Cell cycle arrest biomarkers for predicting renal recovery from acute kidney injury: a prospective validation study

Annals of Intensive Care

Tian-En Zhang¹  Yi-Bing Weng²  Li Cheng²  Jing-Yi Wang³  Hui-Miao Jia³  Yi-Jia Jiang³  Fang-Xing Guo³  Xin Xin³  Yu-Zhen Han³  Chao-Dong Chen³  Wen-Xiong Li³  Shu-Yan Guo³  Xi Zheng³ 

[1] 17325, Gettysburg, PA, USA;Department of Emergent Intensive Critical Unit, Beijing Lu-He Hospital, Capital Medical University, 101100, Beijing, China;Department of Surgical Intensive Critical Unit, Beijing Chao-yang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, 100020, Beijing, China;

关键词: TIMP-2;    IGFBP7;    Acute kidney injury;    Renal recovery;    Prognosis;   

DOI  :  10.1186/s13613-022-00989-8

来源: Springer

【 摘 要 】

BackgroundAcute kidney injury (AKI) is a common disease in the intensive care unit (ICU). AKI patients with nonrecovery of renal function have a markedly increased risk of death compared with patients with recovery. The current study aimed to explore and validate the utility of urinary cell cycle arrest biomarkers for predicting nonrecovery in patients who developed AKI after ICU admission.MethodsWe prospectively and consecutively enrolled 379 critically ill patients who developed AKI after admission to the ICU, which were divided into a derivation cohort (194 AKI patients) and a validation cohort (185 AKI patients). The biomarkers of urinary tissue inhibitor of metalloproteinase-2 (TIMP-2) and insulin-like growth factor-binding protein 7 (IGFBP7) were detected at inclusion immediately after AKI diagnosis (day 0) and 24 h later (day 1). The optimal cut-off values of these biomarkers for predicting nonrecovery were estimated in the derivation cohort, and their predictive accuracy was assessed in the validation cohort. The primary endpoint was nonrecovery from AKI (within 7 days).ResultsOf 379 patients, 159 (41.9%) patients failed to recover from AKI onset, with 79 in the derivation cohort and 80 in the validation cohort. Urinary [TIMP-2]*[IGFBP7] on day 0 showed a better prediction ability for nonrecovery than TIMP-2 and IGFBP7 alone, with an area under the reciever operating characteristic curve (AUC) of 0.751 [95% confidence interval (CI) 0.701–0.852, p < 0.001] and an optimal cut-off value of 1.05 ((ng/mL)2/1000). When [TIMP-2]*[IGFBP7] was combined with the clinical factors of AKI diagnosed by the urine output (UO) criteria, AKI stage 2–3 and nonrenal SOFA score for predicting nonrecovery, the AUC was significantly improved to 0.852 (95% CI 0.750–0.891, p < 0.001), which achieved a sensitivity and specificity of 88.8% (72.9, 98.7) and 92.6% (80.8, 100.0), respectively. However, urine [TIMP-2]*[IGFBP7], TIMP-2 alone, and IGFBP7 alone on day 1 performed poorly for predicting AKI recovery.ConclusionUrinary [TIMP-2]*[IGFBP7] on day 0 showed a fair performance for predicting nonrecovery from AKI. The predictive accuracy can be improved when urinary [TIMP-2]*[IGFBP7] is combined with the clinical factors of AKI diagnosed by the UO criteria, AKI stage 2–3 and nonrenal SOFA score.

【 授权许可】

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