Mehmet Oezkur1,2, Attila Magyar1,2, Phillip Thomas1,2, Tabea Stork1,2, Reinhard Schneider3, Constanze Bening1, Stefan Störk4,5, Peter U Heuschmann2,4,6, Rainer G Leyh1, Martin Wagner2,3,4. 1. Department of Cardiovascular surgery, University Hospital Würzburg, Würzburg, Germany. 2. Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany. 3. Div. of Nephrology, Dept. of Medicine I, University Hospital Würzburg, Würzburg, Germany. 4. Comprehensive Heart Failure Center, University of Würzburg, Würzburg, Germany. 5. Div of Cardiology, Dept. of Medicine I, University Hospital Würzburg, Würzburg, Germany. 6. Clinical Trial Center Würzburg, University Hospital Würzburg, Würzburg, Germany.
Abstract
BACKGROUND/AIMS: Acute kidney injury (AKI) is a postoperative complication after cardiac surgery with a high impact on mortality and morbidity. Nephrocheck® [TIMP-2*IGFBP7] determines markers of tubular stress, which occurs prior to tubular damage. It is unknown at which time-point [TIMP-2*IGFBP7] measurement should be performed to ideally predict AKI. We investigated the association of [TIMP-2*IGFBP7] at various time-points with the incidence of AKI in patients undergoing elective cardiac surgery including cardio-pulmonary bypass. METHODS: In a prospective cohort study, serial blood and urine samples were collected from 150 patients: pre-operative, at ICU-admission, 24h and 48h post-surgery. AKI was defined as Serum-Creatinine rise >0.3 mg/dl within 48hrs. Urinary [TIMP-2*IGFBP7] was measured at pre-operative, ICU-admission and 24h post-surgery; medical staff was kept blinded to these results. RESULTS: A total of 35 patients (23.5%) experienced AKI, with a higher incidence in those with high [TIMP-2*IGFBP7] values at ICU admission (57.1% vs. 10.1%, p<0.001). In logistic regression [TIMP-2*IGFBP7] at ICU admission was independently associated with the occurrence of AKI (Odds Ratio 11.83; p<0.001, C-statistic= 0.74) after adjustment for EuroSCORE II and CBP-time. CONCLUSIONS: Early detection of elevated [TIMP-2*IGFBP7] at ICU admission was strongly predictive for postoperative AKI and appeared to be more precise as compared to subsequent measurements.
BACKGROUND/AIMS: Acute kidney injury (AKI) is a postoperative complication after cardiac surgery with a high impact on mortality and morbidity. Nephrocheck® [TIMP-2*IGFBP7] determines markers of tubular stress, which occurs prior to tubular damage. It is unknown at which time-point [TIMP-2*IGFBP7] measurement should be performed to ideally predict AKI. We investigated the association of [TIMP-2*IGFBP7] at various time-points with the incidence of AKI in patients undergoing elective cardiac surgery including cardio-pulmonary bypass. METHODS: In a prospective cohort study, serial blood and urine samples were collected from 150 patients: pre-operative, at ICU-admission, 24h and 48h post-surgery. AKI was defined as Serum-Creatinine rise >0.3 mg/dl within 48hrs. Urinary [TIMP-2*IGFBP7] was measured at pre-operative, ICU-admission and 24h post-surgery; medical staff was kept blinded to these results. RESULTS: A total of 35 patients (23.5%) experienced AKI, with a higher incidence in those with high [TIMP-2*IGFBP7] values at ICU admission (57.1% vs. 10.1%, p<0.001). In logistic regression [TIMP-2*IGFBP7] at ICU admission was independently associated with the occurrence of AKI (Odds Ratio 11.83; p<0.001, C-statistic= 0.74) after adjustment for EuroSCORE II and CBP-time. CONCLUSIONS: Early detection of elevated [TIMP-2*IGFBP7] at ICU admission was strongly predictive for postoperative AKI and appeared to be more precise as compared to subsequent measurements.
Authors: David S Gardner; Jennifer C Allen; Deborah Goodson; Daniel Harvey; Andrew Sharman; Henry Skinner; Adam Szafranek; John S Young; Elizabeth H Bailey; Mark A J Devonald Journal: Kidney Int Rep Date: 2022-04-29
Authors: Nathan M Lee; Lev Deriy; Timothy R Petersen; Vallabh O Shah; Michael P Hutchens; Neal S Gerstein Journal: J Cardiothorac Vasc Anesth Date: 2018-08-01 Impact factor: 2.894