TIMP-2*IGFBP7 (Nephrocheck®) Measurements at Intensive Care Unit Admission After Cardiac Surgery are Predictive for Acute Kidney Injury Within 48 Hours

Mehmet Oezkur; Attila Magyar; Phillip Thomas; Tabea Stork; Reinhard Schneider; Constanze Bening; Stefan Störk; Peter U Heuschmann; Rainer G Leyh; Martin Wagner

doi:10.1159/000479298

TIMP-2*IGFBP7 (Nephrocheck®) Measurements at Intensive Care Unit Admission After Cardiac Surgery are Predictive for Acute Kidney Injury Within 48 Hours

Kidney Blood Press Res. 2017 Jul 27;42(3):456-467. doi: 10.1159/000479298. Online ahead of print.

Authors

Mehmet Oezkur^{1

2}, Attila Magyar^{1

2}, Phillip Thomas^{1

2}, Tabea Stork^{1

2}, Reinhard Schneider³, Constanze Bening¹, Stefan Störk^{4

5}, Peter U Heuschmann^{2

4

6}, Rainer G Leyh¹, Martin Wagner^{2

3

4}

Affiliations

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.

PMID: 28750409
DOI: 10.1159/000479298

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.

Keywords: AKI; Cardiac Surgery; Epidemiology; Nephrocheck.