This prospective observational study evaluated whether plasma and urinary kidney injury biomarkers (NGAL, KIM-1, cystatin C) measured at 0, 24, and 72 hours post-ROSC improve early prediction of poor neurological outcomes/mortality (CPC 3–5) and AKI compared with serum creatinine in 82 comatose adult OHCA patients.
Urinary NGAL was the strongest predictor of both CPC 3–5 (AUC 0.79 vs. sCr AUC 0.57) and AKI (AUC 0.81); admission kidney biomarkers predicted AKI with AUCs of 0.75–0.85 vs. sCr AUC 0.65. AKI occurred in 65.9% of patients, with 23.2% requiring renal replacement therapy; patients with rising sCr (>20%) or dialysis need had a 71% CPC 3–5 incidence vs. 20% in those with stable or falling sCr.
Single-center prospective observational design limits generalizability; small sample size (n=82) may reduce precision of AUC estimates; study did not assess whether acting on biomarker results improves clinical outcomes.
In comatose OHCA survivors, urinary NGAL at admission outperforms serum creatinine for predicting both AKI and poor neurological outcomes — consider early measurement to improve risk stratification. Conventional sCr-based assessment alone is likely insufficient for identifying high-risk patients post-cardiac arrest.
