E-6 5.7E-4 nCohort Non-persistent 54 56 106 73 73 113 82
82 117 nCohort Persistent 95 93 42 76 76 35 67 67 31 Cutoff
Quartile 2 0.000339 0.000339 0.000339 0.000339 0.000339 0.000339
0.000339 0.000339 0.000339 Sensitivity 86% 86% 88% 86% 84% 91% 87%
85% 97% Specificity 28% 27% 21% 23% 22% 21% 23% 22% 22% Cutoff
Quartile 3 0.170 0.170 0.205 0.170 0.170 0.205 0.170 0.170 0.205
Sensitivity 63% 63% 60% 61% 59% 63% 66% 66% 68% Specificity 72% 71%
54% 60% 59% 54% 62% 62% 55% Cutoff Quartile 4 2.99 2.99 3.01 2.99
2.99 3.01 2.99 2.99 3.01 Sensitivity 38% 38% 38% 37% 36% 40% 40%
40% 45% Specificity 96% 95% 80% 86% 85% 80% 87% 87% 80% OR Quartile
2 2.43 2.25 1.94 1.79 1.50 2.88 1.94 1.60 8.57 p Value 0.037 0.056
0.21 0.17 0.34 0.10 0.13 0.28 0.039 Lower limit of 95% CI 1.05
0.979 0.681 0.776 0.653 0.811 0.815 0.684 1.12 Upper limit of 95%
CI 5.59 5.18 5.51 4.15 3.43 10.2 4.64 3.76 65.9 OR Quartile 3 4.46
4.34 1.71 2.33 2.08 1.99 3.15 3.15 2.54 p Value 5.6E-5 6.0E-5 0.15
0.012 0.028 0.085 8.5E-4 8.5E-4 0.029 Lower limit of 95% CI 2.15
2.12 0.829 1.21 1.08 0.911 1.60 1.60 1.10 Upper limit of 95% CI
9.22 8.89 3.53 4.49 4.00 4.33 6.17 6.17 5.85 OR Quartile 4 15.9
10.7 2.49 3.68 3.11 2.61 4.36 4.36 3.37 p Value 2.3E-4 1.8E-4 0.023
0.0017 0.0052 0.021 3.2E-4 3.2E-4 0.0047 Lower limit of 95% CI 3.64
3.10 1.14 1.63 1.40 1.15 1.96 1.96 1.45 Upper limit of 95% CI 69.1
36.7 5.46 8.29 6.88 5.90 9.71 9.71 7.81
TABLE-US-00077 TABLE 19.3 Comparison of marker levels and the area
under the ROC curve (AUC) in urine samples for the "persistent" and
"non-persistent" cohorts where persistence starts within 72 hours
after sample collection and renal status is assessed by serum
creatinine (sCr) only, urine output (UO) only, or serum creatinine
or urine output RIFLE criteria. Persistence Period Duration (hr) 24
48 72 Non-persistent Persistent Non-persistent Persistent
Non-persistent Persistent Cohort Cohort Cohort Cohort Cohort Cohort
sCr or UO Median 0.000472 0.927 0.0328 0.927 0.000747 1.21 Average
2.53 10.5 3.32 11.6 3.07 12.6 Stdev 15.0 20.3 13.8 22.0 13.3 22.7 p
(t-test) 0.013 0.0070 0.0019 Min 0.000212 0.000212 0.000212
0.000212 0.000212 0.000212 Max 110 120 110 120 110 120 n (Patient)
54 95 72 77 78 71 sCr only Median 0.000473 0.927 0.0328 0.872
0.0169 1.14 Average 2.66 10.6 3.50 11.5 3.24 12.4 Stdev 14.8 20.5
13.8 22.1 13.3 22.8 p (t-test) 0.013 0.0098 0.0028 Min 0.000212
0.000212 0.000212 0.000212 0.000212 0.000212 Max 110 120 110 120
110 120 n (Patient) 56 93 72 77 78 71 UO only Median 0.122 0.899
0.104 1.13 0.104 1.28 Average 7.45 8.12 7.12 9.05 6.87 9.97 Stdev
20.9 14.4 20.4 15.1 20.0 15.6 p (t-test) 0.84 0.58 0.39 Min
0.000212 0.000212 0.000212 0.000212 0.000212 0.000212 Max 120 50.9
120 50.9 120 50.9 n (Patient) 100 48 106 42 110 38 Persistence
Period Duration (hr) 24 48 72 sCr or UO sCr only UO only sCr or UO
sCr only UO only sCr or UO sCr only UO only AUC 0.74 0.73 0.59 0.68
0.66 0.63 0.71 0.69 0.66 SE 0.040 0.040 0.051 0.044 0.044 0.053
0.043 0.044 0.054 p Value 1.0E-9 6.8E-9 0.062 5.7E-5 4.2E-4 0.017
1.5E-6 1.9E-5 0.0031 nCohort Non-persistent 54 56 100 72 72 106 78
78 110 nCohort Persistent 95 93 48 77 77 42 71 71 38 Cutoff
Quartile 2 0.000339 0.000339 0.000339 0.000339 0.000339 0.000339
0.000339 0.000339 0.000339 Sensitivity 86% 86% 85% 86% 84% 88% 86%
85% 92% Specificity 28% 27% 20% 24% 22% 21% 23% 22% 22% Cutoff
Quartile 3 0.170 0.170 0.205 0.170 0.170 0.205 0.170 0.170 0.205
Sensitivity 63% 63% 56% 61% 60% 60% 65% 63% 63% Specificity 72% 71%
53% 61% 60% 54% 63% 62% 55% Cutoff Quartile 4 2.99 2.99 3.01 2.99
2.99 3.01 2.99 2.99 3.01 Sensitivity 38% 38% 35% 36% 35% 38% 39%
38% 42% Specificity 96% 95% 80% 86% 85% 80% 87% 86% 81% OR Quartile
2 2.43 2.25 1.46 1.85 1.55 1.94 1.83 1.52 3.26 p Value 0.037 0.056
0.43 0.15 0.30 0.21 0.16 0.33 0.067 Lower limit of 95% CI 1.05
0.979 0.572 0.802 0.675 0.681 0.781 0.658 0.921 Upper limit of 95%
CI 5.59 5.18 3.75 4.29 3.55 5.51 4.29 3.51 11.5 OR Quartile 3 4.46
4.34 1.45 2.46 2.20 1.71 3.11 2.77 2.06 p Value 5.6E-5 6.0E-5 0.29
0.0074 0.018 0.15 9.0E-4 0.0027 0.062 Lower limit of 95% CI 2.15
2.12 0.725 1.27 1.14 0.829 1.59 1.43 0.963 Upper limit of 95% CI
9.22 8.89 2.90 4.76 4.24 3.53 6.07 5.38 4.39 OR Quartile 4 15.9
10.7 2.19 3.54 2.99 2.49 4.43 3.74 3.08 p Value 2.3E-4 1.8E-4 0.045
0.0023 0.0068 0.023 3.6E-4 0.0012 0.0058 Lower limit of 95% CI 3.64
3.10 1.02 1.57 1.35 1.14 1.96 1.68 1.38 Upper limit of 95% CI 69.1
36.7 4.73 7.99 6.63 5.46 10.0 8.30 6.86
TABLE-US-00078 TABLE 19.4 Comparison of marker levels and the area
under the ROC curve (AUC) in urine samples for the "persistent" and
"non-persistent" cohorts where persistence starts within 96 hours
after sample collection and renal status is assessed by serum
creatinine (sCr) only, urine output (UO) only, or serum creatinine
or urine output RIFLE criteria. Persistence Period Duration (hr) 24
48 72 Non-persistent Persistent Non-persistent Persistent
Non-persistent Persistent Cohort Cohort Cohort Cohort Cohort Cohort
sCr or UO Median 0.000472 0.927 0.0328 0.927 0.000747 1.21 Average
2.53 10.5 3.32 11.6 3.07 12.6 Stdev 15.0 20.3 13.8 22.0 13.3 22.7 p
(t-test) 0.013 0.0070 0.0019 Min 0.000212 0.000212 0.000212
0.000212 0.000212 0.000212 Max 110 120 110 120 110 120 n (Patient)
54 95 72 77 78 71 sCr only Median 0.000473 0.927 0.0328 0.872
0.0169 1.14 Average 2.66 10.6 3.50 11.5 3.24 12.4 Stdev 14.8 20.5
13.8 22.1 13.3 22.8 p (t-test) 0.013 0.0098 0.0028 Min 0.000212
0.000212 0.000212 0.000212 0.000212 0.000212 Max 110 120 110 120
110 120 n (Patient) 56 93 72 77 78 71 UO only Median 0.142 0.869
0.0895 0.927 0.0895 1.14 Average 7.60 7.79 7.32 8.47 7.05 9.27
Stdev 21.1 14.2 20.6 14.7 20.3 15.2 p (t-test) 0.95 0.74 0.53 Min
0.000212 0.000212 0.000212 0.000212 0.000212 0.000212 Max 120 50.9
120 50.9 120 50.9 n (Patient) 98 50 103 45 107 41 Persistence
Period Duration (hr) 24 48 72 sCr or UO sCr only UO only sCr or UO
sCr only UO only sCr or UO sCr only UO only AUC 0.74 0.73 0.58 0.68
0.66 0.61 0.71 0.69 0.64 SE 0.040 0.040 0.050 0.044 0.044 0.052
0.043 0.044 0.053 p Value 1.0E-9 6.8E-9 0.10 5.7E-5 4.2E-4 0.028
1.5E-6 1.9E-5 0.0063 nCohort Non-persistnet 54 56 98 72 72 103 78
78 107 nCohort Persistent 95 93 50 77 77 45 71 71 41 Cutoff
Quartile 2 0.000339 0.000339 0.000339 0.000339 0.000339 0.000339
0.000339 0.000339 0.000339 Sensitivity 86% 86% 84% 86% 84% 87% 86%
85% 90% Specificity 28% 27% 19% 24% 22% 20% 23% 22% 21% Cutoff
Quartile 3 0.170 0.170 0.205 0.170 0.170 0.205 0.170 0.170 0.205
Sensitivity 63% 63% 54% 61% 60% 58% 65% 63% 61% Specificity 72% 71%
52% 61% 60% 53% 63% 62% 54% Cutoff Quartile 4 2.99 2.99 3.01 2.99
2.99 3.01 2.99 2.99 3.01 Sensitivity 38% 38% 34% 36% 35% 36% 39%
38% 39% Specificity 96% 95% 80% 86% 85% 80% 87% 86% 80% OR Quartile
2 2.43 2.25 1.26 1.85 1.55 1.66 1.83 1.52 2.53 p Value 0.037 0.056
0.61 0.15 0.30 0.31 0.16 0.33 0.11 Lower limit of 95% CI 1.05 0.979
0.510 0.802 0.675 0.622 0.781 0.658 0.818 Upper limit of 95% CI
5.59 5.18 3.13 4.29 3.55 4.45 4.29 3.51 7.84 OR Quartile 3 4.46
4.34 1.27 2.46 2.20 1.57 3.11 2.77 1.85 p Value 5.6E-5 6.0E-5 0.49
0.0074 0.018 0.21 9.0E-4 0.0027 0.10 Lower limit of 95% CI 2.15
2.12 0.643 1.27 1.14 0.773 1.59 1.43 0.888 Upper limit of 95% CI
9.22 8.89 2.52 4.76 4.24 3.18 6.07 5.38 3.85 OR Quartile 4 15.9
10.7 2.01 3.54 2.99 2.15 4.43 3.74 2.62 p Value 2.3E-4 1.8E-4 0.073
0.0023 0.0068 0.053 3.6E-4 0.0012 0.017 Lower limit of 95% CI 3.64
3.10 0.936 1.57 1.35 0.991 1.96 1.68 1.19 Upper limit of 95% CI
69.1 36.7 4.31 7.99 6.63 4.68 10.0 8.30 5.77
TABLE-US-00079 TABLE 19.5 Comparison of marker levels and the area
under the ROC curve (AUC) in urine samples for the "persistent" and
"non-persistent" cohorts where persistence starts within 168 hours
after sample collection and renal status is assessed by serum
creatinine (sCr) only, urine output (UO) only, or serum creatinine
or urine output RIFLE criteria. Persistence Period Duration (hr) 24
48 72 Non-persistent Persistent Non-persistent Persistent
Non-persistent Persistent Cohort Cohort Cohort Cohort Cohort Cohort
sCr or UO Median 0.000472 0.927 0.0328 0.899 0.0169 1.14 Average
2.38 10.4 3.27 11.4 3.06 12.1 Stdev 15.2 20.2 14.0 21.7 13.6 22.2 p
(t-test) 0.013 0.0089 0.0032 Min 0.000212 0.000212 0.000212
0.000212 0.000212 0.000212 Max 110 120 110 120 110 120 n (Patient)
52 97 69 80 74 75 sCr only Median 0.000473 1.03 0.0328 0.927
0.000747 1.21 Average 2.48 10.6 3.22 11.5 2.98 12.4 Stdev 14.9 20.4
13.9 21.8 13.4 22.4 p (t-test) 0.011 0.0073 0.0020 Min 0.000212
0.000212 0.000212 0.000212 0.000212 0.000212 Max 110 120 110 120
110 120 n (Patient) 55 94 70 79 76 73 UO only Median 0.104 0.899
0.0895 0.927 0.0873 1.13 Average 7.15 8.61 7.02 8.96 6.82 9.54
Stdev 21.0 14.8 20.7 15.2 20.4 15.5 p (t-test) 0.66 0.56 0.42 Min
0.000212 0.000212 0.000212 0.000212 0.000212 0.000212 Max 120 50.9
120 50.9 120 50.9 n (Patient) 96 52 99 49 102 46 Persistence Period
Duration (hr) 24 48 72 sCr or UO sCr only UO only sCr or UO sCr
only UO only sCr or UO sCr only UO only AUC 0.75 0.75 0.60 0.67
0.68 0.62 0.70 0.71 0.65 SE 0.040 0.040 0.050 0.044 0.044 0.050
0.043 0.043 0.050 p Value 4.5E-10 5.2E-10 0.036 7.9E-5 5.1E-5 0.015
4.9E-6 1.4E-6 0.0026 nCohort Non-persistnet 52 55 96 69 70 99 74 76
102 nCohort Persistent 97 94 52 80 79 49 75 73 46 Cutoff Quartile 2
0.000339 0.000339 0.000339 0.000339 0.000339 0.000339 0.000339
0.000339 0.000339 Sensitivity 86% 86% 85% 85% 85% 88% 85% 85% 91%
Specificity 27% 27% 20% 23% 23% 21% 23% 22% 23% Cutoff Quartile 3
0.170 0.170 0.205 0.170 0.170 0.205 0.170 0.170 0.205 Sensitivity
63% 64% 56% 60% 61% 57% 63% 64% 61% Specificity 73% 73% 53% 61% 61%
54% 62% 63% 55% Cutoff Quartile 4 2.99 2.99 3.01 2.99 2.99 3.01
2.99 2.99 3.01 Sensitivity 38% 38% 37% 36% 37% 37% 39% 40% 39%
Specificity 98% 96% 81% 87% 87% 81% 88% 88% 81% OR Quartile 2 2.18
2.34 1.36 1.71 1.65 1.93 1.74 1.62 3.06 p Value 0.066 0.046 0.51
0.20 0.23 0.19 0.20 0.26 0.052 Lower limit of 95% CI 0.948 1.02
0.549 0.746 0.721 0.724 0.750 0.702 0.992 Upper limit of 95% CI
5.03 5.38 3.36 3.92 3.79 5.14 4.01 3.75 9.42 OR Quartile 3 4.60
4.71 1.43 2.33 2.47 1.54 2.76 3.10 1.89 p Value 5.1E-5 3.0E-5 0.30
0.012 0.0074 0.22 0.0027 9.1E-4 0.078 Lower limit of 95% CI 2.20
2.27 0.725 1.21 1.27 0.771 1.42 1.59 0.932 Upper limit of 95% CI
9.62 9.74 2.82 4.51 4.77 3.06 5.35 6.05 3.85 OR Quartile 4 31.4
16.4 2.49 3.79 3.93 2.44 4.55 4.91 2.81 p Value 8.3E-4 1.9E-4 0.019
0.0018 0.0013 0.022 3.9E-4 2.0E-4 0.0089 Lower limit of 95% CI 4.17
3.78 1.16 1.64 1.70 1.14 1.97 2.12 1.30 Upper limit of 95% CI 237
71.7 5.35 8.74 9.07 5.26 10.5 11.4 6.09
Example 20. Use of Insulin-Like Growth Factor-Binding Protein 6 for
Evaluating Renal Status in Patients Admitted to the ICU: Persistent
at RIFLE F
[0172] Patients from the intensive care unit (ICU) with RIFLE stage
of injury (I) or failure (F) are enrolled in the following study.
EDTA anti-coagulated blood samples (10 mL) and urine samples (50
mL) are collected from each patient at enrollment, and at every 12
hours up to day 3, and then every 24 hours thereafter up to day 7
while the subject is hospitalized. Insulin-like growth
factor-binding protein 6 is measured in the enrollment samples by
standard immunoassay methods using commercially available assay
reagents.
[0173] Kidney status is assessed by RIFLE criteria based on serum
creatinine, urine output, or both serum creatinine and urine
output. Two cohorts are defined to represent a "persistent" and a
"non-persistent" population. "Persistent" indicates those patients
whose minimum RIFLE stage during a period of 24, 48 or 72 hours is
failure (F) where the persistence period can start from the time of
sample collection to 24, 48, 72, 96 or 168 hours after sample
collection. "Non-persistent" indicates those patients who are not
persistent at failure (F) and whose minimum RIFLE stage during a
period of 24, 48 or 72 hours is non-injury (RIFLE 0), risk of
injury (R), or injury (I) where the persistence period can start
from the time of sample collection to 24, 48, 72, 96 or 168 hours
after sample collection. If a patient dies after failure (F) or is
placed on renal replacement therapy (RRT) at any time from sample
collection to 24, 48, 72, 96 or 168 hours after sample collection,
the patient is considered "persistent".
[0174] The ability to distinguish the "persistent" and
"non-persistent" cohorts is determined using receiver operating
characteristic (ROC) analysis.
TABLE-US-00080 TABLE 20.1 Comparison of marker levels and the area
under the ROC curve (AUC) in urine samples for the "persistent" and
"non-persistent" cohorts where persistence starts within 24 hours
after sample collection and renal status is assessed by serum
creatinine (sCr) only, urine output (UO) only, or serum creatinine
or urine output RIFLE criteria. Persistence Period Duration (hr) 24
48 72 Non-persistent Persistent Non-persistent Persistent
Non-persistent Persistent Cohort Cohort Cohort Cohort Cohort Cohort
sCr or UO Median 44.2 171 48.9 221 58.3 196 Average 163 507 168 559
197 542 Stdev 336 743 330 792 370 827 p (t-test) 1.5E-4 3.5E-5
6.3E-4 Min 0.259 3.12 0.259 3.12 0.259 3.12 Max 2160 3600 2160 3600
2160 3600 n (Patient) 98 51 106 43 113 36 sCr only Median 47.5 149
54.2 305 58.8 196 Average 164 497 166 562 198 521 Stdev 337 738 330
791 372 810 p (t-test) 2.3E-4 2.8E-5 0.0011 Min 0.259 3.12 0.259
3.12 0.259 3.12 Max 2160 3600 2160 3600 2160 3600 n (Patient) 97 52
106 43 111 38 UO only Median 62.9 263 63.7 305 63.7 305 Average 245
556 244 582 244 582 Stdev 482 799 481 815 481 815 p (t-test) 0.021
0.014 0.014 Min 0.259 12.3 0.259 12.3 0.259 12.3 Max 3600 3210 3600
3210 3600 3210 n (Patient) 130 18 131 17 131 17 Persistence Period
Duration (hr) 24 48 72 sCr or UO sCr only UO only sCr or UO sCr
only UO only sCr or UO sCr only UO only AUC 0.72 0.71 0.72 0.73
0.72 0.73 0.70 0.68 0.73 SE 0.046 0.046 0.071 0.048 0.049 0.073
0.053 0.053 0.073 p Value 9.8E-7 4.3E-6 0.0018 2.3E-6 5.2E-6 0.0017
1.6E-4 4.8E-4 0.0017 nCohort Non-persistent 98 97 130 106 106 131
113 111 131 nCohort Persistent 51 52 18 43 43 17 36 38 17 Cutoff
Quartile 2 17.2 17.2 17.6 17.2 17.2 17.6 17.2 17.2 17.6 Sensitivity
88% 87% 94% 88% 86% 94% 86% 84% 94% Specificity 32% 31% 28% 30% 29%
27% 28% 28% 27% Cutoff Quartile 3 78.3 78.3 80.9 78.3 78.3 80.9
78.3 78.3 80.9 Sensitivity 71% 69% 83% 72% 70% 82% 72% 68% 82%
Specificity 60% 60% 55% 58% 58% 54% 57% 56% 54% Cutoff Quartile 4
331 331 331 331 331 331 331 331 331 Sensitivity 45% 44% 44% 47% 49%
47% 44% 45% 47% Specificity 85% 85% 78% 83% 84% 78% 81% 81% 78% OR
Quartile 2 3.47 2.88 6.51 3.29 2.55 6.06 2.45 2.07 6.06 p Value
0.010 0.022 0.074 0.022 0.056 0.086 0.088 0.14 0.086 Lower limit of
95% CI 1.34 1.16 0.836 1.18 0.977 0.776 0.875 0.787 0.776 Upper
limit of 95% CI 8.99 7.12 50.7 9.12 6.65 47.4 6.86 5.43 47.4 OR
Quartile 3 3.63 3.35 6.02 3.64 3.13 5.52 3.40 2.74 5.52 p Value
5.0E-4 9.3E-4 0.0063 0.0010 0.0031 0.0096 0.0034 0.011 0.0096 Lower
limit of 95% CI 1.76 1.64 1.66 1.68 1.47 1.51 1.50 1.26 1.51 Upper
limit of 95% CI 7.50 6.84 21.8 7.86 6.66 20.1 7.70 5.98 20.1 OR
Quartile 4 4.55 4.34 2.79 4.25 5.00 3.13 3.31 3.47 3.13 p Value
1.4E-4 2.1E-4 0.048 3.0E-4 6.8E-5 0.031 0.0036 0.0022 0.031 Lower
limit of 95% CI 2.09 2.00 1.01 1.94 2.26 1.11 1.48 1.56 1.11 Upper
limit of 95% CI 9.90 9.42 7.71 9.32 11.0 8.83 7.41 7.69 8.83
TABLE-US-00081 TABLE 20.2 Comparison of marker levels and the area
under the ROC curve (AUC) in urine samples for the "persistent" and
"non-persistent" cohorts where persistence starts within 48 hours
after sample collection and renal status is assessed by serum
creatinine (sCr) only, urine output (UO) only, or serum creatinine
or urine output RIFLE criteria. Persistence Period Duration (hr) 24
48 72 Non-persistent Persistent Non-persistent Persistent
Non-persistent Persistent Cohort Cohort Cohort Cohort Cohort Cohort
sCr or UO Median 39.7 144 39.3 171 47.5 144 Average 164 463 163 506
197 479 Stdev 347 707 338 741 379 764 p (t-test) 7.8E-4 1.6E-4
0.0031 Min 0.259 0.723 0.259 3.12 0.259 3.12 Max 2160 3600 2160
3600 2160 3600 n (Patient) 91 58 98 51 105 44 sCr only Median 40.8
144 39.7 196 50.3 144 Average 165 462 162 501 198 465 Stdev 347 708
339 735 382 750 p (t-test) 8.4E-4 1.7E-4 0.0045 Min 0.259 0.723
0.259 3.12 0.259 3.12 Max 2160 3600 2160 3600 2160 3600 n (Patient)
91 58 97 52 103 46 UO only Median 59.0 119 59.4 123 59.4 123
Average 249 446 248 460 248 460 Stdev 493 707 491 718 491 718 p
(t-test) 0.095 0.077 0.077 Min 0.259 5.59 0.259 5.59 0.259 5.59 Max
3600 3210 3600 3210 3600 3210 n (Patient) 123 25 124 24 124 24
Persistence Period Duration (hr) 24 48 72 sCr or UO sCr only UO
only sCr or UO sCr only UO only sCr or UO sCr only UO only AUC 0.71
0.70 0.67 0.73 0.73 0.68 0.70 0.69 0.68 SE 0.045 0.045 0.063 0.045
0.045 0.064 0.050 0.049 0.064 p Value 2.7E-6 8.9E-6 0.0057 2.8E-7
4.5E-7 0.0061 6.8E-5 1.5E-4 0.0061 nCohort Non-persistent 91 91 123
98 97 124 105 103 124 nCohort Persistent 58 58 25 51 52 24 44 46 24
Cutoff Quartile 2 17.2 17.2 17.6 17.2 17.2 17.6 17.2 17.2 17.6
Sensitivity 86% 84% 92% 88% 87% 92% 86% 85% 92% Specificity 32% 31%
28% 32% 31% 28% 30% 29% 28% Cutoff Quartile 3 78.3 78.3 80.9 78.3
78.3 80.9 78.3 78.3 80.9 Sensitivity 69% 69% 76% 73% 73% 75% 73%
72% 75% Specificity 62% 62% 55% 61% 62% 55% 59% 59% 55% Cutoff
Quartile 4 331 331 331 331 331 331 331 331 331 Sensitivity 41% 41%
36% 43% 44% 38% 41% 41% 38% Specificity 85% 85% 77% 84% 85% 77% 81%
82% 77% OR Quartile 2 2.92 2.42 4.57 3.47 2.88 4.33 2.65 2.29 4.33
p Value 0.015 0.039 0.047 0.010 0.022 0.056 0.046 0.074 0.056 Lower
limit of 95% CI 1.23 1.05 1.02 1.34 1.16 0.966 1.02 0.922 0.966
Upper limit of 95% CI 6.96 5.60 20.4 8.99 7.12 19.4 6.91 5.69 19.4
OR Quartile 3 3.56 3.56 3.92 4.17 4.40 3.64 3.84 3.69 3.64 p Value
3.7E-4 3.7E-4 0.0066 1.5E-4 8.1E-5 0.010 6.0E-4 6.8E-4 0.010 Lower
limit of 95% CI 1.77 1.77 1.46 2.00 2.11 1.35 1.78 1.74 1.35 Upper
limit of 95% CI 7.15 7.15 10.5 8.72 9.20 9.80 8.30 7.83 9.80 OR
Quartile 4 3.88 3.88 1.91 3.89 4.34 2.06 2.94 3.11 2.06 p Value
5.8E-4 5.8E-4 0.17 5.5E-4 2.1E-4 0.13 0.0063 0.0038 0.13 Lower
limit of 95% CI 1.79 1.79 0.761 1.80 2.00 0.814 1.36 1.44 0.814
Upper limit of 95% CI 8.41 8.41 4.78 8.40 9.42 5.20 6.38 6.72
5.20
TABLE-US-00082 TABLE 20.3 Comparison of marker levels and the area
under the ROC curve (AUC) in urine samples for the "persistent" and
"non-persistent" cohorts where persistence starts within 72 hours
after sample collection and renal status is assessed by serum
creatinine (sCr) only, urine output (UO) only, or serum creatinine
or urine output RIFLE criteria. Persistence Period Duration (hr) 24
48 72 Non-persistent Persistent Non-persistent Persistent
Non-persistent Persistent Cohort Cohort Cohort Cohort Cohort Cohort
sCr or UO Median 39.3 119 38.5 161 47.4 119 Average 167 436 161 463
190 455 Stdev 355 685 348 700 366 737 p (t-test) 0.0021 6.4E-4
0.0038 Min 0.259 0.723 0.259 3.12 0.259 3.12 Max 2160 3600 2160
3600 2160 3600 n (Patient) 86 63 90 59 98 51 sCr only Median 39.7
119 38.5 161 47.5 118 Average 168 430 161 463 191 447 Stdev 357 682
348 701 368 732 p (t-test) 0.0029 6.6E-4 0.0052 Min 0.259 0.723
0.259 3.12 0.259 3.12 Max 2160 3600 2160 3600 2160 3600 n (Patient)
85 64 90 59 97 52 UO only Median 59.4 113 59.7 117 59.7 117 Average
244 422 243 432 243 432 Stdev 490 672 488 680 488 680 p (t-test)
0.097 0.081 0.081 Min 0.259 5.59 0.259 5.59 0.259 5.59 Max 3600
3210 3600 3210 3600 3210 n (Patient) 116 32 117 31 117 31
Persistence Period Duration (hr) 24 48 72 sCr or UO sCr only UO
only sCr or UO sCr only UO only sCr or UO sCr only UO only AUC 0.70
0.69 0.65 0.73 0.72 0.65 0.69 0.68 0.65 SE 0.044 0.044 0.058 0.044
0.044 0.058 0.048 0.048 0.058 p Value 4.7E-6 1.6E-5 0.0080 2.0E-7
4.1E-7 0.0089 9.9E-5 2.3E-4 0.0089 nCohort Non-persistent 86 85 116
90 90 117 98 97 117 nCohort Persistent 63 64 32 59 59 31 51 52 31
Cutoff Quartile 2 17.2 17.2 17.6 17.2 17.2 17.6 17.2 17.2 17.6
Sensitivity 87% 86% 94% 90% 88% 94% 88% 87% 94% Specificity 34% 33%
30% 34% 33% 30% 32% 31% 30% Cutoff Quartile 3 78.3 78.3 80.9 78.3
78.3 80.9 78.3 78.3 80.9 Sensitivity 67% 66% 69% 69% 69% 68% 69%
67% 68% Specificity 62% 61% 55% 62% 62% 55% 59% 59% 55% Cutoff
Quartile 4 331 331 331 331 331 331 331 331 331 Sensitivity 40% 39%
34% 42% 42% 35% 39% 38% 35% Specificity 85% 85% 78% 86% 86% 78% 82%
81% 78% OR Quartile 2 3.50 3.00 6.48 4.64 3.71 6.19 3.47 2.88 6.19
p Value 0.0046 0.010 0.014 0.0015 0.0044 0.016 0.010 0.022 0.016
Lower limit of 95% CI 1.47 1.30 1.47 1.80 1.51 1.40 1.34 1.16 1.40
Upper limit of 95% CI 8.32 6.94 28.6 12.0 9.16 27.4 8.99 7.12 27.4
OR Quartile 3 3.21 3.01 2.71 3.75 3.75 2.54 3.17 2.93 2.54 p Value
7.8E-4 0.0014 0.019 2.1E-4 2.1E-4 0.029 0.0016 0.0028 0.029 Lower
limit of 95% CI 1.63 1.53 1.18 1.86 1.86 1.10 1.55 1.45 1.10 Upper
limit of 95% CI 6.34 5.91 6.22 7.55 7.55 5.85 6.49 5.95 5.85 OR
Quartile 4 3.69 3.55 1.81 4.36 4.36 1.92 2.87 2.74 1.92 p Value
9.7E-4 0.0014 0.17 2.3E-4 2.3E-4 0.13 0.0066 0.0091 0.13 Lower
limit of 95% CI 1.70 1.64 0.775 1.99 1.99 0.819 1.34 1.29 0.819
Upper limit of 95% CI 8.03 7.71 4.24 9.52 9.52 4.53 6.13 5.85
4.53
TABLE-US-00083 TABLE 20.4 Comparison of marker levels and the area
under the ROC curve (AUC) in urine samples for the "persistent" and
"non-persistent" cohorts where persistence starts within 96 hours
after sample collection and renal status is assessed by serum
creatinine (sCr) only, urine output (UO) only, or serum creatinine
or urine output RIFLE criteria. Persistence Period Duration (hr) 24
48 72 Non-persistent Persistent Non-persistent Persistent
Non-persistent Persistent Cohort Cohort Cohort Cohort Cohort Cohort
sCr or UO Median 39.0 123 38.5 161 44.2 119 Average 162 438 161 463
182 460 Stdev 355 680 348 700 358 730 p (t-test) 0.0017 6.4E-4
0.0022 Min 0.259 0.723 0.259 3.12 0.259 3.12 Max 2160 3600 2160
3600 2160 3600 n (Patient) 85 64 90 59 96 53 sCr only Median 39.7
119 39.0 144 47.5 118 Average 168 430 163 455 184 451 Stdev 357 682
350 697 359 726 p (t-test) 0.0029 9.2E-4 0.0031 Min 0.259 0.723
0.259 3.12 0.259 3.12 Max 2160 3600 2160 3600 2160 3600 n (Patient)
85 64 89 60 95 54 UO only Median 58.5 118 58.9 118 58.9 118 Average
214 497 216 507 216 507 Stdev 382 829 380 851 380 851 p (t-test)
0.0056 0.0051 0.0051 Min 0.259 5.59 0.259 5.59 0.259 5.59 Max 2160
3600 2160 3600 2160 3600 n (Patient) 112 36 114 34 114 34
Persistence Period Duration (hr) 24 48 72 sCr or UO sCr only UO
only sCr or UO sCr only UO only sCr or UO sCr only UO only AUC 0.71
0.69 0.68 0.73 0.72 0.67 0.69 0.68 0.67 SE 0.043 0.044 0.054 0.044
0.044 0.056 0.047 0.047 0.056 p Value 1.2E-6 1.6E-5 0.0010 2.0E-7
9.3E-7 0.0026 4.2E-5 1.3E-4 0.0026 nCohort Non-persistent 85 85 112
90 89 114 96 95 114 nCohort Persistent 64 64 36 59 60 34 53 54 34
Cutoff Quartile 2 17.2 17.2 17.6 17.2 17.2 17.6 17.2 17.2 17.6
Sensitivity 88% 86% 94% 90% 88% 94% 89% 87% 94% Specificity 34% 33%
31% 34% 34% 31% 32% 32% 31% Cutoff Quartile 3 78.3 78.3 80.9 78.3
78.3 80.9 78.3 78.3 80.9 Sensitivity 67% 66% 69% 69% 68% 68% 68%
67% 68% Specificity 62% 61% 56% 62% 62% 55% 59% 59% 55% Cutoff
Quartile 4 331 331 331 331 331 331 331 331 331 Sensitivity 41% 39%
36% 42% 42% 35% 40% 39% 35% Specificity 86% 85% 79% 86% 85% 78% 82%
82% 78% OR Quartile 2 3.62 3.00 7.73 4.64 3.85 7.09 3.74 3.10 7.09
p Value 0.0036 0.010 0.0068 0.0015 0.0034 0.0096 0.0066 0.014
0.0096 Lower limit of 95% CI 1.52 1.30 1.76 1.80 1.56 1.61 1.44
1.25 1.61 Upper limit of 95% CI 8.62 6.94 34.0 12.0 9.49 31.2 9.67
7.65 31.2 OR Quartile 3 3.39 3.01 2.92 3.75 3.49 2.58 3.10 2.87
2.58 p Value 4.5E-4 0.0014 0.0087 2.1E-4 4.0E-4 0.021 0.0017 0.0031
0.021 Lower limit of 95% CI 1.72 1.53 1.31 1.86 1.75 1.15 1.53 1.43
1.15 Upper limit of 95% CI 6.71 5.91 6.51 7.55 6.97 5.79 6.27 5.77
5.79 OR Quartile 4 4.16 3.55 2.07 4.36 4.18 1.94 3.05 2.92 1.94 p
Value 3.9E-4 0.0014 0.080 2.3E-4 3.3E-4 0.12 0.0040 0.0056 0.12
Lower limit of 95% CI 1.89 1.64 0.916 1.99 1.91 0.845 1.43 1.37
0.845 Upper limit of 95% CI 9.16 7.71 4.69 9.52 9.12 4.46 6.52 6.23
4.46
TABLE-US-00084 TABLE 20.5 Comparison of marker levels and the area
under the ROC curve (AUC) in urine samples for the "persistent" and
"non-persistent" cohorts where persistence starts within 168 hours
after sample collection and renal status is assessed by serum
creatinine (sCr) only, urine output (UO) only, or serum creatinine
or urine output RIFLE criteria. Persistence Period Duration (hr) 24
48 72 Non-persistent Persistent Non-persistent Persistent
Non-persistent Persistent Cohort Cohort Cohort Cohort Cohort Cohort
sCr or UO Median 37.9 126 37.5 171 40.8 123 Average 141 451 137 477
178 451 Stdev 309 688 302 702 361 713 p (t-test) 3.6E-4 9.3E-5
0.0023 Min 0.259 0.723 0.259 3.12 0.259 3.12 Max 2160 3600 2160
3600 2160 3600 n (Patient) 82 67 86 63 93 56 sCr only Median 39.0
123 38.1 166 40.8 123 Average 146 450 141 476 164 474 Stdev 310 693
303 707 319 736 p (t-test) 4.8E-4 1.3E-4 5.1E-4 Min 0.259 0.723
0.259 3.12 0.259 3.12 Max 2160 3600 2160 3600 2160 3600 n (Patient)
83 66 87 62 93 56 UO only Median 58.3 119 58.5 123 58.5 123 Average
201 528 200 539 200 539 Stdev 358 839 357 848 357 848 p (t-test)
0.0012 8.2E-4 8.2E-4 Min 0.259 5.59 0.259 5.59 0.259 5.59 Max 2160
3600 2160 3600 2160 3600 n (Patient) 111 37 112 36 112 36
Persistence Period Duration (hr) 24 48 72 sCr or UO sCr only UO
only sCr or UO sCr only UO only sCr or UO sCr only UO only AUC 0.72
0.71 0.69 0.74 0.73 0.69 0.70 0.70 0.69 SE 0.043 0.043 0.053 0.042
0.043 0.054 0.046 0.046 0.054 p Value 2.5E-7 1.1E-6 3.1E-4 6.8E-9
4.0E-8 3.6E-4 2.1E-5 1.4E-5 3.6E-4 nCohort Non-persistent 82 83 111
86 87 112 93 93 112 nCohort Persistent 67 66 37 63 62 36 56 56 36
Cutoff Quartile 2 17.2 17.2 17.6 17.2 17.2 17.6 17.2 17.2 17.6
Sensitivity 87% 86% 95% 89% 89% 94% 88% 88% 94% Specificity 34% 34%
32% 35% 34% 31% 32% 32% 31% Cutoff Quartile 3 78.3 78.3 80.9 78.3
78.3 80.9 78.3 78.3 80.9 Sensitivity 67% 67% 70% 70% 69% 69% 68%
68% 69% Specificity 63% 63% 57% 64% 63% 56% 60% 60% 56% Cutoff
Quartile 4 331 331 331 331 331 331 331 331 331 Sensitivity 42% 41%
38% 44% 44% 39% 41% 41% 39% Specificity 88% 87% 79% 88% 87% 79% 84%
84% 79% OR Quartile 2 3.34 3.22 8.06 4.29 4.14 7.73 3.33 3.33 7.73
p Value 0.0048 0.0061 0.0057 0.0016 0.0020 0.0068 0.0090 0.0090
0.0068 Lower limit of 95% CI 1.45 1.40 1.83 1.74 1.68 1.76 1.35
1.35 1.76 Upper limit of 95% CI 7.72 7.45 35.4 10.6 10.2 34.0 8.23
8.23 34.0 OR Quartile 3 3.55 3.35 3.10 4.11 3.89 2.92 3.20 3.20
2.92 p Value 2.6E-4 4.7E-4 0.0055 6.8E-5 1.2E-4 0.0087 0.0011
0.0011 0.0087 Lower limit of 95% CI 1.80 1.70 1.40 2.05 1.94 1.31
1.59 1.59 1.31 Upper limit of 95% CI 7.00 6.61 6.90 8.23 7.79 6.51
6.42 6.42 6.51 OR Quartile 4 5.17 4.53 2.33 6.08 5.33 2.46 3.62
3.62 2.46 p Value 8.7E-5 2.2E-4 0.040 1.8E-5 4.9E-5 0.030 0.0010
0.0010 0.030 Lower limit of 95% CI 2.28 2.03 1.04 2.66 2.38 1.09
1.68 1.68 1.09 Upper limit of 95% CI 11.7 10.1 5.22 13.9 11.9 5.55
7.81 7.81 5.55
Example 21. Use of Insulin-Like Growth Factor-Binding Protein 6 for
Evaluating Renal Status in Patients Admitted to the ICU: Persistent
at RIFLE I or F
[0175] Patients from the intensive care unit (ICU) with RIFLE stage
of injury (I) or failure (F) are enrolled in the following study.
EDTA anti-coagulated blood samples (10 mL) and urine samples (50
mL) are collected from each patient at enrollment, and at every 12
hours up to day 3, and then every 24 hours thereafter up to day 7
while the subject is hospitalized. Insulin-like growth
factor-binding protein 6 is measured in the enrollment samples by
standard immunoassay methods using commercially available assay
reagents.
[0176] Kidney status is assessed by RIFLE criteria based on serum
creatinine, urine output, or both serum creatinine and urine
output. Two cohorts are defined to represent a "persistent" and a
"non-persistent" population. "Persistent" indicates those patients
whose minimum RIFLE stage during a period of 24, 48 or 72 hours is
injury (I) or failure (F) where the persistence period can start
from the time of sample collection to 24, 48, 72, 96 or 168 hours
after sample collection. "Non-persistent" indicates those patients
who are not persistent at injury (I) or failure (F) and whose
minimum RIFLE stage during a period of 24, 48 or 72 hours is
non-injury (RIFLE 0) or risk of injury (R) where the persistence
period can start from the time of sample collection to 24, 48, 72,
96 or 168 hours after sample collection. If a patient dies after
injury (I) or failure (F) or is placed on renal replacement therapy
(RRT) at any time from sample collection to 24, 48, 72, 96 or 168
hours after sample collection, the patient is considered
"persistent".
[0177] The ability to distinguish the "persistent" and
"non-persistent" cohorts is determined using receiver operating
characteristic (ROC) analysis.
TABLE-US-00085 TABLE 21.1 Comparison of marker levels and the area
under the ROC curve (AUC) in urine samples for the "persistent" and
"non-persistent" cohorts where persistence starts within 24 hours
after sample collection and renal status is assessed by serum
creatinine (sCr) only, urine output (UO) only, or serum creatinine
or urine output RIFLE criteria. Persistence Period Duration (hr) 24
48 72 Non-persistent Persistent Non-persistent Persistent
Non-persistent Persistent Cohort Cohort Cohort Cohort Cohort Cohort
sCr or UO Median 22.2 118 37.9 117 39.3 171 Average 114 378 149 425
141 482 Stdev 312 612 315 676 299 713 p (t-test) 0.0033 0.0015
9.5E-5 Min 0.259 0.723 0.259 0.723 0.259 0.723 Max 2160 3600 2160
3600 2160 3600 n (Patient) 55 94 78 71 88 61 sCr only Median 30.9
110 35.3 117 39.0 180 Average 124 378 153 413 146 480 Stdev 311 618
322 669 305 717 p (t-test) 0.0045 0.0028 1.4E-4 Min 0.259 0.723
0.259 0.723 0.259 0.723 Max 2160 3600 2160 3600 2160 3600 n
(Patient) 57 92 76 73 89 60 UO only Median 59.4 138 63.7 190 63.7
243 Average 242 417 241 469 236 535 Stdev 495 649 483 713 476 755 p
(t-test) 0.097 0.045 0.014 Min 0.259 2.91 0.259 7.04 0.259 7.04 Max
3600 3210 3600 3210 3600 3210 n (Patient) 114 34 121 27 125 23
Persistence Period Duration (hr) 24 48 72 sCr or UO sCr only UO
only sCr or UO sCr only UO only sCr or UO sCr only UO only AUC 0.74
0.71 0.66 0.69 0.69 0.67 0.72 0.72 0.70 SE 0.040 0.042 0.056 0.044
0.043 0.061 0.044 0.044 0.065 p Value 7.5E-10 3.7E-7 0.0032 1.6E-5
1.5E-5 0.0046 4.7E-7 4.3E-7 0.0021 nCohort Non-persistent 55 57 114
78 76 121 88 89 125 nCohort Persistent 94 92 34 71 73 27 61 60 23
Cutoff Quartile 2 17.2 17.2 17.6 17.2 17.2 17.6 17.2 17.2 17.6
Sensitivity 85% 84% 91% 85% 85% 93% 85% 85% 91% Specificity 42% 39%
30% 33% 34% 29% 32% 31% 28% Cutoff Quartile 3 78.3 78.3 80.9 78.3
78.3 80.9 78.3 78.3 80.9 Sensitivity 65% 63% 68% 63% 63% 70% 69%
68% 74% Specificity 75% 70% 55% 62% 62% 55% 62% 62% 54% Cutoff
Quartile 4 331 331 331 331 331 331 331 331 331 Sensitivity 36% 36%
35% 38% 37% 37% 43% 43% 43% Specificity 93% 91% 78% 86% 86% 78% 86%
87% 78% OR Quartile 2 4.11 3.23 4.39 2.73 2.93 5.09 2.70 2.60 4.08
p Value 3.9E-4 0.0028 0.020 0.014 0.0082 0.033 0.020 0.025 0.066
Lower limit of 95% CI 1.88 1.50 1.26 1.23 1.32 1.14 1.17 1.13 0.909
Upper limit of 95% CI 8.97 6.96 15.3 6.05 6.51 22.6 6.23 6.01 18.3
OR Quartile 3 5.41 4.01 2.58 2.77 2.76 2.85 3.68 3.49 3.38 p Value
7.7E-6 1.2E-4 0.021 0.0027 0.0027 0.023 2.2E-4 4.0E-4 0.016 Lower
limit of 95% CI 2.58 1.98 1.15 1.43 1.42 1.16 1.84 1.75 1.25 Upper
limit of 95% CI 11.3 8.15 5.79 5.38 5.36 7.01 7.37 6.97 9.14 OR
Quartile 4 7.22 5.82 1.94 3.74 3.47 2.05 4.70 4.91 2.79 p Value
4.3E-4 6.5E-4 0.12 0.0012 0.0022 0.11 1.3E-4 8.7E-5 0.030 Lower
limit of 95% CI 2.40 2.11 0.845 1.68 1.56 0.840 2.13 2.22 1.10
Upper limit of 95% CI 21.7 16.0 4.46 8.30 7.69 4.99 10.4 10.9
7.06
TABLE-US-00086 TABLE 21.2 Comparison of marker levels and the area
under the ROC curve (AUC) in urine samples for the "persistent" and
"non-persistent" cohorts where persistence starts within 48 hours
after sample collection and renal status is assessed by serum
creatinine (sCr) only, urine output (UO) only, or serum creatinine
or urine output RIFLE criteria. Persistence Period Duration (hr) 24
48 72 Non-persistent Persistent Non-persistent Persistent
Non-persistent Persistent Cohort Cohort Cohort Cohort Cohort Cohort
sCr or UO Median 21.6 117 33.8 118 37.5 161 Average 115 375 148 408
140 453 Stdev 315 610 324 657 308 687 p (t-test) 0.0041 0.0027
3.0E-4 Min 0.259 0.723 0.259 0.723 0.259 0.723 Max 2160 3600 2160
3600 2160 3600 n (Patient) 54 95 73 76 82 67 sCr only Median 28.9
109 36.8 114 37.5 161 Average 125 374 155 401 142 450 Stdev 314 616
327 659 311 688 p (t-test) 0.0057 0.0046 4.0E-4 Min 0.259 0.723
0.259 0.723 0.259 0.723 Max 2160 3600 2160 3600 2160 3600 n
(Patient) 56 93 73 76 82 67 UO only Median 58.2 124 58.8 126 58.8
221 Average 213 457 213 505 209 559 Stdev 390 775 382 837 376 876 p
(t-test) 0.013 0.0046 0.0011 Min 0.259 2.91 0.259 5.59 0.259 5.59
Max 2160 3600 2160 3600 2160 3600 n (Patient) 106 42 113 35 117 31
Persistence Period Duration (hr) 24 48 72 sCr or UO sCr only UO
only sCr or UO sCr only UO only sCr or UO sCr only UO only AUC 0.74
0.71 0.67 0.70 0.68 0.68 0.73 0.72 0.70 SE 0.040 0.042 0.051 0.043
0.044 0.055 0.042 0.042 0.057 p Value 1.4E-9 6.2E-7 6.9E-4 2.9E-6
3.5E-5 0.0012 7.0E-8 1.9E-7 6.0E-4 nCohort Non-persistent 54 56 106
73 73 113 82 82 117 nCohort Persistent 95 93 42 76 76 35 67 67 31
Cutoff Quartile 2 17.2 17.2 17.6 17.2 17.2 17.6 17.2 17.2 17.6
Sensitivity 85% 84% 90% 86% 84% 91% 87% 85% 90% Specificity 43% 39%
31% 36% 34% 30% 34% 33% 29% Cutoff Quartile 3 78.3 78.3 80.9 78.3
78.3 80.9 78.3 78.3 80.9 Sensitivity 64% 62% 69% 63% 62% 71% 69%
69% 74% Specificity 74% 70% 58% 63% 62% 57% 65% 65% 56% Cutoff
Quartile 4 331 331 331 331 331 331 331 331 331 Sensitivity 36% 35%
36% 37% 36% 37% 40% 40% 42% Specificity 93% 91% 79% 86% 85% 79% 87%
87% 79% OR Quartile 2 4.29 3.36 4.29 3.27 2.78 4.59 3.34 2.80 3.82
p Value 2.6E-4 0.0020 0.010 0.0037 0.011 0.017 0.0048 0.013 0.036
Lower limit of 95% CI 1.96 1.56 1.42 1.47 1.27 1.32 1.45 1.24 1.09
Upper limit of 95% CI 9.39 7.27 13.0 7.27 6.08 16.0 7.72 6.32 13.4
OR Quartile 3 5.13 3.80 3.02 2.92 2.60 3.27 4.00 4.00 3.72 p Value
1.5E-5 2.2E-4 0.0043 0.0016 0.0045 0.0048 7.5E-5 7.5E-5 0.0036
Lower limit of 95% CI 2.45 1.87 1.42 1.50 1.35 1.43 2.01 2.01 1.54
Upper limit of 95% CI 10.7 7.71 6.46 5.68 5.04 7.43 7.95 7.95 9.00
OR Quartile 4 6.97 5.61 2.12 3.68 3.11 2.19 4.36 4.36 2.80 p Value
5.5E-4 8.4E-4 0.061 0.0017 0.0052 0.061 3.2E-4 3.2E-4 0.017 Lower
limit of 95% CI 2.32 2.04 0.966 1.63 1.40 0.965 1.96 1.96 1.20
Upper limit of 95% CI 21.0 15.4 4.66 8.29 6.88 4.98 9.71 9.71
6.50
TABLE-US-00087 TABLE 21.3 Comparison of marker levels and the area
under the ROC curve (AUC) in urine samples for the "persistent" and
"non-persistent" cohorts where persistence starts within 72 hours
after sample collection and renal status is assessed by serum
creatinine (sCr) only, urine output (UO) only, or serum creatinine
or urine output RIFLE criteria. Persistence Period Duration (hr) 24
48 72 Non-persistent Persistent Non-persistent Persistent
Non-persistent Persistent Cohort Cohort Cohort Cohort Cohort Cohort
sCr or UO Median 21.6 117 33.4 117 35.3 126 Average 115 375 148 404
140 435 Stdev 315 610 327 654 315 672 p (t-test) 0.0041 0.0033
6.8E-4 Min 0.259 0.723 0.259 0.723 0.259 0.723 Max 2160 3600 2160
3600 2160 3600 n (Patient) 54 95 72 77 78 71 sCr only Median 28.9
109 35.3 111 37.5 119 Average 125 374 156 397 147 427 Stdev 314 616
329 655 318 674 p (t-test) 0.0057 0.0055 0.0012 Min 0.259 0.723
0.259 0.723 0.259 0.723 Max 2160 3600 2160 3600 2160 3600 n
(Patient) 56 93 72 77 78 71 UO only Median 58.5 118 58.9 118 58.9
123 Average 221 411 217 448 212 485 Stdev 400 735 391 778 384 809 p
(t-test) 0.043 0.018 0.0065 Min 0.259 2.91 0.259 3.55 0.259 3.55
Max 2160 3600 2160 3600 2160 3600 n (Patient) 100 48 106 42 110 38
Persistence Period Duration (hr) 24 48 72 sCr or UO sCr only UO
only sCr or UO sCr only UO only sCr or UO sCr only UO only AUC 0.74
0.71 0.64 0.70 0.68 0.65 0.73 0.71 0.66 SE 0.040 0.042 0.050 0.042
0.043 0.052 0.042 0.043 0.054 p Value 1.4E-9 6.2E-7 0.0042 2.1E-6
2.6E-5 0.0038 6.0E-8 1.3E-6 0.0026 nCohort Non-persistent 54 56 100
72 72 106 78 78 110 nCohort Persistent 95 93 48 77 77 42 71 71 38
Cutoff Quartile 2 17.2 17.2 17.6 17.2 17.2 17.6 17.2 17.2 17.6
Sensitivity 85% 84% 90% 86% 84% 90% 87% 86% 89% Specificity 43% 39%
32% 36% 35% 31% 36% 35% 30% Cutoff Quartile 3 78.3 78.3 80.9 78.3
78.3 80.9 78.3 78.3 80.9 Sensitivity 64% 62% 65% 64% 62% 67% 68%
66% 68% Specificity 74% 70% 57% 64% 62% 57% 65% 64% 56% Cutoff
Quartile 4 331 331 331 331 331 331 331 331 331 Sensitivity 36% 35%
31% 36% 35% 33% 39% 38% 37% Specificity 93% 91% 78% 86% 85% 78% 87%
86% 79% OR Quartile 2 4.29 3.36 4.05 3.39 2.88 4.29 3.86 3.23 3.64
p Value 2.6E-4 0.0020 0.0071 0.0027 0.0082 0.010 0.0016 0.0048
0.023 Lower limit of 95% CI 1.96 1.56 1.46 1.53 1.32 1.42 1.67 1.43
1.20 Upper limit of 95% CI 9.39 7.27 11.2 7.54 6.31 13.0 8.92 7.30
11.1 OR Quartile 3 5.13 3.80 2.42 3.10 2.76 2.61 3.94 3.50 2.80 p
Value 1.5E-5 2.2E-4 0.015 9.2E-4 0.0027 0.012 8.0E-5 2.8E-4 0.0098
Lower limit of 95% CI 2.45 1.87 1.19 1.59 1.42 1.24 1.99 1.78 1.28
Upper limit of 95% CI 10.7 7.71 4.93 6.04 5.36 5.51 7.79 6.87 6.11
OR Quartile 4 6.97 5.61 1.61 3.54 2.99 1.80 4.43 3.74 2.21 p Value
5.5E-4 8.4E-4 0.23 0.0023 0.0068 0.14 3.6E-4 0.0012 0.054 Lower
limit of 95% CI 2.32 2.04 0.744 1.57 1.35 0.818 1.96 1.68 0.988
Upper limit of 95% CI 21.0 15.4 3.49 7.99 6.63 3.98 10.0 8.30
4.93
TABLE-US-00088 TABLE 21.4 Comparison of marker levels and the area
under the ROC curve (AUC) in urine samples for the "persistent" and
"non-persistent" cohorts where persistence starts within 96 hours
after sample collection and renal status is assessed by serum
creatinine (sCr) only, urine output (UO) only, or serum creatinine
or urine output RIFLE criteria. Persistence Period Duration (hr) 24
48 72 Non-persistent Persistent Non-persistent Persistent
Non-persistent Persistent Cohort Cohort Cohort Cohort Cohort Cohort
sCr or UO Median 21.6 117 33.4 117 35.3 126 Average 115 375 148 404
140 435 Stdev 315 610 327 654 315 672 p (t-test) 0.0041 0.0033
6.8E-4 Min 0.259 0.723 0.259 0.723 0.259 0.723 Max 2160 3600 2160
3600 2160 3600 n (Patient) 54 95 72 77 78 71 sCr only Median 28.9
109 35.3 111 37.5 119 Average 125 374 156 397 147 427 Stdev 314 616
329 655 318 674 p (t-test) 0.0057 0.0055 0.0012 Min 0.259 0.723
0.259 0.723 0.259 0.723 Max 2160 3600 2160 3600 2160 3600 n
(Patient) 56 93 72 77 78 71 UO only Median 58.5 118 58.8 117 58.8
119 Average 223 399 220 424 216 457 Stdev 403 723 396 756 389 785 p
(t-test) 0.060 0.033 0.014 Min 0.259 2.91 0.259 3.55 0.259 3.55 Max
2160 3600 2160 3600 2160 3600 n (Patient) 98 50 103 45 107 41
Persistence Period Duration (hr) 24 48 72 sCr or UO sCr only UO
only sCr or UO sCr only UO only sCr or UO sCr only UO only AUC 0.74
0.71 0.64 0.70 0.68 0.65 0.73 0.71 0.66 SE 0.040 0.042 0.049 0.042
0.043 0.051 0.042 0.043 0.052 p Value 1.4E-9 6.2E-7 0.0040 2.1E-6
2.6E-5 0.0041 6.0E-8 1.3E-6 0.0030 nCohort Non-persistent 54 56 98
72 72 103 78 78 107 nCohort Persistent 95 93 50 77 77 45 71 71 41
Cutoff Quartile 2 17.2 17.2 17.6 17.2 17.2 17.6 17.2 17.2 17.6
Sensitivity 85% 84% 90% 86% 84% 91% 87% 86% 90% Specificity 43% 39%
33% 36% 35% 32% 36% 35% 31% Cutoff Quartile 3 78.3 78.3 80.9 78.3
78.3 80.9 78.3 78.3 80.9 Sensitivity 64% 62% 64% 64% 62% 64% 68%
66% 66% Specificity 74% 70% 57% 64% 62% 56% 65% 64% 56% Cutoff
Quartile 4 331 331 331 331 331 331 331 331 331 Sensitivity 36% 35%
30% 36% 35% 31% 39% 38% 34% Specificity 93% 91% 78% 86% 85% 78% 87%
86% 79% OR Quartile 2 4.29 3.36 4.36 3.39 2.88 4.83 3.86 3.23 4.12
p Value 2.6E-4 0.0020 0.0045 0.0027 0.0082 0.0053 0.0016 0.0048
0.012 Lower limit of 95% CI 1.96 1.56 1.58 1.53 1.32 1.60 1.67 1.43
1.36 Upper limit of 95% CI 9.39 7.27 12.1 7.54 6.31 14.6 8.92 7.30
12.5 OR Quartile 3 5.13 3.80 2.37 3.10 2.76 2.34 3.94 3.50 2.46 p
Value 1.5E-5 2.2E-4 0.016 9.2E-4 0.0027 0.022 8.0E-5 2.8E-4 0.019
Lower limit of 95% CI 2.45 1.87 1.17 1.59 1.42 1.13 1.99 1.78 1.16
Upper limit of 95% CI 10.7 7.71 4.79 6.04 5.36 4.82 7.79 6.87 5.21
OR Quartile 4 6.97 5.61 1.48 3.54 2.99 1.57 4.43 3.74 1.89 p Value
5.5E-4 8.4E-4 0.32 0.0023 0.0068 0.26 3.6E-4 0.0012 0.11 Lower
limit of 95% CI 2.32 2.04 0.686 1.57 1.35 0.718 1.96 1.68 0.857
Upper limit of 95% CI 21.0 15.4 3.19 7.99 6.63 3.44 10.0 8.30
4.19
TABLE-US-00089 TABLE 21.5 Comparison of marker levels and the area
under the ROC curve (AUC) in urine samples for the "persistent" and
"non-persistent" cohorts where persistence starts within 168 hours
after sample collection and renal status is assessed by serum
creatinine (sCr) only, urine output (UO) only, or serum creatinine
or urine output RIFLE criteria. Persistence Period Duration (hr) 24
48 72 Non-persistent Persistent Non-persistent Persistent
Non-persistent Persistent Cohort Cohort Cohort Cohort Cohort Cohort
sCr or UO Median 21.6 117 32.9 118 35.3 126 Average 107 374 147 396
141 419 Stdev 311 605 332 643 322 658 p (t-test) 0.0034 0.0044
0.0014 Min 0.259 0.723 0.259 0.723 0.259 0.723 Max 2160 3600 2160
3600 2160 3600 n (Patient) 52 97 69 80 74 75 sCr only Median 26.8
110 33.4 117 35.3 126 Average 115 377 145 400 137 430 Stdev 307 614
327 647 315 665 p (t-test) 0.0037 0.0034 7.3E-4 Min 0.259 0.723
0.259 0.723 0.259 0.723 Max 2160 3600 2160 3600 2160 3600 n
(Patient) 55 94 70 79 76 73 UO only Median 54.3 121 58.3 119 54.3
138 Average 207 422 207 434 203 459 Stdev 380 729 376 749 371 767 p
(t-test) 0.019 0.015 0.0070 Min 0.259 2.91 0.259 2.91 0.259 2.91
Max 2160 3600 2160 3600 2160 3600 n (Patient) 96 52 99 49 102 46
Persistence Period Duration (hr) 24 48 72 sCr or UO sCr only UO
only sCr or UO sCr only UO only sCr or UO sCr only UO only AUC 0.75
0.72 0.66 0.70 0.70 0.65 0.72 0.72 0.67 SE 0.040 0.041 0.048 0.042
0.042 0.049 0.042 0.042 0.050 p Value 4.5E-10 7.2E-8 8.4E-4 1.2E-6
2.2E-6 0.0018 2.3E-7 6.8E-8 8.9E-4 nCohort Non-persistent 52 55 96
69 70 99 74 76 102 nCohort Persistent 97 94 52 80 79 49 75 73 46
Cutoff Quartile 2 17.2 17.2 17.6 17.2 17.2 17.6 17.2 17.2 17.6
Sensitivity 85% 84% 90% 85% 85% 90% 85% 86% 89% Specificity 42% 40%
33% 36% 36% 32% 35% 36% 31% Cutoff Quartile 3 78.3 78.3 80.9 78.3
78.3 80.9 78.3 78.3 80.9 Sensitivity 64% 63% 65% 64% 63% 65% 67%
67% 67% Specificity 75% 71% 58% 65% 64% 58% 66% 66% 58% Cutoff
Quartile 4 331 331 331 331 331 331 331 331 331 Sensitivity 36% 36%
33% 36% 37% 33% 39% 40% 35% Specificity 94% 93% 79% 87% 87% 79% 88%
88% 79% OR Quartile 2 4.01 3.51 4.70 3.22 3.10 4.20 3.15 3.47 3.75
p Value 4.7E-4 0.0014 0.0028 0.0035 0.0047 0.0056 0.0048 0.0028
0.011 Lower limit of 95% CI 1.84 1.62 1.70 1.47 1.41 1.52 1.42 1.54
1.35 Upper limit of 95% CI 8.73 7.60 13.0 7.07 6.80 11.6 7.00 7.85
10.4 OR Quartile 3 5.31 4.11 2.64 3.30 3.10 2.55 3.92 3.93 2.84 p
Value 1.3E-5 1.1E-4 0.0065 5.1E-4 9.2E-4 0.0097 8.3E-5 8.2E-5
0.0052 Lower limit of 95% CI 2.50 2.01 1.31 1.68 1.59 1.26 1.99
1.99 1.37 Upper limit of 95% CI 11.3 8.41 5.33 6.46 6.06 5.20 7.74
7.75 5.89 OR Quartile 4 9.22 7.22 1.85 3.79 3.93 1.80 4.55 4.91
2.06 p Value 4.3E-4 4.3E-4 0.11 0.0018 0.0013 0.13 3.9E-4 2.0E-4
0.068 Lower limit of 95% CI 2.68 2.40 0.863 1.64 1.70 0.836 1.97
2.12 0.949 Upper limit of 95% CI 31.8 21.7 3.95 8.74 9.07 3.88 10.5
11.4 4.46
[0178] While the invention has been described and exemplified in
sufficient detail for those skilled in this art to make and use it,
various alternatives, modifications, and improvements should be
apparent without departing from the spirit and scope of the
invention. The examples provided herein are representative of
preferred embodiments, are exemplary, and are not intended as
limitations on the scope of the invention. Modifications therein
and other uses will occur to those skilled in the art. These
modifications are encompassed within the spirit of the invention
and are defined by the scope of the claims.
[0179] It will be readily apparent to a person skilled in the art
that varying substitutions and modifications may be made to the
invention disclosed herein without departing from the scope and
spirit of the invention.
[0180] All patents and publications mentioned in the specification
are indicative of the levels of those of ordinary skill in the art
to which the invention pertains. All patents and publications are
herein incorporated by reference to the same extent as if each
individual publication was specifically and individually indicated
to be incorporated by reference.
[0181] The invention illustratively described herein suitably may
be practiced in the absence of any element or elements, limitation
or limitations which is not specifically disclosed herein. Thus,
for example, in each instance herein any of the terms "comprising",
"consisting essentially of" and "consisting of" may be replaced
with either of the other two terms. The terms and expressions which
have been employed are used as terms of description and not of
limitation, and there is no intention that in the use of such terms
and expressions of excluding any equivalents of the features shown
and described or portions thereof, but it is recognized that
various modifications are possible within the scope of the
invention claimed. Thus, it should be understood that although the
present invention has been specifically disclosed by preferred
embodiments and optional features, modification and variation of
the concepts herein disclosed may be resorted to by those skilled
in the art, and that such modifications and variations are
considered to be within the scope of this invention as defined by
the appended claims.
[0182] Other embodiments are set forth within the following claims.
Sequence CWU 1
1
51291PRTHomo sapiensmisc_featureInsulin-like growth factor-binding
protein 3 precursor 1Met Gln Arg Ala Arg Pro Thr Leu Trp Ala Ala
Ala Leu Thr Leu Leu1 5 10 15Val Leu Leu Arg Gly Pro Pro Val Ala Arg
Ala Gly Ala Ser Ser Ala 20 25 30Gly Leu Gly Pro Val Val Arg Cys Glu
Pro Cys Asp Ala Arg Ala Leu 35 40 45Ala Gln Cys Ala Pro Pro Pro Ala
Val Cys Ala Glu Leu Val Arg Glu 50 55 60Pro Gly Cys Gly Cys Cys Leu
Thr Cys Ala Leu Ser Glu Gly Gln Pro65 70 75 80Cys Gly Ile Tyr Thr
Glu Arg Cys Gly Ser Gly Leu Arg Cys Gln Pro 85 90 95Ser Pro Asp Glu
Ala Arg Pro Leu Gln Ala Leu Leu Asp Gly Arg Gly 100 105 110Leu Cys
Val Asn Ala Ser Ala Val Ser Arg Leu Arg Ala Tyr Leu Leu 115 120
125Pro Ala Pro Pro Ala Pro Gly Asn Ala Ser Glu Ser Glu Glu Asp Arg
130 135 140Ser Ala Gly Ser Val Glu Ser Pro Ser Val Ser Ser Thr His
Arg Val145 150 155 160Ser Asp Pro Lys Phe His Pro Leu His Ser Lys
Ile Ile Ile Ile Lys 165 170 175Lys Gly His Ala Lys Asp Ser Gln Arg
Tyr Lys Val Asp Tyr Glu Ser 180 185 190Gln Ser Thr Asp Thr Gln Asn
Phe Ser Ser Glu Ser Lys Arg Glu Thr 195 200 205Glu Tyr Gly Pro Cys
Arg Arg Glu Met Glu Asp Thr Leu Asn His Leu 210 215 220Lys Phe Leu
Asn Val Leu Ser Pro Arg Gly Val His Ile Pro Asn Cys225 230 235
240Asp Lys Lys Gly Phe Tyr Lys Lys Lys Gln Cys Arg Pro Ser Lys Gly
245 250 255Arg Lys Arg Gly Phe Cys Trp Cys Val Asp Lys Tyr Gly Gln
Pro Leu 260 265 270Pro Gly Tyr Thr Thr Lys Gly Lys Glu Asp Val His
Cys Tyr Ser Met 275 280 285Gln Ser Lys 29027PRTHomo
sapiensmisc_featuredomain identified in Insulin-like growth
factor-binding protein 3 in isoform 2 2Gly Glu Pro Pro Ala Pro Gly1
53325PRTHomo sapiensmisc_featureInsulin-like growth factor-binding
protein 2 precursor 3Met Leu Pro Arg Val Gly Cys Pro Ala Leu Pro
Leu Pro Pro Pro Pro1 5 10 15Leu Leu Pro Leu Leu Leu Leu Leu Leu Gly
Ala Ser Gly Gly Gly Gly 20 25 30Gly Ala Arg Ala Glu Val Leu Phe Arg
Cys Pro Pro Cys Thr Pro Glu 35 40 45Arg Leu Ala Ala Cys Gly Pro Pro
Pro Val Ala Pro Pro Ala Ala Val 50 55 60Ala Ala Val Ala Gly Gly Ala
Arg Met Pro Cys Ala Glu Leu Val Arg65 70 75 80Glu Pro Gly Cys Gly
Cys Cys Ser Val Cys Ala Arg Leu Glu Gly Glu 85 90 95Ala Cys Gly Val
Tyr Thr Pro Arg Cys Gly Gln Gly Leu Arg Cys Tyr 100 105 110Pro His
Pro Gly Ser Glu Leu Pro Leu Gln Ala Leu Val Met Gly Glu 115 120
125Gly Thr Cys Glu Lys Arg Arg Asp Ala Glu Tyr Gly Ala Ser Pro Glu
130 135 140Gln Val Ala Asp Asn Gly Asp Asp His Ser Glu Gly Gly Leu
Val Glu145 150 155 160Asn His Val Asp Ser Thr Met Asn Met Leu Gly
Gly Gly Gly Ser Ala 165 170 175Gly Arg Lys Pro Leu Lys Ser Gly Met
Lys Glu Leu Ala Val Phe Arg 180 185 190Glu Lys Val Thr Glu Gln His
Arg Gln Met Gly Lys Gly Gly Lys His 195 200 205His Leu Gly Leu Glu
Glu Pro Lys Lys Leu Arg Pro Pro Pro Ala Arg 210 215 220Thr Pro Cys
Gln Gln Glu Leu Asp Gln Val Leu Glu Arg Ile Ser Thr225 230 235
240Met Arg Leu Pro Asp Glu Arg Gly Pro Leu Glu His Leu Tyr Ser Leu
245 250 255His Ile Pro Asn Cys Asp Lys His Gly Leu Tyr Asn Leu Lys
Gln Cys 260 265 270Lys Met Ser Leu Asn Gly Gln Arg Gly Glu Cys Trp
Cys Val Asn Pro 275 280 285Asn Thr Gly Lys Leu Ile Gln Gly Ala Pro
Thr Ile Arg Gly Asp Pro 290 295 300Glu Cys His Leu Phe Tyr Asn Glu
Gln Gln Glu Ala Arg Gly Val His305 310 315 320Thr Gln Arg Met Gln
3254258PRTHomo sapiensmisc_featureInsulin-like growth
factor-binding protein 4 precursor 4Met Leu Pro Leu Cys Leu Val Ala
Ala Leu Leu Leu Ala Ala Gly Pro1 5 10 15Gly Pro Ser Leu Gly Asp Glu
Ala Ile His Cys Pro Pro Cys Ser Glu 20 25 30Glu Lys Leu Ala Arg Cys
Arg Pro Pro Val Gly Cys Glu Glu Leu Val 35 40 45Arg Glu Pro Gly Cys
Gly Cys Cys Ala Thr Cys Ala Leu Gly Leu Gly 50 55 60Met Pro Cys Gly
Val Tyr Thr Pro Arg Cys Gly Ser Gly Leu Arg Cys65 70 75 80Tyr Pro
Pro Arg Gly Val Glu Lys Pro Leu His Thr Leu Met His Gly 85 90 95Gln
Gly Val Cys Met Glu Leu Ala Glu Ile Glu Ala Ile Gln Glu Ser 100 105
110Leu Gln Pro Ser Asp Lys Asp Glu Gly Asp His Pro Asn Asn Ser Phe
115 120 125Ser Pro Cys Ser Ala His Asp Arg Arg Cys Leu Gln Lys His
Phe Ala 130 135 140Lys Ile Arg Asp Arg Ser Thr Ser Gly Gly Lys Met
Lys Val Asn Gly145 150 155 160Ala Pro Arg Glu Asp Ala Arg Pro Val
Pro Gln Gly Ser Cys Gln Ser 165 170 175Glu Leu His Arg Ala Leu Glu
Arg Leu Ala Ala Ser Gln Ser Arg Thr 180 185 190His Glu Asp Leu Tyr
Ile Ile Pro Ile Pro Asn Cys Asp Arg Asn Gly 195 200 205Asn Phe His
Pro Lys Gln Cys His Pro Ala Leu Asp Gly Gln Arg Gly 210 215 220Lys
Cys Trp Cys Val Asp Arg Lys Thr Gly Val Lys Leu Pro Gly Gly225 230
235 240Leu Glu Pro Lys Gly Glu Leu Asp Cys His Gln Leu Ala Asp Ser
Phe 245 250 255Arg Glu5240PRTHomo sapiensmisc_featureInsulin-like
growth factor-binding protein 6 precursor 5Met Thr Pro His Arg Leu
Leu Pro Pro Leu Leu Leu Leu Leu Ala Leu1 5 10 15Leu Leu Ala Ala Ser
Pro Gly Gly Ala Leu Ala Arg Cys Pro Gly Cys 20 25 30Gly Gln Gly Val
Gln Ala Gly Cys Pro Gly Gly Cys Val Glu Glu Glu 35 40 45Asp Gly Gly
Ser Pro Ala Glu Gly Cys Ala Glu Ala Glu Gly Cys Leu 50 55 60Arg Arg
Glu Gly Gln Glu Cys Gly Val Tyr Thr Pro Asn Cys Ala Pro65 70 75
80Gly Leu Gln Cys His Pro Pro Lys Asp Asp Glu Ala Pro Leu Arg Ala
85 90 95Leu Leu Leu Gly Arg Gly Arg Cys Leu Pro Ala Arg Ala Pro Ala
Val 100 105 110Ala Glu Glu Asn Pro Lys Glu Ser Lys Pro Gln Ala Gly
Thr Ala Arg 115 120 125Pro Gln Asp Val Asn Arg Arg Asp Gln Gln Arg
Asn Pro Gly Thr Ser 130 135 140Thr Thr Pro Ser Gln Pro Asn Ser Ala
Gly Val Gln Asp Thr Glu Met145 150 155 160Gly Pro Cys Arg Arg His
Leu Asp Ser Val Leu Gln Gln Leu Gln Thr 165 170 175Glu Val Tyr Arg
Gly Ala Gln Thr Leu Tyr Val Pro Asn Cys Asp His 180 185 190Arg Gly
Phe Tyr Arg Lys Arg Gln Cys Arg Ser Ser Gln Gly Gln Arg 195 200
205Arg Gly Pro Cys Trp Cys Val Asp Arg Met Gly Lys Ser Leu Pro Gly
210 215 220Ser Pro Asp Gly Asn Gly Ser Ser Ser Cys Pro Thr Gly Ser
Ser Gly225 230 235 240
* * * * *