尿组织金属蛋白酶抑制因子-2（TIMP-2）和胰岛素样生长因子结合蛋白-7（IGFBP-7）对危重症儿童急性肾损伤的早期诊断及预后价值
Early Diagnostic and Prognostic Value of the Urinary TIMP-2 and IGFBP-7 in Acute Kidney Injury in Critically Ill Children.
作者信息
Ismail Mervat, Abdelhamid Nehal, Hasanin Hasanin M, Hamed Hanan M, Motawie Ayat A, Kamel Solaf, Hassan Eman M, Iraqy Radwa S
机构信息
Department of Pediatrics, Institute of Medical Research and Clinical studies, National Research Center, Cairo, Egypt.
Department of Clinical Pathology, Kasr Al-Ainy School of Medicine, Cairo University, Cairo, Egypt.
出版信息
Indian J Crit Care Med. 2024 Oct;28(10):970-976. doi: 10.5005/jp-journals-10071-24815. Epub 2024 Sep 30.
BACKGROUND
Acute kidney injury (AKI) is a hidden complication among children within pediatric intensive care units (PICU).
AIM
To evaluate the early predictive and diagnostic value of Urinary [TIMP-2][IGFBP7] to detect AKI in PICU patients.
METHODS
A case-control study was conducted on 112 children (72 admitted to PICU and 40 healthy controls) Urinary [TIMP-2][IGFBP7] was measured within 24 hours of PICU admission.
RESULTS
Acute kidney injury developed in 52 (72.2%) out of 72 critically ill patients. The AKI group had significantly higher serum creatinine, CRP, and pediatric sequential organ failure assessment score (pSOFA) score ( = 0.001, 0.01, and 0.001, respectively) and significantly lower estimated creatinine clearance (eCCl) ( = 0.001). Urinary [TIMP-2][IGFBP7] was significantly higher in the AKI group as compared with the non-AKI group ( = 0.007). The duration of the PICU stay was 1.8-fold higher in the AKI group ( = 0.004). At the time of study enrollment, 7 (13.5%) patients had normal initial eCCl. 26 patients (50.0%) fulfilled the "Risk," 18 patients (34.6%) the "Injury," 1 patient (1.9%) the "Failure" and 0 patient (0%) the "Loss" criteria. Nine (17%) patients progressed to the next higher pediatrics risk, injury, failure, loss, end-stage renal disease (pRIFLE) stage. Urinary [TIMP-2][IGFBP7] was significantly higher in the "Failure" stage followed by "Injury," stage then the "Risk," stage ( = 0.001). Hypovolemia/dehydration had the highest [TIMP-2][IGFBP7] values followed by sepsis. Urinary [TIMP-2][IGFBP7] was significantly increased in mechanically ventilated and patients who received inotropic medications.
CONCLUSIONS
[TIMP-2]·[IGFBP7] was higher in AKI patients compared with non-AKI ones especially cases with hypovolemia and sepsis. It may predict severe morbidity and mortality because its higher levels in mechanically ventilated children and those on positive inotropic support.
HOW TO CITE THIS ARTICLE
Ismail M, Abdelhamid N, Hasanin HM, Hamed HM, Motawie A, Kamel S, Early Diagnostic and Prognostic Value of the Urinary TIMP-2 and IGFBP-7 in Acute Kidney Injury in Critically Ill Children. Indian J Crit Care Med 2024;28(10):970-976.
背景
急性肾损伤（AKI）是儿科重症监护病房（PICU）患儿中一种隐匿的并发症。
目的
评估尿 [TIMP - 2][IGFBP7] 对检测PICU患者AKI的早期预测和诊断价值。
方法
对112名儿童进行病例对照研究（72名入住PICU，40名健康对照）。在入住PICU的24小时内测定尿 [TIMP - 2][IGFBP7]。
结果
72名重症患者中有52名（72.2%）发生急性肾损伤。AKI组的血清肌酐、CRP和儿科序贯器官衰竭评估评分（pSOFA）显著更高（分别为P = 0.001、0.01和0.001），而估计肌酐清除率（eCCl）显著更低（P = 0.001）。与非AKI组相比，AKI组的尿 [TIMP - 2][IGFBP7] 显著更高（P = 0.007）。AKI组的PICU住院时间长1.8倍（P = 0.004）。在研究入组时，7名（13.5%）患者的初始eCCl正常。26名患者（50.0%）符合“风险”标准，18名患者（34.6%）符合“损伤”标准，1名患者（1.9%）符合“衰竭”标准，0名患者（0%）符合“失功”标准。9名（17%）患者进展到更高一级的儿科风险、损伤、衰竭、失功、终末期肾病（pRIFLE）阶段。尿 [TIMP - 2][IGFBP7] 在“衰竭”阶段最高，其次是“损伤”阶段，然后是“风险”阶段（P = 0.001）。低血容量/脱水的 [TIMP - 2][IGFBP7] 值最高，其次是脓毒症。在机械通气患者和接受血管活性药物治疗的患者中，尿 [TIMP - 2][IGFBP7] 显著升高。
结论
与非AKI患者相比，AKI患者的 [TIMP - 2]·[IGFBP7] 更高，尤其是低血容量和脓毒症患者。它可能预测严重的发病率和死亡率，因为在机械通气儿童和接受正性血管活性支持的儿童中其水平更高。
如何引用本文
伊斯梅尔·M、阿卜杜勒哈米德·N、哈桑宁·H·M、哈米德·H·M、莫塔维·A、卡迈勒·S，《尿TIMP - 2和IGFBP - 7对危重症儿童急性肾损伤的早期诊断和预后价值》。《印度危重症医学杂志》2024；28(10):970 - 976。
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