BoReal Study Group, Medical Intensive Care Unit and EA7517, Amiens University Hospital, F-80054, Amiens, France.
Department of Intensive Care Medicine, Lapeyronie University Hospital, Montpellier, France.
Crit Care. 2020 Jun 1;24(1):280. doi: 10.1186/s13054-020-02984-6.
The urine biomarkers tissue inhibitor of metalloproteinases-2 (TIMP-2) and insulin-like growth factor-binding protein 7 (IGFBP7) have been validated for predicting and stratifying AKI. In this study, we analyzed the utility of these biomarkers for distinguishing between transient and persistent AKI in the early phase of septic shock.
We performed a prospective, multicenter study in 11 French ICUs. Patients presenting septic shock, with the development of AKI within the first 6 h, were included. Urine [TIMP-2]*[IGFBP7] was determined at inclusion (0 h), 6 h, 12 h, and 24 h. AKI was considered transient if it resolved within 3 days. Discriminative power was evaluated by receiver operating characteristic (ROC) curve analysis.
We included 184 patients, within a median [IQR] time of 1.0 [0.0-3.0] h after norepinephrine (NE) initiation; 100 (54%) patients presented transient and 84 (46%) presented persistent AKI. Median [IQR] baseline urine [TIMP-2][IGFBP7] was higher in the persistent AKI group (2.21 [0.81-4.90] (ng/ml)/1000) than in the transient AKI group (0.75 [0.20-2.12] (ng/ml)/1000; p < 0.001). Baseline urine [TIMP-2][IGFBP7] was poorly discriminant, with an AUROC [95% CI] of 0.67 [0.59-0.73]. The clinical prediction model combining baseline serum creatinine concentration, baseline urine output, baseline NE dose, and baseline extrarenal SOFA performed well for the prediction of persistent AKI, with an AUROC [95% CI] of 0.81 [0.74-0.86]. The addition of urine [TIMP-2]*[IGFBP7] to this model did not improve the predictive performance.
Urine [TIMP-2]*[IGFBP7] measurements in the early phase of septic shock discriminate poorly between transient and persistent AKI and do not improve clinical prediction over that achieved with the usual variables.
NCT02812784.
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）等尿生物标志物已被验证可用于预测和分层急性肾损伤（AKI）。本研究分析了这些生物标志物在脓毒性休克早期阶段鉴别急性肾损伤（AKI）是否持续存在的作用。
我们在法国 11 家 ICU 进行了一项前瞻性、多中心研究。纳入了在发病 6 小时内出现脓毒性休克并发展为 AKI 的患者。分别于纳入（0 小时）、6 小时、12 小时和 24 小时测量尿 [TIMP-2]*[IGFBP7]。如果在 3 天内恢复，AKI 被认为是短暂的。通过接受者操作特征（ROC）曲线分析评估鉴别能力。
我们共纳入了 184 例患者，在去甲肾上腺素（NE）开始后中位数[IQR]时间为 1.0 [0.0-3.0] 小时；100 例（54%）患者出现短暂性 AKI，84 例（46%）出现持续性 AKI。持续性 AKI 组的基线尿 [TIMP-2][IGFBP7]中位数[IQR]（2.21 [0.81-4.90]（ng/ml）/1000）高于短暂性 AKI 组（0.75 [0.20-2.12]（ng/ml）/1000；p<0.001）。基线尿 [TIMP-2][IGFBP7]的鉴别能力较差，AUROC[95%CI]为 0.67[0.59-0.73]。结合基线血清肌酐浓度、基线尿量、基线 NE 剂量和基线肾外 SOFA 的临床预测模型对持续性 AKI 的预测效果良好，AUROC[95%CI]为 0.81[0.74-0.86]。在该模型中添加尿 [TIMP-2]*[IGFBP7]并不能提高预测性能。
脓毒性休克早期阶段的尿 [TIMP-2]*[IGFBP7] 测量值在鉴别短暂性和持续性 AKI 方面效果不佳，与使用常规变量相比，不能提高临床预测能力。
NCT02812784。
