The predictive value of TIMP-2 and IGFBP7 for kidney failure and 30-day mortality after elective cardiac surgery

Abstract Acute kidney injury (AKI) is an important risk factor for chronic kidney disease, renal replacement therapy (RRT), and mortality. However, predicting AKI with currently available markers remains problematic. We assessed the predictive value of urinary tissue inhibitor of metalloprotease-2 (...

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Autores principales:	Kevin Esmeijer, Abraham Schoe, L. Renee Ruhaak, Ellen K. Hoogeveen, Darius Soonawala, Fred P. H. T. M. Romijn, Maryam R. Shirzada, Jaap T. van Dissel, Christa M. Cobbaert, Johan W. de Fijter
Formato:	article
Lenguaje:	EN
Publicado:	Nature Portfolio 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/a91c01ab470d47fe8274b86d610df48e
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spelling	oai:doaj.org-article:a91c01ab470d47fe8274b86d610df48e2021-12-02T14:12:45ZThe predictive value of TIMP-2 and IGFBP7 for kidney failure and 30-day mortality after elective cardiac surgery10.1038/s41598-020-80196-22045-2322https://doaj.org/article/a91c01ab470d47fe8274b86d610df48e2021-01-01T00:00:00Zhttps://doi.org/10.1038/s41598-020-80196-2https://doaj.org/toc/2045-2322Abstract Acute kidney injury (AKI) is an important risk factor for chronic kidney disease, renal replacement therapy (RRT), and mortality. However, predicting AKI with currently available markers remains problematic. We assessed the predictive value of urinary tissue inhibitor of metalloprotease-2 (TIMP-2) and insulin-like growth factor-binding protein 7 (IGFBP7) regarding the need for RRT, and 30-day mortality, in elective cardiac surgery patients. In 344 elective cardiac surgery patients, we measured urinary TIMP-2 and IGFBP7 and serum creatinine at baseline and directly after surgery. Discrimination of both urinary biomarkers was assessed by the C-statistic. Model improvement for each biomarker when added to a basic model containing serum creatinine and duration of surgery was tested by the net-reclassification index (cf-NRI) and integrated discrimination index (IDI). At baseline, mean age was 66 years and 67% were men. Of all patients, 22 required RRT following surgery. IGFBP7 pre- and post-surgery and change in TIMP-2 during surgery predicted RRT with a C-statistic of about 0.80. However, a simple model including baseline serum creatinine and duration of surgery had a C-statistic of 0.92, which was improved to 0.93 upon addition of post-surgery TIMP-2 or IGFBP7, with statistically significant cf-NRIs but non-significant IDIs. Post-surgery TIMP-2 and IGFBP predicted 30-day mortality, with C-statistics of 0.74 and 0.80. In conclusion, in elective cardiac surgery patients, pre- and peri-operative clinical variables were highly discriminating about which patients required RRT after surgery. Nonetheless, in elective cardiac surgery patients, urinary TIMP-2 and IGFBP7 improved prediction of RRT and 30-day mortality post-surgery.Kevin EsmeijerAbraham SchoeL. Renee RuhaakEllen K. HoogeveenDarius SoonawalaFred P. H. T. M. RomijnMaryam R. ShirzadaJaap T. van DisselChrista M. CobbaertJohan W. de FijterNature PortfolioarticleMedicineRScienceQENScientific Reports, Vol 11, Iss 1, Pp 1-8 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Kevin Esmeijer Abraham Schoe L. Renee Ruhaak Ellen K. Hoogeveen Darius Soonawala Fred P. H. T. M. Romijn Maryam R. Shirzada Jaap T. van Dissel Christa M. Cobbaert Johan W. de Fijter The predictive value of TIMP-2 and IGFBP7 for kidney failure and 30-day mortality after elective cardiac surgery
description	Abstract Acute kidney injury (AKI) is an important risk factor for chronic kidney disease, renal replacement therapy (RRT), and mortality. However, predicting AKI with currently available markers remains problematic. We assessed the predictive value of urinary tissue inhibitor of metalloprotease-2 (TIMP-2) and insulin-like growth factor-binding protein 7 (IGFBP7) regarding the need for RRT, and 30-day mortality, in elective cardiac surgery patients. In 344 elective cardiac surgery patients, we measured urinary TIMP-2 and IGFBP7 and serum creatinine at baseline and directly after surgery. Discrimination of both urinary biomarkers was assessed by the C-statistic. Model improvement for each biomarker when added to a basic model containing serum creatinine and duration of surgery was tested by the net-reclassification index (cf-NRI) and integrated discrimination index (IDI). At baseline, mean age was 66 years and 67% were men. Of all patients, 22 required RRT following surgery. IGFBP7 pre- and post-surgery and change in TIMP-2 during surgery predicted RRT with a C-statistic of about 0.80. However, a simple model including baseline serum creatinine and duration of surgery had a C-statistic of 0.92, which was improved to 0.93 upon addition of post-surgery TIMP-2 or IGFBP7, with statistically significant cf-NRIs but non-significant IDIs. Post-surgery TIMP-2 and IGFBP predicted 30-day mortality, with C-statistics of 0.74 and 0.80. In conclusion, in elective cardiac surgery patients, pre- and peri-operative clinical variables were highly discriminating about which patients required RRT after surgery. Nonetheless, in elective cardiac surgery patients, urinary TIMP-2 and IGFBP7 improved prediction of RRT and 30-day mortality post-surgery.
format	article
author	Kevin Esmeijer Abraham Schoe L. Renee Ruhaak Ellen K. Hoogeveen Darius Soonawala Fred P. H. T. M. Romijn Maryam R. Shirzada Jaap T. van Dissel Christa M. Cobbaert Johan W. de Fijter
author_facet	Kevin Esmeijer Abraham Schoe L. Renee Ruhaak Ellen K. Hoogeveen Darius Soonawala Fred P. H. T. M. Romijn Maryam R. Shirzada Jaap T. van Dissel Christa M. Cobbaert Johan W. de Fijter
author_sort	Kevin Esmeijer
title	The predictive value of TIMP-2 and IGFBP7 for kidney failure and 30-day mortality after elective cardiac surgery
title_short	The predictive value of TIMP-2 and IGFBP7 for kidney failure and 30-day mortality after elective cardiac surgery
title_full	The predictive value of TIMP-2 and IGFBP7 for kidney failure and 30-day mortality after elective cardiac surgery
title_fullStr	The predictive value of TIMP-2 and IGFBP7 for kidney failure and 30-day mortality after elective cardiac surgery
title_full_unstemmed	The predictive value of TIMP-2 and IGFBP7 for kidney failure and 30-day mortality after elective cardiac surgery
title_sort	predictive value of timp-2 and igfbp7 for kidney failure and 30-day mortality after elective cardiac surgery
publisher	Nature Portfolio
publishDate	2021
url	https://doaj.org/article/a91c01ab470d47fe8274b86d610df48e
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The predictive value of TIMP-2 and IGFBP7 for kidney failure and 30-day mortality after elective cardiac surgery

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