Early recognition of cardiac surgery-associated acute kidney injury: lack of added value of TIMP2 IGFBP7 over short-term changes in creatinine (an observational pilot study)

For the detection of cardiac surgery-associated acute kidney injury (CS-AKI), the performance of urine tissue inhibitor of metalloproteinase 2 insulin-like growth factor-binding protein 7 (TIMP2 IGFBP7) has never been compared with that of very early changes in plasma creatinine (∆pCr). We hypothesi...

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Published in:	BMC anesthesiology 2021-10, Vol.21 (1), p.244-244, Article 244
Main Authors:	Lakhal, Karim, Bigot-Corbel, Edith, Sacchetto, Emilie, Chabrun, Floris, Senage, Thomas, Figueres, Lucile, Leroy, Maxime, Legrand, Arnaud, Rozec, Bertrand
Format:	Article
Language:	eng
Subjects:	Acute Kidney Injury - diagnosis Acute Kidney Injury - etiology Acute kidney injury [MeSH] Aged Aged, 80 and over Anesthesia Aorta Aortic valve Aortic Valve - surgery Biomarkers Biomarkers - analysis Cardiopulmonary Bypass - adverse effects Catheters Comparative analysis Coronary artery bypass Creatinine Creatinine/blood [MeSH] Cystatin Cystatin C Early Diagnosis Female Gelatinase Heart Heart surgery Heart Valve Prosthesis Implantation - adverse effects Humans Insulin Insulin-Like Growth Factor Binding Proteins - urine Insulin-like growth factor binding proteins/urine [MeSH] Kidneys Leukocytes (neutrophilic) Life Sciences Lipocalin Lipocalins/metabolism [MeSH] Male Metalloproteinase Oliguria Patients Pilot Projects Plasma Prospective Studies Protein binding Sensitivity and Specificity Surgery Tissue inhibitor of metalloproteinase 2 Tissue Inhibitor of Metalloproteinase-2 - urine Tissue inhibitor of Metalloproteinase-2 [MeSH] Tissue inhibitor of Metalloproteinase-2/urine [MeSH] Urea Urine
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Summary:	For the detection of cardiac surgery-associated acute kidney injury (CS-AKI), the performance of urine tissue inhibitor of metalloproteinase 2 insulin-like growth factor-binding protein 7 (TIMP2 IGFBP7) has never been compared with that of very early changes in plasma creatinine (∆pCr). We hypothesized that, in the context of perioperative haemodilution, lack of postoperative decrease in pCr would be of honourable performance for the detection of CS-AKI. We therefore aimed at comparing these biomarkers and their kinetics (primary objective). As secondary objectives, we assessed plasma neutrophil gelatinase-associated lipocalin (pNGAL), cystatin C (pCysC) and urea (pUrea). We also determined the ability of these biomarkers to early discriminate persistent from transient CS-AKI. Patients over 75 years-old undergoing aortic valve replacement with cardiopulmonary bypass (CPB) were included in this prospective observational study. Biomarkers were measured before/after CPB and at the sixth postoperative hour (H6). In 65 patients, CS-AKI occurred in 27 (42%). ∆pCr from post-CPB to H6 (∆pCr ): outperformed TIMP2 IGFBP7 at H6 and its intra- or postoperative changes: area under the receiver operating characteristic curve (AUC ) of 0.84 [95%CI:0.73-0.92] vs. ≤0.67 [95%CI:0.54-0.78], p ≤ 0.03. The AUC of pNGAL, pCysC and pUrea did not exceed 0.72 [95%CI:0.59-0.83]. Indexing biomarkers levels for blood or urine dilution did not improve their performance. Combining TIMP2 IGFBP7 and ∆pCr was of no evident added value over considering ∆pCr alone. For the early recognition of persistent CS-AKI, no biomarker outperformed ∆pCr (AUC = 0.69 [95%CI:0.48-0.85]). In this hypothesis-generating study mostly testing early detection of mild CS-AKI, there was no evident added value of the tested modern biomarkers over early minimal postoperative changes in pCr: despite the common perioperative hemodilution in the setting of cardiac surgery, if pCr failed to decline within the 6 h after CPB, the development of CS-AKI was likely. Confirmatory studies with more severe forms of CS-AKI are required.
ISSN:	1471-2253 1471-2253