Post-surgery urinary TIMP-2 and IGFBP7 levels improved the prediction of the need for renal replacement therapy when added to a clinical model, achieving a C-statistic of 0.93.
Observational (n=344)
No
Do urinary TIMP-2 and IGFBP7 improve the prediction of renal replacement therapy and 30-day mortality in patients undergoing elective cardiac surgery?
Urinary TIMP-2 and IGFBP7 measured post-surgery slightly improve the prediction of severe AKI requiring RRT and 30-day mortality beyond standard clinical variables in elective cardiac surgery patients.
Effect estimate: C-statistic 0.93 (95% CI 0.90-0.97)
Acute kidney injury (AKI) is an important risk factor for chronic kidney disease, renal replacement therapy (RRT), and mortality. However, predicting AKI with currently available markers remains problematic. We assessed the predictive value of urinary tissue inhibitor of metalloprotease-2 (TIMP-2) and insulin-like growth factor-binding protein 7 (IGFBP7) regarding the need for RRT, and 30-day mortality, in elective cardiac surgery patients. In 344 elective cardiac surgery patients, we measured urinary TIMP-2 and IGFBP7 and serum creatinine at baseline and directly after surgery. Discrimination of both urinary biomarkers was assessed by the C-statistic. Model improvement for each biomarker when added to a basic model containing serum creatinine and duration of surgery was tested by the net-reclassification index (cf-NRI) and integrated discrimination index (IDI). At baseline, mean age was 66 years and 67% were men. Of all patients, 22 required RRT following surgery. IGFBP7 pre- and post-surgery and change in TIMP-2 during surgery predicted RRT with a C-statistic of about 0.80. However, a simple model including baseline serum creatinine and duration of surgery had a C-statistic of 0.92, which was improved to 0.93 upon addition of post-surgery TIMP-2 or IGFBP7, with statistically significant cf-NRIs but non-significant IDIs. Post-surgery TIMP-2 and IGFBP predicted 30-day mortality, with C-statistics of 0.74 and 0.80. In conclusion, in elective cardiac surgery patients, pre- and peri-operative clinical variables were highly discriminating about which patients required RRT after surgery. Nonetheless, in elective cardiac surgery patients, urinary TIMP-2 and IGFBP7 improved prediction of RRT and 30-day mortality post-surgery.
Esmeijer et al. (Wed,) conducted a observational in Elective cardiac surgery (n=344). Urinary TIMP-2 and IGFBP7 vs. Clinical variables (serum creatinine and duration of surgery) was evaluated on Need for renal replacement therapy (RRT) within two weeks after surgery (C-statistic 0.93, 95% CI 0.90-0.97). Post-surgery urinary TIMP-2 and IGFBP7 levels improved the prediction of the need for renal replacement therapy when added to a clinical model, achieving a C-statistic of 0.93.
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