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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.


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Receiver operator characteristic (ROC) curve for the prediction of AKI 2/3. a Preoperative serum creatinine and eGFR. b [TIMP 2]*[IGFBP7], serum creatinine and ∆ eGFR 4 h after TAVI. c [TIMP 2]*[IGFBP7],serum creatinine and ∆ eGFR on postoperative day 1 after TAVI. d Maximum [TIMP 2]*[IGFBP7], serum creatinine and ∆ eGFR during the first 24 h after surgery. AKI = acute kidney injury, AUC = Area under the curve, IGFBP7 = insulin-like growth factor binding protein 7, KDIGO = Kidney Disease: Improving Global Outcomes; ROC = Receiver operating characteristic; RRT = renal replacement therapy, TIMP- 2 = tissue metalloproteinase 2. * defined as maximum level in the first 24 h after surgery
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Fig4: Receiver operator characteristic (ROC) curve for the prediction of AKI 2/3. a Preoperative serum creatinine and eGFR. b [TIMP 2]*[IGFBP7], serum creatinine and ∆ eGFR 4 h after TAVI. c [TIMP 2]*[IGFBP7],serum creatinine and ∆ eGFR on postoperative day 1 after TAVI. d Maximum [TIMP 2]*[IGFBP7], serum creatinine and ∆ eGFR during the first 24 h after surgery. AKI = acute kidney injury, AUC = Area under the curve, IGFBP7 = insulin-like growth factor binding protein 7, KDIGO = Kidney Disease: Improving Global Outcomes; ROC = Receiver operating characteristic; RRT = renal replacement therapy, TIMP- 2 = tissue metalloproteinase 2. * defined as maximum level in the first 24 h after surgery

Mentions: At a cut-off of 0.91, the maximum value of [TIMP 2] *[IGFBP7] urine concentrations within 24 h after intervention showed a 87.5 % sensitivity and a 82.8 % specificity for detecting patients who develop KDIGO AKI 2/3 (AUC 0.869, SE 0.080, 95 % CI 0.721–1.0, p = 0.002). The diagnostic accuracy for [TIMP 2] *[IGFBP7] was better than for maximum serum creatinine concentrations within the first 24 h after intervention with a sensitivity of 75.0 % and a specificity of 55.2 % for a cut-off-value 1.160 (AUC 0.655, SE 0.108, p = 0.184, 95 % CI 0.443–0.867) as well as maximum ∆ GFR (AUC 0.616, SE 0.142, 95%CI 0.338–0.983, p = 0.326). The concordant ROC curves are illustrated in Fig. 4.Fig. 4


Early prediction of acute kidney injury after transapical and transaortic aortic valve implantation with urinary G1 cell cycle arrest biomarkers
Receiver operator characteristic (ROC) curve for the prediction of AKI 2/3. a Preoperative serum creatinine and eGFR. b [TIMP 2]*[IGFBP7], serum creatinine and ∆ eGFR 4 h after TAVI. c [TIMP 2]*[IGFBP7],serum creatinine and ∆ eGFR on postoperative day 1 after TAVI. d Maximum [TIMP 2]*[IGFBP7], serum creatinine and ∆ eGFR during the first 24 h after surgery. AKI = acute kidney injury, AUC = Area under the curve, IGFBP7 = insulin-like growth factor binding protein 7, KDIGO = Kidney Disease: Improving Global Outcomes; ROC = Receiver operating characteristic; RRT = renal replacement therapy, TIMP- 2 = tissue metalloproteinase 2. * defined as maximum level in the first 24 h after surgery
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Fig4: Receiver operator characteristic (ROC) curve for the prediction of AKI 2/3. a Preoperative serum creatinine and eGFR. b [TIMP 2]*[IGFBP7], serum creatinine and ∆ eGFR 4 h after TAVI. c [TIMP 2]*[IGFBP7],serum creatinine and ∆ eGFR on postoperative day 1 after TAVI. d Maximum [TIMP 2]*[IGFBP7], serum creatinine and ∆ eGFR during the first 24 h after surgery. AKI = acute kidney injury, AUC = Area under the curve, IGFBP7 = insulin-like growth factor binding protein 7, KDIGO = Kidney Disease: Improving Global Outcomes; ROC = Receiver operating characteristic; RRT = renal replacement therapy, TIMP- 2 = tissue metalloproteinase 2. * defined as maximum level in the first 24 h after surgery
Mentions: At a cut-off of 0.91, the maximum value of [TIMP 2] *[IGFBP7] urine concentrations within 24 h after intervention showed a 87.5 % sensitivity and a 82.8 % specificity for detecting patients who develop KDIGO AKI 2/3 (AUC 0.869, SE 0.080, 95 % CI 0.721–1.0, p = 0.002). The diagnostic accuracy for [TIMP 2] *[IGFBP7] was better than for maximum serum creatinine concentrations within the first 24 h after intervention with a sensitivity of 75.0 % and a specificity of 55.2 % for a cut-off-value 1.160 (AUC 0.655, SE 0.108, p = 0.184, 95 % CI 0.443–0.867) as well as maximum ∆ GFR (AUC 0.616, SE 0.142, 95%CI 0.338–0.983, p = 0.326). The concordant ROC curves are illustrated in Fig. 4.Fig. 4

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.


Related in: MedlinePlus