Key result
Four-hour post-cardiac surgery urinary TIMP2*IGFBP7 is ~14-fold higher in patients developing AKI.
Why the study?
Identifying biomarkers that detect kidney injury before GFR reduction is crucial to improve diagnosis and management of AKI in septic patients after cardiac surgery.
Do TIMP2*IGFBP7 and MR-proADM predict acute kidney injury and the need for renal replacement therapy in patients after cardiac surgery?
Observational (n=230)
Do TIMP2*IGFBP7 and MR-proADM predict acute kidney injury and the need for renal replacement therapy in patients after cardiac surgery?
Absolute Event Rate: 1.1% vs 0.08%
p-value: p=< 0.001
TIMP2*IGBP7 and MR-proADM measured 4 hours after cardiac surgery can early identify patients at high risk for AKI and the need for renal replacement therapy.
May aid early post-cardiac surgery AKI risk stratification; Level 3 data leave open predictive utility for RRT and require prospective validation.
Identifying a panel of markers detecting kidney injury before the glomerular filtration rate (GFR) reduction is the challenge to improve the diagnosis and the management of acute kidney injury (AKI) in septic patients. This study evaluated the roles of tissue inhibitor metal proteinase, insulin growth factor binding protein (TIMP2*IGFBP7), and mid-regional pro-adrenomedullin (MR-proADM) in AKI patients. Patients and Methods: This study was prospectively conducted in the Intensive Care Unit (ICU) enrolling 230 patients who underwent cardiac surgery. Biomarkers were evaluated before and after 4 hours of the cardiac surgery. Results: Whereas urine and creatinine alterations appeared at 23.2 (12.7 – 36.5) hours, after cardiac surgery, urinary TIMP2*IGBP7 levels were higher at 4 hours in AKI patients (1.1±0.4 mg/l vs 0.08±0.02 mg/l; p < 0.001). Its concentration >2 mg/l increases the AKI risk within the following 24 hours, clearly identifying the population at high risk of renal replacement therapy (RRT). In patients with sepsis, MR-proADM levels were 2.3 nmol/l (0.7–7.8 nmol/l), with the highest values observed in septic shock [5.6 nmol/l (3.2–18 nmol/l)] and a better diagnostic profile than procalcitonin and C-reactive protein to identify septic patients. MR-proADM values >5.1 nmol/l and urine TIMP2*IGBP7 levels > 2 mg/l showed a significantly faster progression to RRT, with a mean follow-up time of 1.1 days. Conclusions: TIMP2*IGBP7 and MR-proADM precociously diagnose AKI in septic patients after cardiac surgery, giving prognostic information for RRT requirement.
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Lacquaniti et al. (2023) conducted an observational in Acute Kidney Injury and Sepsis after Cardiac Surgery (n=230). TIMP2*IGFBP7 and MR-proADM vs. Patients without AKI or sepsis was evaluated on Urinary TIMP2*IGBP7 levels at 4 hours post-surgery in AKI vs non-AKI patients (p=< 0.001). Urinary TIMP2*IGBP7 levels at 4 hours post-cardiac surgery were significantly higher in patients who developed AKI (1.1±0.4 mg/l vs 0.08±0.02 mg/l; p<0.001).
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