Abstract
BackgroundAcute kidney injury (AKI) following cardiac surgery is common and associated with poor patient outcomes. Early risk assessment for development of AKI remains a challenge. The combination of urinary tissue inhibitor of metalloproteinase 2 (TIMP-2) and insulin-like growth factor binding protein 7 (IGFBP7) has been shown to be an excellent predictor of AKI following cardiac surgery, but reported studies are for predominately non-Asian populations.MethodsAdult patients were prospectively enrolled at Zhongshan hospital in Shanghai, China. The primary analysis was prediction of AKI and stage 2–3 AKI by [TIMP-2]*[IGFBP7] measured 4 h after postoperative ICU admission assessed using receiver operating characteristic curve (ROC) analysis. Kinetics of [TIMP-2]*[IGFBP7] following ICU admission were also examined.ResultsWe prospectively enrolled 57 cardiac surgery patients, of which 20 (35%) developed AKI and 6 (11%) developed stage 2–3 AKI. The area under the ROC curve (AUC) of [TIMP-2]*[IGFBP7] at 4 h after ICU admission was 0.80 (95% confidence interval (CI): 0.68–0.91) for development of AKI and 0.83 (95% CI: 0.69–0.96) for development of stage 2–3 AKI. Urinary [TIMP-2]*[IGFBP7] values at 4 h after ICU admission were significantly (P < 0.001) higher in patients who developed AKI than in patients who did not develop AKI (mean (standard error) of 1.08 (0.34) (ng/mL)2/1000 and 0.29 (0.05) (ng/mL)2/1000, respectively). The time-profile of [TIMP-2]*[IGFBP7] suggests the markers started to elevate by the time of ICU admission in patients who developed AKI and either decreased or remained flat in patients without AKI.ConclusionThe combination of urinary TIMP-2 and IGFBP7 4 h after postoperative ICU admission identifies patients at risk for developing AKI, not just stage 2–3 AKI following cardiac surgery.
Highlights
Acute kidney injury (AKI) following cardiac surgery is common and associated with poor patient outcomes
We investigated the use of [tissue inhibitor of metalloproteinase 2 (TIMP-2)][insulin-like growth factor binding protein 7 (IGFBP7)] for prediction of AKI in a cohort of adults undergoing cardiac surgery in China
The area under the receiver operating characteristic (ROC) curve (AUC) of the model increased from 0.83 (0.73–0.91) to 0.94 (0.83–0.98) with the addition of urinary [TIMP-2][IGFBP7] to the model (P = 0.03)
Summary
Acute kidney injury (AKI) following cardiac surgery is common and associated with poor patient outcomes. Acute kidney injury (AKI) is a global health concern associated with increased morbidity and mortality [1,2,3]. Especially with cardiopulmonary bypass, are at high risk for AKI. Diagnosis of AKI requires close monitoring of changes in serum creatinine and urine output, which may not be practical for all patients. Changes in these markers of renal function often lag injury [9]. Risk assessment for AKI is recommended by clinical practice guidelines to facilitate early detection of
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