Wetz Anna J, Richardt Eva M, Wand Saskia, Kunze Nils, Schotola Hanna, Quintel Michael, Bräuer Anselm, Moerer Onnen
Department of Anaesthesiology, Emergency and Intensive Care Medicine, University of Goettingen, Robert-Koch-Strasse 40, 37075, Goettingen, Germany.
Crit Care. 2015 Jan 6;19(1):3. doi: 10.1186/s13054-014-0717-4.
Postoperative acute kidney injury (AKI) is a frequently observed complication after on-pump cardiac surgery (CS) and is associated with adverse patient outcomes. Early identification of patients at risk is essential for the prevention of AKI after CS. In this study, we analysed whether urinary tissue inhibitor of metalloproteinase 2 (TIMP-2) combined with urine insulin-like growth factor binding protein 7 (IGFBP-7) ([TIMP-2] × [IGFBP-7]) is an adequate diagnostic test to identify early AKI after on-pump CS.
In 42 patients undergoing coronary artery bypass graft surgery, we surveyed individual risk factors for AKI and defined AKI by applying the Kidney Disease: Improving Global Outcomes (KDIGO) classification during the day of surgery and the following 2 days after surgery. Concentrations of urinary TIMP-2 multiplied by IGFBP-7 were recorded at four time points: at baseline pre-surgery, at the end of surgery, 4 hours after cardiopulmonary bypass (CPB) and at 8:00 AM on the first postoperative day.
In total, 38% of the patients experienced AKI. The results showed a median baseline [TIMP-2] × [IGFBP-7] concentration of 0.3 (ng/ml)(2)/1,000, decreasing at the end of surgery and then increasing at the next measurement point 4 hours after CPB and further on the first postoperative day. On the first postoperative day, patients with AKI had significantly higher concentrations of [TIMP-2] × [IGFBP-7]. On the day of surgery, the concentration did not significantly differ between patients classified as KDIGO 0 or KDIGO 1 or 2. Previously published cutoff points of 0.3 and 2 were not confirmed in our study cohort.
[TIMP-2] × [IGFBP-7] concentration can be used as a diagnostic test to identify patients at increased risk of AKI after CS on the first postoperative day. At earlier time points, no significant difference in [TIMP-2] × [IGFBP-7] concentration was found between patients classified as KDIGO 0 or KDIGO 1 or 2.
German Clinical Trials Register (DRKS) DRKS00005457. Registered 26 November 2013.
术后急性肾损伤（AKI）是体外循环心脏手术（CS）后常见的并发症，与不良患者预后相关。早期识别高危患者对于预防CS后的AKI至关重要。在本研究中，我们分析了尿金属蛋白酶组织抑制剂2（TIMP-2）联合尿胰岛素样生长因子结合蛋白7（IGFBP-7）（[TIMP-2]×[IGFBP-7]）是否是识别体外循环CS后早期AKI的充分诊断试验。
在42例行冠状动脉旁路移植术的患者中，我们调查了AKI的个体危险因素，并在手术当天及术后2天应用肾脏病改善全球预后（KDIGO）分类法定义AKI。在四个时间点记录尿TIMP-2乘以IGFBP-7的浓度：术前基线、手术结束时、体外循环（CPB）后4小时以及术后第一天上午8:00。
总共38%的患者发生了AKI。结果显示，基线时[TIMP-2]×[IGFBP-7]浓度中位数为0.3（ng/ml）²/1000，手术结束时下降，然后在CPB后4小时的下一个测量点上升，并在术后第一天进一步上升。术后第一天，发生AKI的患者[TIMP-2]×[IGFBP-7]浓度显著更高。在手术当天，KDIGO 0或KDIGO 1或2分类的患者之间浓度无显著差异。我们的研究队列未证实先前公布的0.3和2的截断点。
[TIMP-2]×[IGFBP-7]浓度可作为诊断试验，用于识别术后第一天CS后发生AKI风险增加的患者。在更早的时间点，KDIGO 0或KDIGO 1或2分类的患者之间未发现[TIMP-2]×[IGFBP-7]浓度有显著差异。
德国临床试验注册中心（DRKS）DRKS00005457。2013年11月26日注册。
