Document Type

Journal Article

Publication Date

11-2014

Journal

Nephrology, Dialysis, Transplantation

Volume

Volume 29, Issue 11

Inclusive Pages

2054-2061

DOI

10.1093/ndt/gfu292

Keywords

Acute Kidney Injury--urine; Insulin-Like Growth Factor Binding Proteins--urine; Tissue Inhibitor of Metalloproteinase-2--urine

Abstract

Background

Acute kidney injury (AKI) remains a deadly condition. Tissue inhibitor of metalloproteinases (TIMP)-2 and insulin-like growth factor binding protein (IGFBP)7 are two recently discovered urinary biomarkers for AKI. We now report on the development, and diagnostic accuracy of two clinical cutoffs for a test using these markers.

Methods

We derived cutoffs based on sensitivity and specificity for prediction of Kidney Disease: Improving Global Outcomes Stages 2–3 AKI within 12 h using data from a previously published multicenter cohort (Sapphire). Next, we verified these cutoffs in a new study (Opal) enrolling 154 critically ill adults from six sites in the USA.

Results

One hundred subjects (14%) in Sapphire and 27 (18%) in Opal met the primary end point. The results of the Opal study replicated those of Sapphire. Relative risk (95% CI) in both studies for subjects testing at ≤0.3 versus >0.3–2 were 4.7 (1.5–16) and 4.4 (2.5–8.7), or 12 (4.2–40) and 18 (10–37) for ≤0.3 versus >2. For the 0.3 cutoff, sensitivity was 89% in both studies, and specificity 50 and 53%. For 2.0, sensitivity was 42 and 44%, and specificity 95 and 90%.

Conclusions

Urinary [TIMP-2]•[IGFBP7] values of 0.3 or greater identify patients at high risk and those >2 at highest risk for AKI and provide new information to support clinical decision-making.

Clinical Trials Registration

Clintrials.gov # NCT01209169 (Sapphire) and NCT01846884 (Opal).

Comments

Reproduced with permission of Oxford Journals. Nephrology, Dialysis, Transplantation.

Creative Commons License

Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial 3.0 License

Peer Reviewed

1

Open Access

1

Supplementary Data1.doc (503 kB)
Supplementary Data

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