Plasma L-FABP as a superior biomarker for detecting and characterizing cardiorenal syndrome in acute heart failure: comparative insights with hs‐troponin T and NT‐proBNP

Background & Objective: The interplay between cardiac and renal dysfunction poses a major diagnostic and therapeutic challenge in acute heart failure (AHF). While high‐sensitivity troponin T (hs-TnT) and N‐terminal pro‐B‐type natriuretic peptide (NT‐proBNP) are valuable for cardiac assessment, they offer limited insights into renal injury. We evaluated the performance of plasma liver‐type fatty acid–binding protein (L‐FABP) in distinguishing acute cardiorenal syndrome (CRS) from AHF and its correlation with renal function. Methods: A case-control study was conducted with 90 participants categorized as controls (n=30), AHF (n=30), and acute CRS (n = 30). Clinical and laboratory data were obtained, including echocardiographic parameters, serum creatinine, estimated glomerular filtration rate (eGFR), and biomarker levels (L‐FABP, hs-TnT, NT‐proBNP). Plasma L-FABP, hs-TnT, and NT-proBNP levels were measured and correlated with renal and cardiac functions. Receiver operating characteristic (ROC) curve analysis was used to assess the diagnostic performance of biomarkers in differentiating acute CRS from AHF. Results: Plasma L‐FABP levels were markedly elevated in CRS compared to both AHF and controls (P < 0.001). L‐FABP demonstrated a stronger correlation with serum creatinine (r = 0.84) and an inverse relationship with eGFR (r = −0.55) relative to the other biomarkers. In ROC analyses, L‐FABP showed the highest discriminatory power (AUC = 0.968) in differentiating CRS from AHF, exceeding hs-TnT (0.958) and NT‐proBNP (0.913). Multiple regression analysis revealed that only L‐FABP remained a significant independent predictor of current renal impairment (P = 0.001). Conclusion: Plasma L‐FABP offers superior diagnostic accuracy and correlates more closely with renal dysfunction than conventional cardiac markers in AHF and CRS. Integrating L‐FABP into routine evaluation may enhance early risk stratification and guide targeted therapeutic interventions for patients at risk of worsening kidney injury. Abbreviations: AHF: Acute heart failure, CRS: cardiorenal syndrome, hs‐TNT: high‐sensitivity troponin T, L-FABP: liver‐type fatty acid–binding protein Keywords: Acute Heart Failure; AHF; CRS; hs-Tnt; NT-Probnp; Plasma L-FABP Citation: Alredha RD, Farman HA. Plasma L-FABP as a superior biomarker for detecting and characterizing cardiorenal syndrome in acute heart failure: comparative insights with hs‐troponin T and NT‐proBNP. Anaesth. pain intensive care 2025;29(2):284-293. DOI: 10.35975/apic.v29i2.2717 Received: September 27, 2024; Reviewed: October 24, 2024; Accepted: January 01, 2025