Early prediction of acute kidney injury after transapical and transaortic aortic valve implantation with urinary G1 cell cycle arrest biomarkers

被引:30
作者
Dusse, Fabian [1 ,2 ]
Edayadiyil-Dudasova, Michaela [1 ,3 ]
Thielmann, Matthias [1 ]
Wendt, Daniel [1 ]
Kahlert, Philipp [4 ]
Demircioglu, Ender [1 ]
Jakob, Heinz [1 ]
Schaefer, Simon T. [3 ,5 ]
Pilarczyk, Kevin [1 ,6 ]
机构
[1] Univ Hosp Essen, West German Heart & Vasc Ctr Essen, Dept Thorac & Cardiovasc Surg, Hufelandstr 55, D-45122 Essen, Germany
[2] Univ Witten Herdecke, Med Ctr Cologne Merheim, Dept Anesthesiol & Intens Care Med, Ostmerheimerstr 200, D-51109 Cologne, Germany
[3] Univ Hosp Essen, Klin Anasthesiol & Intens Med, Hufelandstr 55, D-45122 Essen, Germany
[4] Univ Hosp Essen, Dept Cardiol, West German Heart & Vasc Ctr Essen, Hufelandstr 55, D-45122 Essen, Germany
[5] Univ Munich, Anasthesiol Klin, Marchioninistr 15, D-81377 Munich, Germany
[6] Imland Klin Rendsburg, Dept Intens Care Med, Lilienstr 20-28, D-24768 Rendsburg, Germany
来源
BMC ANESTHESIOLOGY | 2016年 / 16卷
关键词
Acute kidney injury; AKI; TIMP-2; IGFBP7; Cell cycle arrest; NephroCheck; TAVI; TAVR; Biomarker; VALIDATION; STENOSIS; MORTALITY;
D O I
10.1186/s12871-016-0244-8
中图分类号
R614 [麻醉学];
学科分类号
100217 ;
摘要
Background: Acute kidney injury (AKI) is a common complication following transcatheter aortic valve implantation (TAVI) leading to increased mortality and morbidity. Urinary G1 cell cycle arrest proteins TIMP-2 and IGFBP7 have recently been suggested as sensitive biomarkers for early detection of AKI in critically ill patients. However, the precise role of urinary TIMP-2 and IGFBP7 in patients undergoing TAVI is unknown. Methods: In a prospective observational trial, 40 patients undergoing TAVI (either transaortic or transapical) were enrolled. Serial measurements of TIMP-2 and IGFBP7 were performed in the early post interventional course. The primary clinical endpoint was the occurrence of AKI stage 2/3 according to the KDIGO classification. Results: Now we show, that ROC analyses of [TIMP-2]*[IGFBP7] on day one after TAVI reveals a sensitivity of 100 % and a specificity of 90 % for predicting AKI 2/3 (AUC 0.971, 95 % CI 0.914-1.0, SE 0.0299, p = 0.001, cut-off 1.03). In contrast, preoperative and postoperative serum creatinine levels as well as glomerular filtration rate (GFR) and perioperative change in GFR did not show any association with the development of AKI. Furthermore, [TIMP2]*[IGFBP7] remained stable in patients with AKI = 1, but its levels increased significantly as early as 24 h after TAVI in patients who developed AKI 2/3 in the further course (4.77 +/- 3.21 vs. 0.48 +/- 0.68, p = 0.022). Mean patients age was 81.2 +/- 5.6 years, 16 patients were male (40.0 %). 35 patients underwent transapical and five patients transaortic TAVI. 15 patients (37.5 %) developed any kind of AKI; eight patients (20 %) met the primary endpoint and seven patients required renal replacement therapy (RRT) within 72 h after surgery. Conclusion: Early elevation of urinary cell cycle arrest biomarkers after TAVI is associated with the development of postoperative AKI. [TIMP-2]*[ IGFBP7] provides an excellent diagnostic accuracy in the prediction of AKI that is superior to that of serum creatinine.
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页数:12
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