Shanghai Children's Medical Center-bioMérieux Laboratory, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
The Laboratory of Pediatric Infectious Diseases, Pediatric Translational Medicine Institute, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
Pediatr Nephrol. 2022 Nov;37(11):2743-2753. doi: 10.1007/s00467-022-05477-6. Epub 2022 Feb 24.
With adult patients, the measurement of [TIMP-2][IGFBP7] can predict the risk of moderate to severe AKI within 12 h of testing. In pediatrics, however, the performance of [TIMP-2][IGFBP7] as a predictor of AKI was less studied and yet to be widely utilized in clinical practice. This study was conducted to validate the utility of [TIMP-2]*[IGFBP7] as an earlier biomarker for AKI prediction in Chinese infants and small children.
We measured urinary [TIMP-2][IGFBP7] using NEPHROCHECK® at eight perioperative time points in 230 patients undergoing complex cardiac surgery and evaluated the performance of [TIMP-2][IGFBP7] for predicting severe AKI within 72 h of surgery.
A total of 50 (22%) of 230 developed AKI stages 2-3 within 72 h after CPB initiation. In the AKI stage 2-3 patients, two patterns of serum creatinine (SCr) elevations were observed. The patients with only a transient increase in SCr within 24 h (< 24 h, early AKI 2-3) did not experience a worse outcome than patients in AKI stage 0-1. AKI stage 2-3 patients with SCr elevation after 24 h (24-72 h, late AKI 2-3), as well as AKI dialysis patients (together designated severe AKI), did experience worse outcomes. Compared to AKI stages 0-1, significant elevations of [TIMP-2][IGFBP7] values were observed in severe AKI patients at hours T2, T4, T12, and T24 following CPB initiation. The AUC for predicting severe AKI with [TIMP-2][IGFBP7] at T2 (AUC = 0.76) and maximum T2/T24 (AUC = 0.80) are higher than other time points. The addition of the NEPHROCHECK® test to the postoperative parameters improved the risk assessment of severe AKI.
Multiple AKI phenotypes (early versus late AKI) were identified after pediatric complex cardiac surgery according to SCr-based AKI definition. Urinary [TIMP-2]*[IGFBP7] predicts late severe AKI (but not early AKI) as early as 2 h following CPB initiation. A higher resolution version of the Graphical abstract is available as Supplementary information.
在成年患者中，检测 [TIMP-2][IGFBP7] 可预测检测后 12 小时内发生中重度 AKI 的风险。然而，在儿科领域，[TIMP-2][IGFBP7] 作为 AKI 预测指标的性能研究较少，尚未广泛应用于临床实践。本研究旨在验证 [TIMP-2]*[IGFBP7] 作为中国婴幼儿 AKI 预测早期生物标志物的效用。
我们在 230 例接受复杂心脏手术的患者中，使用 NEPHROCHECK® 在 8 个围手术期时间点测量尿 [TIMP-2][IGFBP7]，并评估 [TIMP-2][IGFBP7] 预测术后 72 小时内严重 AKI 的性能。
共有 230 例患者中有 50 例（22%）在体外循环启动后 72 小时内发展为 AKI 2-3 期。在 AKI 2-3 期患者中，观察到两种血清肌酐（SCr）升高模式。仅在 24 小时内 SCr 一过性升高（<24 小时，早期 AKI 2-3）的患者与 AKI 0-1 期患者的结局无差异。在 24 小时后 SCr 升高的 AKI 2-3 期患者（24-72 小时，晚期 AKI 2-3）和需要透析的 AKI 患者（统称为严重 AKI），其结局更差。与 AKI 0-1 期相比，在体外循环启动后 2、4、12 和 24 小时，严重 AKI 患者的 [TIMP-2][IGFBP7] 值明显升高。T2 时（AUC=0.76）和最大 T2/T24（AUC=0.80）时 [TIMP-2][IGFBP7] 预测严重 AKI 的 AUC 更高。将 NEPHROCHECK® 检测添加到术后参数中，可提高严重 AKI 的风险评估。
根据基于 SCr 的 AKI 定义，在儿科复杂心脏手术后可识别多种 AKI 表型（早期 AKI 与晚期 AKI）。在体外循环启动后 2 小时内，尿 [TIMP-2]*[IGFBP7] 即可预测晚期严重 AKI（但不能预测早期 AKI）。可提供图文摘要的高分辨率版本作为补充信息。
