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Quantification of urinary TIMP-2 and IGFBP-7: an adequate diagnostic test to predict acute kidney injury after cardiac surgery?

Wetz AJ, Richardt EM, Wand S, Kunze N, Schotola H, Quintel M, Bräuer A, Moerer O - Crit Care (2015)

Bottom Line: On the first postoperative day, patients with AKI had significantly higher concentrations of [TIMP-2] × [IGFBP-7].Previously published cutoff points of 0.3 and 2 were not confirmed in our study cohort. [TIMP-2] × [IGFBP-7] concentration can be used as a diagnostic test to identify patients at increased risk of AKI after CS on the first postoperative day.At earlier time points, no significant difference in [TIMP-2] × [IGFBP-7] concentration was found between patients classified as KDIGO 0 or KDIGO 1 or 2.

View Article: PubMed Central - PubMed

Affiliation: Department of Anaesthesiology, Emergency and Intensive Care Medicine, University of Goettingen, Robert-Koch-Strasse 40, 37075, Goettingen, Germany. anna.wetz@med.uni-goettingen.de.

ABSTRACT

Introduction: Postoperative acute kidney injury (AKI) is a frequently observed complication after on-pump cardiac surgery (CS) and is associated with adverse patient outcomes. Early identification of patients at risk is essential for the prevention of AKI after CS. In this study, we analysed whether urinary tissue inhibitor of metalloproteinase 2 (TIMP-2) combined with urine insulin-like growth factor binding protein 7 (IGFBP-7) ([TIMP-2] × [IGFBP-7]) is an adequate diagnostic test to identify early AKI after on-pump CS.

Methods: In 42 patients undergoing coronary artery bypass graft surgery, we surveyed individual risk factors for AKI and defined AKI by applying the Kidney Disease: Improving Global Outcomes (KDIGO) classification during the day of surgery and the following 2 days after surgery. Concentrations of urinary TIMP-2 multiplied by IGFBP-7 were recorded at four time points: at baseline pre-surgery, at the end of surgery, 4 hours after cardiopulmonary bypass (CPB) and at 8:00 AM on the first postoperative day.

Results: In total, 38% of the patients experienced AKI. The results showed a median baseline [TIMP-2] × [IGFBP-7] concentration of 0.3 (ng/ml)(2)/1,000, decreasing at the end of surgery and then increasing at the next measurement point 4 hours after CPB and further on the first postoperative day. On the first postoperative day, patients with AKI had significantly higher concentrations of [TIMP-2] × [IGFBP-7]. On the day of surgery, the concentration did not significantly differ between patients classified as KDIGO 0 or KDIGO 1 or 2. Previously published cutoff points of 0.3 and 2 were not confirmed in our study cohort.

Conclusion: [TIMP-2] × [IGFBP-7] concentration can be used as a diagnostic test to identify patients at increased risk of AKI after CS on the first postoperative day. At earlier time points, no significant difference in [TIMP-2] × [IGFBP-7] concentration was found between patients classified as KDIGO 0 or KDIGO 1 or 2.

Trial registration: German Clinical Trials Register (DRKS) DRKS00005457. Registered 26 November 2013.

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Related in: MedlinePlus

Boxplots grouped by Kidney Disease: improving global outcomes stage (0 vs. 1 or 2) and time. The measurement of urinary tissue inhibitor of metalloproteinase 2 (TIMP-2) combined with urinary insulin-like growth factor binding protein 7 (IGFBP-7) using the diagnostic test in 42 cardiac surgery patients revealed that the test was able to discriminate between patients without (dark grey) acute kidney injury (AKI) and those with (light grey) AKI on the first postoperative day (area under the receiver operating characteristic curve, 0.706). The x-axis is measurement time points 1 through 4. The y-axis is the combined concentration of [TIMP-2] × [IGFBP-7] (ng/ml)2/1,000.
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Fig1: Boxplots grouped by Kidney Disease: improving global outcomes stage (0 vs. 1 or 2) and time. The measurement of urinary tissue inhibitor of metalloproteinase 2 (TIMP-2) combined with urinary insulin-like growth factor binding protein 7 (IGFBP-7) using the diagnostic test in 42 cardiac surgery patients revealed that the test was able to discriminate between patients without (dark grey) acute kidney injury (AKI) and those with (light grey) AKI on the first postoperative day (area under the receiver operating characteristic curve, 0.706). The x-axis is measurement time points 1 through 4. The y-axis is the combined concentration of [TIMP-2] × [IGFBP-7] (ng/ml)2/1,000.

Mentions: On the day of surgery, the concentration of ([TIMP-2] × [IGFBP-7]) (ng/ml)2/1,000 did not significantly differ between KDIGO 0 and KDIGO 1 or 2. At the first postoperative day, the median [TIMP-2] × [IGFBP-7] concentration of patients without AKI was 0.28 (ng/ml)2/1,000, whereas patients with AKI had a significantly higher [TIMP-2] × [IGFBP-7] concentration of 0.79 (ng/ml)2/1,000 (Figure 1 and Table 4).Figure 1


Quantification of urinary TIMP-2 and IGFBP-7: an adequate diagnostic test to predict acute kidney injury after cardiac surgery?

Wetz AJ, Richardt EM, Wand S, Kunze N, Schotola H, Quintel M, Bräuer A, Moerer O - Crit Care (2015)

Boxplots grouped by Kidney Disease: improving global outcomes stage (0 vs. 1 or 2) and time. The measurement of urinary tissue inhibitor of metalloproteinase 2 (TIMP-2) combined with urinary insulin-like growth factor binding protein 7 (IGFBP-7) using the diagnostic test in 42 cardiac surgery patients revealed that the test was able to discriminate between patients without (dark grey) acute kidney injury (AKI) and those with (light grey) AKI on the first postoperative day (area under the receiver operating characteristic curve, 0.706). The x-axis is measurement time points 1 through 4. The y-axis is the combined concentration of [TIMP-2] × [IGFBP-7] (ng/ml)2/1,000.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4310039&req=5

Fig1: Boxplots grouped by Kidney Disease: improving global outcomes stage (0 vs. 1 or 2) and time. The measurement of urinary tissue inhibitor of metalloproteinase 2 (TIMP-2) combined with urinary insulin-like growth factor binding protein 7 (IGFBP-7) using the diagnostic test in 42 cardiac surgery patients revealed that the test was able to discriminate between patients without (dark grey) acute kidney injury (AKI) and those with (light grey) AKI on the first postoperative day (area under the receiver operating characteristic curve, 0.706). The x-axis is measurement time points 1 through 4. The y-axis is the combined concentration of [TIMP-2] × [IGFBP-7] (ng/ml)2/1,000.
Mentions: On the day of surgery, the concentration of ([TIMP-2] × [IGFBP-7]) (ng/ml)2/1,000 did not significantly differ between KDIGO 0 and KDIGO 1 or 2. At the first postoperative day, the median [TIMP-2] × [IGFBP-7] concentration of patients without AKI was 0.28 (ng/ml)2/1,000, whereas patients with AKI had a significantly higher [TIMP-2] × [IGFBP-7] concentration of 0.79 (ng/ml)2/1,000 (Figure 1 and Table 4).Figure 1

Bottom Line: On the first postoperative day, patients with AKI had significantly higher concentrations of [TIMP-2] × [IGFBP-7].Previously published cutoff points of 0.3 and 2 were not confirmed in our study cohort. [TIMP-2] × [IGFBP-7] concentration can be used as a diagnostic test to identify patients at increased risk of AKI after CS on the first postoperative day.At earlier time points, no significant difference in [TIMP-2] × [IGFBP-7] concentration was found between patients classified as KDIGO 0 or KDIGO 1 or 2.

View Article: PubMed Central - PubMed

Affiliation: Department of Anaesthesiology, Emergency and Intensive Care Medicine, University of Goettingen, Robert-Koch-Strasse 40, 37075, Goettingen, Germany. anna.wetz@med.uni-goettingen.de.

ABSTRACT

Introduction: Postoperative acute kidney injury (AKI) is a frequently observed complication after on-pump cardiac surgery (CS) and is associated with adverse patient outcomes. Early identification of patients at risk is essential for the prevention of AKI after CS. In this study, we analysed whether urinary tissue inhibitor of metalloproteinase 2 (TIMP-2) combined with urine insulin-like growth factor binding protein 7 (IGFBP-7) ([TIMP-2] × [IGFBP-7]) is an adequate diagnostic test to identify early AKI after on-pump CS.

Methods: In 42 patients undergoing coronary artery bypass graft surgery, we surveyed individual risk factors for AKI and defined AKI by applying the Kidney Disease: Improving Global Outcomes (KDIGO) classification during the day of surgery and the following 2 days after surgery. Concentrations of urinary TIMP-2 multiplied by IGFBP-7 were recorded at four time points: at baseline pre-surgery, at the end of surgery, 4 hours after cardiopulmonary bypass (CPB) and at 8:00 AM on the first postoperative day.

Results: In total, 38% of the patients experienced AKI. The results showed a median baseline [TIMP-2] × [IGFBP-7] concentration of 0.3 (ng/ml)(2)/1,000, decreasing at the end of surgery and then increasing at the next measurement point 4 hours after CPB and further on the first postoperative day. On the first postoperative day, patients with AKI had significantly higher concentrations of [TIMP-2] × [IGFBP-7]. On the day of surgery, the concentration did not significantly differ between patients classified as KDIGO 0 or KDIGO 1 or 2. Previously published cutoff points of 0.3 and 2 were not confirmed in our study cohort.

Conclusion: [TIMP-2] × [IGFBP-7] concentration can be used as a diagnostic test to identify patients at increased risk of AKI after CS on the first postoperative day. At earlier time points, no significant difference in [TIMP-2] × [IGFBP-7] concentration was found between patients classified as KDIGO 0 or KDIGO 1 or 2.

Trial registration: German Clinical Trials Register (DRKS) DRKS00005457. Registered 26 November 2013.

Show MeSH
Related in: MedlinePlus