Daubin Delphine, Cristol Jean Paul, Dupuy Anne Marie, Kuster Nils, Besnard Noémie, Platon Laura, Buzançais Aurèle, Brunot Vincent, Garnier Fanny, Jonquet Olivier, Klouche Kada
Department of Intensive Care Medicine, Lapeyronie University Hospital, Montpellier, France.
Department of Biochemistry, Lapeyronie University Hospital, Montpellier, France.
PLoS One. 2017 Jan 13;12(1):e0169674. doi: 10.1371/journal.pone.0169674. eCollection 2017.
The capability of urinary TIMP-2 (tissue inhibitor of metalloproteinase) and IGFBP7 (insulin-like growth factor binding protein)-NephroCheck Test (NC) = ([TIMP-2] x [IGFBP7]) / 1000)-to predict renal recovery from acute kidney injury (AKI) has been poorly studied. The aim of this study was to assess the performance of measurements of ([TIMP-2] x [IGFBP7]) / 1000) over 24 hours to differentiate transient from persistent AKI.
Of 460 consecutive adult patients admitted to the ICU, 101 were prospectively studied: 56 men, 62 (52-71) years old. A fresh urine sample was collected at H0, H4, H12 and H24 to determine ([TIMP-2] x [IGFBP7]) / 1000) levels. Areas under the curves of Delta NC H4-Ho and H12-H4 and serum creatinine (sCr) for detection of AKI recovery were compared.
Forty-one (40.6%) patient were diagnosed with AKI: 27 transient and 14 persistent AKI. At admission (H0), AKI patients had a significantly higher NC score than patients without AKI (0.43 [0.07-2.06] vs 0.15 [0.07-0.35], p = 0.027). In AKI groups, transient AKI have a higher NC, at H0 and H4, than persistent AKI (0.87 [0.09-2.82] vs 0.13 [0.05-0.66] p = 0.035 and 0.13 [0.07-0.61] vs 0.05 [0.02-0.13] p = 0.013). Thereafter, NC level decreased in both AKI groups with a Delta NC score H4-H0 and H12-H4 significantly more important in transient AKI. Roc curves showed however that delta NC scores did not discriminate between transient and persistent AKI.
In our population, absolute urinary levels of NC score were higher at early hours after ICU admission (H0 and H4) in transient AKI as compared to persistent AKI patients. NC variations (Delta NC scores) over the first 12 hours may indicate the AKI's evolving nature with a more significant decrease in case of transient AKI but were not able to differentiate transient from persistent AKI.
尿组织金属蛋白酶抑制剂-2（TIMP-2）和胰岛素样生长因子结合蛋白7（IGFBP7）-肾损伤检测试验（NC）=（[TIMP-2]×[IGFBP7]）/1000预测急性肾损伤（AKI）后肾功能恢复的能力研究较少。本研究旨在评估24小时内（[TIMP-2]×[IGFBP7]）/1000的测量结果区分短暂性AKI和持续性AKI的性能。
在入住重症监护病房（ICU）的460例连续成年患者中，前瞻性研究了101例：56例男性，年龄62（52 - 71）岁。在H0、H4、H12和H24采集新鲜尿液样本，以测定（[TIMP-2]×[IGFBP7]）/1000水平。比较Delta NC H4 - H0和H12 - H4以及血清肌酐（sCr）检测AKI恢复的曲线下面积。
41例（40.6%）患者被诊断为AKI：27例短暂性AKI和14例持续性AKI。入院时（H0），AKI患者的NC评分显著高于无AKI患者（0.43[0.07 - 2.06]对0.15[0.07 - 0.35]，p = 0.027）。在AKI组中，短暂性AKI在H（0）和H4时的NC高于持续性AKI（0.87[0.09 - 2.82]对0.13[0.05 - 0.66]，p = 0.035；0.13[0.07 - 0.61]对0.05[0.02 - 0.13]，p = 0.013）。此后，两组AKI患者的NC水平均下降，短暂性AKI的Delta NC评分H4 - H0和H12 - H4显著更高。然而，Roc曲线显示Delta NC评分无法区分短暂性AKI和持续性AKI。
在我们的研究人群中，与持续性AKI患者相比，短暂性AKI患者在入住ICU后的早期（H0和H4）尿NC评分的绝对水平更高。最初12小时内NC的变化（Delta NC评分）可能表明AKI的演变性质，短暂性AKI时下降更显著，但无法区分短暂性AKI和持续性AKI。
