Early prediction of acute kidney injury after transapical and transaortic aortic valve implantation with urinary G1 cell cycle arrest biomarkers

BMC Anesthesiology

Research Article

Philipp Kahlert¹  Ender Demircioglu²  Heinz Jakob²  Matthias Thielmann²  Daniel Wendt²  Fabian Dusse³  Kevin Pilarczyk⁴  Michaela Edayadiyil-Dudásova⁵  Simon T Schaefer⁶ 

[1] Department of Cardiology, West German Heart and Vascular Center Essen, University Hospital Essen, Hufelandstraße 55, 45122, Essen, Germany;Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital Essen, Hufelandstraße 55, 45122, Essen, Germany;Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital Essen, Hufelandstraße 55, 45122, Essen, Germany;Department of Anesthesiology and Intensive Care Medicine, Medical Center Cologne-Merheim, University of Witten/Herdecke, Ostmerheimerstrasse 200, 51109, Cologne, Germany;Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital Essen, Hufelandstraße 55, 45122, Essen, Germany;Department of Intensive Care Medicine, Imland-Klinik Rendsburg, Lilienstraße 20-28, 24768, Rendsburg, Germany;Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital Essen, Hufelandstraße 55, 45122, Essen, Germany;Klinik für Anästhesiologie und Intensivmedizin, University Hospital Essen, Hufelandstraße 55, 45122, Essen, Germany;Klinik für Anästhesiologie und Intensivmedizin, University Hospital Essen, Hufelandstraße 55, 45122, Essen, Germany;Klinik für Anästhesiologie, Ludwig-Maximilians Universität München, Marchioninistraße 15, 81377, Munich, Germany;

关键词: Acute kidney injury;    AKI;    TIMP-2;    IGFBP7;    Cell cycle arrest;    NephroCheck;    TAVI;    TAVR;    Biomarker;   

DOI  :  10.1186/s12871-016-0244-8

 received in 2016-01-14, accepted in 2016-08-26,  发布年份 2016

来源: Springer

【 摘 要 】

BackgroundAcute kidney injury (AKI) is a common complication following transcatheter aortic valve implantation (TAVI) leading to increased mortality and morbidity. Urinary G1 cell cycle arrest proteins TIMP-2 and IGFBP7 have recently been suggested as sensitive biomarkers for early detection of AKI in critically ill patients. However, the precise role of urinary TIMP-2 and IGFBP7 in patients undergoing TAVI is unknown.MethodsIn a prospective observational trial, 40 patients undergoing TAVI (either transaortic or transapical) were enrolled. Serial measurements of TIMP-2 and IGFBP7 were performed in the early post interventional course. The primary clinical endpoint was the occurrence of AKI stage 2/3 according to the KDIGO classification.ResultsNow we show, that ROC analyses of [TIMP-2]*[IGFBP7] on day one after TAVI reveals a sensitivity of 100 % and a specificity of 90 % for predicting AKI 2/3 (AUC 0.971, 95 % CI 0.914-1.0, SE 0.0299, p = 0.001, cut-off 1.03). In contrast, preoperative and postoperative serum creatinine levels as well as glomerular filtration rate (GFR) and perioperative change in GFR did not show any association with the development of AKI. Furthermore, [TIMP-2]*[IGFBP7] remained stable in patients with AKI ≤1, but its levels increased significantly as early as 24 h after TAVI in patients who developed AKI 2/3 in the further course (4.77 ± 3.21 vs. 0.48 ± 0.68, p = 0.022). Mean patients age was 81.2 ± 5.6 years, 16 patients were male (40.0 %). 35 patients underwent transapical and five patients transaortic TAVI. 15 patients (37.5 %) developed any kind of AKI; eight patients (20 %) met the primary endpoint and seven patients required renal replacement therapy (RRT) within 72 h after surgery.ConclusionEarly elevation of urinary cell cycle arrest biomarkers after TAVI is associated with the development of postoperative AKI. [TIMP-2]*[IGFBP7] provides an excellent diagnostic accuracy in the prediction of AKI that is superior to that of serum creatinine.

【 授权许可】

CC BY   
© The Author(s). 2016