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10.1097/CCM.0000000000001827

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suck abstract from ncbi


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pmid27355527
      Crit+Care+Med 2016 ; 44 (10 ): 1851-60
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  • Urinary Tissue Inhibitor of Metalloproteinase-2 and Insulin-Like Growth Factor-Binding Protein 7 for Risk Stratification of Acute Kidney Injury in Patients With Sepsis #MMPMID27355527
  • Honore PM ; Nguyen HB ; Gong M ; Chawla LS ; Bagshaw SM ; Artigas A ; Shi J ; Joannes-Boyau O ; Vincent JL ; Kellum JA
  • Crit Care Med 2016[Oct]; 44 (10 ): 1851-60 PMID27355527 show ga
  • OBJECTIVES: To examine the performance of the urinary biomarker panel tissue inhibitor of metalloproteinase-2 and insulin-like growth factor-binding protein 7 in patients with sepsis at ICU admission. To investigate the effect of nonrenal organ dysfunction on tissue inhibitor of metalloproteinase-2 and insulin-like growth factor-binding protein 7 in this population. METHOD: In this ancillary analysis, we included patients with sepsis who were enrolled in either of two trials including 39 ICUs across Europe and North America. The primary endpoint was moderate-severe acute kidney injury (equivalent to Kidney Disease Improving Global Outcome stage 2-3) within 12 hours of enrollment. We assessed biomarker performance by calculating the area under the receiver operating characteristic curve, sensitivity, specificity, and negative and positive predictive values at three cutoffs: 0.3, 1.0, and 2.0 (ng/mL)/1,000. We also calculated nonrenal Sequential Organ Failure Assessment scores for each patient on enrollment and compared tissue inhibitor of metalloproteinase-2 and insulin-like growth factor-binding protein 7 results in patients with and without acute kidney injury and across nonrenal Sequential Organ Failure Assessment scores. Finally, we constructed a clinical model for acute kidney injury in this population and compared the performance of the model with and without tissue inhibitor of metalloproteinase-2 and insulin-like growth factor-binding protein 7. RESULTS: We included 232 patients in the analysis and 40 (17%) developed acute kidney injury. We observed significantly higher urine tissue inhibitor of metalloproteinase-2 and insulin-like growth factor-binding protein 7 in patients with acute kidney injury than without acute kidney injury in both patients with low and high nonrenal Sequential Organ Failure Assessment scores (p < 0.001). The area under the receiver operating characteristic curve (95% CI) of tissue inhibitor of metalloproteinase-2 and insulin-like growth factor-binding protein 7 was 0.84 (0.73-0.92) and 0.85 (0.76-0.94), in low and high nonrenal Sequential Organ Failure Assessment score subgroups. Performance of the tissue inhibitor of metalloproteinase-2 and insulin-like growth factor-binding protein 7 test was not modified by nonrenal Sequential Organ Failure Assessment (p = 0.70). In multivariate analysis, the addition of tissue inhibitor of metalloproteinase-2 and insulin-like growth factor-binding protein 7 significantly improved the performance of a clinical model for predicting acute kidney injury (p = 0.015). CONCLUSION: Urinary tissue inhibitor of metalloproteinase-2 and insulin-like growth factor-binding protein 7 accurately predicts acute kidney injury in septic patients with or without other organ failures.
  • |Acute Kidney Injury/complications/*urine [MESH]
  • |Aged [MESH]
  • |Aged, 80 and over [MESH]
  • |Biomarkers [MESH]
  • |Body Mass Index [MESH]
  • |Creatinine/blood [MESH]
  • |Female [MESH]
  • |Humans [MESH]
  • |Insulin-Like Growth Factor Binding Proteins/*analysis/blood/urine [MESH]
  • |Male [MESH]
  • |Middle Aged [MESH]
  • |Organ Dysfunction Scores [MESH]
  • |Prospective Studies [MESH]
  • |ROC Curve [MESH]
  • |Sepsis/complications/*urine [MESH]
  • |Severity of Illness Index [MESH]


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