University of Pittsburgh School of Pharmacy, Department of Pharmacy and Therapeutics, Pittsburgh, PA, United States of America; UPMC, Department of Pharmacy, Pittsburgh, PA, United States of America; Center for Critical Care Nephrology, Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, United States of America.
Center for Critical Care Nephrology, Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, United States of America; Excellence Center for Critical Care Nephrology, Division of Nephrology, King Chulalongkorn Memorial Hospital, Bangkok, Thailand; Critical Care Nephrology Research Unit, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; Department of Laboratory Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
J Crit Care. 2020 Jun;57:97-101. doi: 10.1016/j.jcrc.2020.02.002. Epub 2020 Feb 4.
To determine the application of various components of the Kidney Disease Improving Global Outcomes (KDIGO) bundle in managing patients at high-risk for AKI progression ([TIMP2]•[IGFBP7] >0.3) in the real-world setting.
Patients with a [TIMP2]•[IGFBP7] test ordered between 5/23/16-2/28/18 were evaluated. We reviewed the medical record for evidence of implementation of the KDIGO bundle in response to biomarker test results. Evidence including explicit documentation in physicians' note discussing [TIMP2]•[IGFBP7] results and implicit evidence from review of dose adjusted medications, discontinued nephrotoxins and therapeutic drug monitoring.
105 [TIMP2]•[IGFBP7] tests were conducted in 100 patients (54% female; mean age 55.4 ± 16.8; 89% in the ICU). Sixty-one patients had a value of >0.3 and 46 (75.4%) of these patients received at least one management strategy consistent with KDIGO. By contrast, nine patients (23.1%) with [TIMP2]•[IGFBP7] ≤0.3 received one or more components of the KDIGO bundle (p < .001).
In a real-world setting the use of urinary [TIMP2]•[IGFBP7] as an AKI risk screening tool resulted in differential application of various components of the KDIGO bundle for patient management for those with a positive test result.
在真实环境中，确定肾脏病改善全球结局组织（KDIGO）各项措施在管理有急性肾损伤（AKI）进展风险的患者（[TIMP2]•[IGFBP7]＞0.3）中的应用。
评估 2016 年 5 月 23 日至 2018 年 2 月 28 日期间进行[TIMP2]•[IGFBP7]检测的患者。我们查阅病历，以了解针对生物标志物检测结果实施 KDIGO 措施的情况。证据包括医生记录中对[TIMP2]•[IGFBP7]结果的明确讨论，以及通过调整剂量的药物、停用肾毒性药物和治疗药物监测等审查获得的间接证据。
在 100 例患者（54%为女性；平均年龄 55.4±16.8 岁；89%在重症监护病房）中进行了 105 次[TIMP2]•[IGFBP7]检测。61 例患者的结果＞0.3，其中 46 例（75.4%）患者接受了至少一种符合 KDIGO 的管理策略。相比之下，9 例（23.1%）[TIMP2]•[IGFBP7]≤0.3 的患者接受了 KDIGO 措施的一个或多个组成部分（p＜0.001）。
在真实环境中，尿液[TIMP2]•[IGFBP7]作为 AKI 风险筛查工具的使用，导致不同患者对 KDIGO 措施的不同应用，阳性检测结果的患者采用了不同的管理策略。
