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J Pediatr Intensive Care 2022; 11(02): 153-158
DOI: 10.1055/s-0041-1740359
Original Article

Elevated Levels of Urinary Biomarkers TIMP-2 and IGFBP-7 Predict Acute Kidney Injury in Neonates after Congenital Heart Surgery

Michelle Ramírez 
1   Pediatric Cardiac Intensive Care, NYU Hassenfeld Children's Hospital, New York, United States
,
Sujata Chakravarti
1   Pediatric Cardiac Intensive Care, NYU Hassenfeld Children's Hospital, New York, United States
,
Melissa Busovsky-McNeal
1   Pediatric Cardiac Intensive Care, NYU Hassenfeld Children's Hospital, New York, United States
,
Jaclyn McKinstry
1   Pediatric Cardiac Intensive Care, NYU Hassenfeld Children's Hospital, New York, United States
,
Yasir Al-qaqaa 
1   Pediatric Cardiac Intensive Care, NYU Hassenfeld Children's Hospital, New York, United States
,
Raj Sahulee 
1   Pediatric Cardiac Intensive Care, NYU Hassenfeld Children's Hospital, New York, United States
,
T.K. Susheel Kumar 
2   Department of Cardiothoracic Surgery, NYU Langone Medical Center, New York, United States
,
Xiaochun Li
3   Division of Biostatistics and NYU + HHC CTSI BERD, NYU Grossman School of Medicine, New York, United States
,
Judith D. Goldberg 
3   Division of Biostatistics and NYU + HHC CTSI BERD, NYU Grossman School of Medicine, New York, United States
,
Ashley M. Gefen 
4   Department of Nephrology, Cohen Children's Medical Center, New York, United States
,
Laura Malaga-Dieguez 
5   Department of Nephrology, NYU Hassenfeld Children's Hospital, New York, United States
› Author Affiliations Funding This study was supported by an institutional grant from the Kids of NYU program and also in part by an NYU CTSA grant (UL1 TR001445,) from the National Center for Advancing Translational Sciences, National Institutes of Health.
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Abstract

Objectives This article investigated the utility of urine biomarkers tissue inhibitor of metalloproteinase-2 (TIMP-2) and insulin-like growth factor binding protein-7 (IGFBP-7) in identifying acute kidney injury (AKI) in neonates after congenital heart surgery (CHS). TIMP-2 and IGFBP-7 are cell cycle arrest proteins detected in urine during periods of kidney stress/injury.

Methods We conducted a single-center, prospective study between September 2017 and May 2019 with neonates undergoing CHS requiring cardiopulmonary bypass (CPB). Urine samples were analyzed using NephroCheck prior to surgery and 6, 12, 24, and 96 hours post-CPB. All patients were evaluated using the Acute Kidney Injury Network (AKIN) criteria. Wilcoxon rank sum tests were used to compare the medians of the [TIMP-2*IGFBP-7] values in the AKIN negative and positive groups at each time point. Receiver operating characteristic curves were used to measure how well the [TIMP-2*IGFBP-7] values predict AKIN status.

Results Thirty-six patients were included. No patients met the AKIN criteria for AKI preoperatively. Postoperatively, 19 patients (53%) met the AKIN criteria for AKI diagnosis: 13 (36%) stage 1, 5 (14%) stage 2, and 1 (3%) stage 3. None required renal replacement therapy. At the 24-hour time points, patients who met the AKIN criteria for AKI had a statistically significantly higher [TIMP-2*IGFBP7] values than the patients without AKI (1.1 vs. 0.27 [ng/mL]2/1,000) at 24 hours (adj-p = 0.0019).

Conclusion AKI is a serious complication associated with adverse outcomes in patients undergoing cardiac surgery. [TIMP-2*IGFBP-7] urinary level 24 hours after CPB is a good predictor of AKI in this population.

Keywords

tissue inhibitor of metalloproteinase-2 - insulin-like growth factor binding proteins - acute kidney injury - heart defects, congenital - cardiopulmonary bypass - biomarkers


Publication History

Received: 14 August 2021

Accepted: 19 October 2021

Article published online:
13 December 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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