Predictive value of urinary [TIMP-2]•[IGFBP7] for AKI among sepsis, stroke, and cardiac surgery cohorts: A prospective study.

Abstract

TIMP-2 and IGFBP7 have shown effectiveness as biomarkers for predicting Acute Kidney Injury (AKI). However, the variations in the predictive capacity of urinary [TIMP-2]• [IGFBP7] for AKI across different etiologies remain unexplored. This study aimed to assess the predictive capability of urinary [TIMP-2]• [IGFBP7] for AKI in three distinct disease cohorts (stroke, sepsis, and cardiac surgery) characterized by differing AKI etiologies. This prospective observational study evaluated the predictive value of urinary [TIMP-2]• [IGFBP7] among three cohorts with varying AKI causes. Binary logistic regression was employed to identify AKI's independent risk factors and develop a combined prediction model. The predictive value was assessed using Receiver Operating Characteristic (ROC) curves and Area Under the Curve (AUC) analyses. 337 patients were included in the final analysis, with 109 (32.3%) developing AKI. AKI occurred in 39 (22.2%) stroke patients, 52 (50%) sepsis patients, and 18 (31.6%) post-cardiac surgery patients. [TIMP-2]• [IGFBP7] exhibited predictive value for AKI with an AUC of 0.86 (95% CI 0.75-0.90) in stroke, 0.82 (95% CI 0.74-0.91) in sepsis, and 0.90 (95% CI 0.82-0.98) in post-cardiac surgery. DeLong's test indicated no significant differences in the predictive value of [TIMP-2]• [IGFBP7] between the cardiac surgery group and the stroke (P=0.20) and sepsis (P=0.21) groups. The combined prediction model, which integrates urinary [TIMP-2]• [IGFBP7] concentrations and AKI risk factors, significantly enhances AKI prediction. No significant differences were found in the predictive value of urinary [TIMP-2]• [IGFBP7] for AKI among the stroke, sepsis, and cardiac surgery cohorts.