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2015 ; 5
(1
): 50
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Urinary TIMP-2 * IGFBP7 for early prediction of acute kidney injury after
coronary artery bypass surgery
#MMPMID26669781
Pilarczyk K
; Edayadiyil-Dudasova M
; Wendt D
; Demircioglu E
; Benedik J
; Dohle DS
; Jakob H
; Dusse F
Ann Intensive Care
2015[Dec]; 5
(1
): 50
PMID26669781
show ga
BACKGROUND: Acute kidney injury (AKI) is a common complication after cardiac
surgery. Currently, prediction of AKI with classical tools remains uncertain.
Therefore, it was the aim of the present study to evaluate two new urinary
biomarkers-insulin-like growth factor-binding protein 7 (IGFBP7) and tissue
inhibitor of metalloproteinases-2 (TIMP-2) in patients after coronary artery
bypass surgery (CABG). METHODS: In a prospective cohort study, 60 consecutive
patients undergoing isolated on-pump CABG were enrolled. Urine samples collected
every 12 h in the postoperative course were analyzed for the product of TIMP-2
and IGFBP7. Urinary output, serum creatinine and estimated glomerular filtration
rate (eGFR) were recorded simultaneously. Primary clinical endpoint was the
development of AKI stage 2 or 3 according to the classification of the KDIGO
within 48 h after surgery. RESULTS: 48 male and 12 female patients with a mean
age of 69.61 ± 8.4 years were included. 19 patients developed an AKI (31.6 %),
six patients met the endpoint with AKI 2 or 3 (10 %). Urinary [TIMP-2]*[IGFBP7]
increased significantly as early as 4 h after CABG in patients with AKI 2/3
(1.83 ± 2.15 vs. 0.23 ± 0.45, p < 0.05) whereas serum creatinine did not increase
until 48 h after surgery. The diagnostic accuracy of [TIMP 2]*[IGFBP7] on day one
after surgery for the prediction of AKI 2/3 was significantly better (sensitivity
0.89, specificity 0.81, AUC 0.817, 95 % CI 0.622-1.0 SE 0.099, p = 0.022, cut-off
0.817) than for serum creatinine (AUC 0.359, sensitivity 0.50, specificity of
0.52, cut-off value 1.17 mg/dl) and eGFR. CONCLUSION: Urinary [TIMP-2]*[IGFBP7]
represents a sensitive and specific biomarker to predict moderate to severe AKI
very early after CABG. Analyses from our ongoing larger study are necessary to
confirm these findings and probably increase sensitivity and specificity.