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Early prediction of acute kidney injury after transapical and transaortic aortic valve implantation with urinary G1 cell cycle arrest biomarkers

View Article: PubMed Central - PubMed

ABSTRACT

Background: Acute kidney injury (AKI) is a common complication following transcatheter aortic valve implantation (TAVI) leading to increased mortality and morbidity. Urinary G1 cell cycle arrest proteins TIMP-2 and IGFBP7 have recently been suggested as sensitive biomarkers for early detection of AKI in critically ill patients. However, the precise role of urinary TIMP-2 and IGFBP7 in patients undergoing TAVI is unknown.

Methods: In a prospective observational trial, 40 patients undergoing TAVI (either transaortic or transapical) were enrolled. Serial measurements of TIMP-2 and IGFBP7 were performed in the early post interventional course. The primary clinical endpoint was the occurrence of AKI stage 2/3 according to the KDIGO classification.

Results: Now we show, that ROC analyses of [TIMP-2]*[IGFBP7] on day one after TAVI reveals a sensitivity of 100 % and a specificity of 90 % for predicting AKI 2/3 (AUC 0.971, 95 % CI 0.914-1.0, SE 0.0299, p = 0.001, cut-off 1.03). In contrast, preoperative and postoperative serum creatinine levels as well as glomerular filtration rate (GFR) and perioperative change in GFR did not show any association with the development of AKI. Furthermore, [TIMP-2]*[IGFBP7] remained stable in patients with AKI ≤1, but its levels increased significantly as early as 24 h after TAVI in patients who developed AKI 2/3 in the further course (4.77 ± 3.21 vs. 0.48 ± 0.68, p = 0.022). Mean patients age was 81.2 ± 5.6 years, 16 patients were male (40.0 %). 35 patients underwent transapical and five patients transaortic TAVI. 15 patients (37.5 %) developed any kind of AKI; eight patients (20 %) met the primary endpoint and seven patients required renal replacement therapy (RRT) within 72 h after surgery.

Conclusion: Early elevation of urinary cell cycle arrest biomarkers after TAVI is associated with the development of postoperative AKI. [TIMP-2]*[IGFBP7] provides an excellent diagnostic accuracy in the prediction of AKI that is superior to that of serum creatinine.

No MeSH data available.


Postoperative course of serum creatinine a, eGFR b and [TIMP-2]*[IGFBP7] c in patients with AKI ≥ 2 compared to patients with AKI ≤ 1. * = p < 0.05 between patients with AKI ≥ 2 and patients with AKI ≤1
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Fig2: Postoperative course of serum creatinine a, eGFR b and [TIMP-2]*[IGFBP7] c in patients with AKI ≥ 2 compared to patients with AKI ≤ 1. * = p < 0.05 between patients with AKI ≥ 2 and patients with AKI ≤1

Mentions: In patients with KDIGO AKI 0/1, serum creatinine as well as eGFR remained stable at all times with no significant undulations over time. In contrast, elevated serum creatinine levels could be observed on POD 2 with a maximum of 1.64 ± 0.99 mg/dl. Accordingly, eGFR showed a significant fall on POD 2 with 38.86 ± 23.79 ml/min/1.73 m2. Furthermore, the postoperative courses of serum creatinine, eGFR and urinary [TIMP 2]*[IGFBP7] urine concentrations for patients with AKI stage 2/3 and for those with no or mild AKI (KDIGO stage 0–1) are displayed in Fig. 2.Fig. 2


Early prediction of acute kidney injury after transapical and transaortic aortic valve implantation with urinary G1 cell cycle arrest biomarkers
Postoperative course of serum creatinine a, eGFR b and [TIMP-2]*[IGFBP7] c in patients with AKI ≥ 2 compared to patients with AKI ≤ 1. * = p < 0.05 between patients with AKI ≥ 2 and patients with AKI ≤1
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC5016985&req=5

Fig2: Postoperative course of serum creatinine a, eGFR b and [TIMP-2]*[IGFBP7] c in patients with AKI ≥ 2 compared to patients with AKI ≤ 1. * = p < 0.05 between patients with AKI ≥ 2 and patients with AKI ≤1
Mentions: In patients with KDIGO AKI 0/1, serum creatinine as well as eGFR remained stable at all times with no significant undulations over time. In contrast, elevated serum creatinine levels could be observed on POD 2 with a maximum of 1.64 ± 0.99 mg/dl. Accordingly, eGFR showed a significant fall on POD 2 with 38.86 ± 23.79 ml/min/1.73 m2. Furthermore, the postoperative courses of serum creatinine, eGFR and urinary [TIMP 2]*[IGFBP7] urine concentrations for patients with AKI stage 2/3 and for those with no or mild AKI (KDIGO stage 0–1) are displayed in Fig. 2.Fig. 2

View Article: PubMed Central - PubMed

ABSTRACT

Background: Acute kidney injury (AKI) is a common complication following transcatheter aortic valve implantation (TAVI) leading to increased mortality and morbidity. Urinary G1 cell cycle arrest proteins TIMP-2 and IGFBP7 have recently been suggested as sensitive biomarkers for early detection of AKI in critically ill patients. However, the precise role of urinary TIMP-2 and IGFBP7 in patients undergoing TAVI is unknown.

Methods: In a prospective observational trial, 40 patients undergoing TAVI (either transaortic or transapical) were enrolled. Serial measurements of TIMP-2 and IGFBP7 were performed in the early post interventional course. The primary clinical endpoint was the occurrence of AKI stage 2/3 according to the KDIGO classification.

Results: Now we show, that ROC analyses of [TIMP-2]*[IGFBP7] on day one after TAVI reveals a sensitivity of 100&nbsp;% and a specificity of 90&nbsp;% for predicting AKI 2/3 (AUC 0.971, 95&nbsp;% CI 0.914-1.0, SE 0.0299, p&thinsp;=&thinsp;0.001, cut-off 1.03). In contrast, preoperative and postoperative serum creatinine levels as well as glomerular filtration rate (GFR) and perioperative change in GFR did not show any association with the development of AKI. Furthermore, [TIMP-2]*[IGFBP7] remained stable in patients with AKI &le;1, but its levels increased significantly as early as 24&nbsp;h after TAVI in patients who developed AKI 2/3 in the further course (4.77&thinsp;&plusmn;&thinsp;3.21 vs. 0.48&thinsp;&plusmn;&thinsp;0.68, p&thinsp;=&thinsp;0.022). Mean patients age was 81.2&thinsp;&plusmn;&thinsp;5.6&nbsp;years, 16 patients were male (40.0&nbsp;%). 35 patients underwent transapical and five patients transaortic TAVI. 15 patients (37.5&nbsp;%) developed any kind of AKI; eight patients (20&nbsp;%) met the primary endpoint and seven patients required renal replacement therapy (RRT) within 72&nbsp;h after surgery.

Conclusion: Early elevation of urinary cell cycle arrest biomarkers after TAVI is associated with the development of postoperative AKI. [TIMP-2]*[IGFBP7] provides an excellent diagnostic accuracy in the prediction of AKI that is superior to that of serum creatinine.

No MeSH data available.