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

Abstract

Background: 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. Methods: 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. Results: 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. Conclusion: 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.