From the Center for Translational Injury Research at McGovern Medical School, University of Texas Health Science Center, Houston, Texas (G.E.H., Y.W.W., K.D.I., L.S.K., C.E.W.), Department of Surgery at McGovern Medical School, University of Texas Health Science Center, Houston, Texas (G.E.H., K.D.I., L.S.K., C.E.W.), and Department of Nephrology and Hypertension at McGovern Medical School, University of Texas Health Science Center, Houston, Texas (K.W.F.), and the Center for Surgical Trials and Evidence-based Practice at McGovern Medical School, University of Texas Health Science Center, Houston, Texas (G.E.H., K.D.I., L.S.K.).
J Trauma Acute Care Surg. 2020 Oct;89(4):761-767. doi: 10.1097/TA.0000000000002864.
Recognition and clinical diagnosis of acute kidney injury (AKI) after trauma is difficult. The majority of trauma patients do not have a known true baseline creatinine, which makes application of the guidelines set forth by the international guidelines difficult to apply. Use of alternative biomarkers of renal dysfunction in trauma patients may be beneficial. We hypothesized that urinary tissue inhibitor of metalloprotease 2 (TIMP-2) × insulin-like growth factor binding protein 7 (IGFBP-7) would accurately predict AKI development in severely injured trauma patients.
A prospective observational study of adult (≥16 years old) trauma intensive care unit (ICU) patients was performed between September 2018 to March 2019. Urine was collected on ICU admission and was measured for TIMP-2 × IGFBP-7. Univariate, multivariable, and receiver operating characteristic curve analyses were performed using the optimal threshold generated by a Youden index.
Of 88 included patients, 75% were male, with a median injury severity score was 27 (interquartile range [IQR], 17-34), and age of 40 years (IQR, 28-54 years). Early AKI developed in 39 patients (44%), and of those, 7 (8%) required dialysis within 48 hours. Patients without early AKI had a TIMP-2 × IGFBP-7 of 0.17 U (IQR, 0.1-0.3 U), while patients with early AKI had a TIMP-2 × IGFBP-7 of 0.46 U (IQR, 0.17-1.29 U; p < 0.001). On multivariable analyses, TIMP-2 × IGFBP-7 was associated with AKI development (p = 0.02) and need for dialysis (p = 0.03). Using the optimal threshold 0.33 U to predict AKI, the area under the receiver operating characteristic curve was 0.731, with an accuracy of 0.75, sensitivity of 0.72, and specificity of 0.78.
Urinary TIMP-2 × IGFBP-7 measured on ICU admission accurately predicted 48-hour AKI and was independently associated with AKI and dialysis requirement after trauma and is a promising screening tool for treatment.
Prognostic, prospective, observational study, level III.
创伤后急性肾损伤（AKI）的识别和临床诊断较为困难。大多数创伤患者没有已知的真实基础肌酐值，这使得国际指南规定的应用变得难以实施。在创伤患者中使用替代肾功能生物标志物可能会有所帮助。我们假设尿液组织金属蛋白酶抑制剂 2（TIMP-2）×胰岛素样生长因子结合蛋白 7（IGFBP-7）将准确预测严重创伤患者 AKI 的发生。
对 2018 年 9 月至 2019 年 3 月期间入住成人（≥16 岁）创伤重症监护病房（ICU）的患者进行前瞻性观察性研究。在 ICU 入院时采集尿液，并测量 TIMP-2×IGFBP-7。使用由 Youden 指数生成的最佳阈值进行单变量、多变量和受试者工作特征曲线分析。
88 例患者中，75%为男性，损伤严重程度评分中位数为 27（四分位距 [IQR]，17-34），年龄为 40 岁（IQR，28-54 岁）。39 例（44%）患者早期发生 AKI，其中 7 例（8%）在 48 小时内需要透析。无早期 AKI 的患者 TIMP-2×IGFBP-7 为 0.17 U（IQR，0.1-0.3 U），而早期 AKI 的患者 TIMP-2×IGFBP-7 为 0.46 U（IQR，0.17-1.29 U；p<0.001）。多变量分析显示，TIMP-2×IGFBP-7 与 AKI 发生（p=0.02）和透析需要（p=0.03）相关。使用最佳阈值 0.33 U 来预测 AKI，受试者工作特征曲线下面积为 0.731，准确性为 0.75，灵敏度为 0.72，特异性为 0.78。
ICU 入院时测量的尿液 TIMP-2×IGFBP-7 准确预测 48 小时 AKI，与创伤后 AKI 和透析需求独立相关，是一种有前途的治疗筛选工具。
预后、前瞻性、观察性研究，III 级。
