Early Diagnostic and Prognostic Value of the Urinary TIMP-2 and IGFBP-7 in Acute Kidney Injury in Critically Ill Children.

IF 1.5 Q3 CRITICAL CARE MEDICINE

Indian Journal of Critical Care Medicine Pub Date : 2024-10-01 Epub Date: 2024-09-30 DOI:10.5005/jp-journals-10071-24815

Mervat Ismail, Nehal Abdelhamid, Hasanin M Hasanin, Hanan M Hamed, Ayat A Motawie, Solaf Kamel, Eman M Hassan, Radwa S Iraqy

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Abstract

Background: Acute kidney injury (AKI) is a hidden complication among children within pediatric intensive care units (PICU).

Aim: To evaluate the early predictive and diagnostic value of Urinary [TIMP-2][IGFBP7] to detect AKI in PICU patients.

Methods: A case-control study was conducted on 112 children (72 admitted to PICU and 40 healthy controls) Urinary [TIMP-2][IGFBP7] was measured within 24 hours of PICU admission.

Results: Acute kidney injury developed in 52 (72.2%) out of 72 critically ill patients. The AKI group had significantly higher serum creatinine, CRP, and pediatric sequential organ failure assessment score (pSOFA) score (p = 0.001, 0.01, and 0.001, respectively) and significantly lower estimated creatinine clearance (eCCl) (p = 0.001). Urinary [TIMP-2][IGFBP7] was significantly higher in the AKI group as compared with the non-AKI group (p = 0.007). The duration of the PICU stay was 1.8-fold higher in the AKI group (p = 0.004). At the time of study enrollment, 7 (13.5%) patients had normal initial eCCl. 26 patients (50.0%) fulfilled the "Risk," 18 patients (34.6%) the "Injury," 1 patient (1.9%) the "Failure" and 0 patient (0%) the "Loss" criteria. Nine (17%) patients progressed to the next higher pediatrics risk, injury, failure, loss, end-stage renal disease (pRIFLE) stage. Urinary [TIMP-2][IGFBP7] was significantly higher in the "Failure" stage followed by "Injury," stage then the "Risk," stage (p = 0.001). Hypovolemia/dehydration had the highest [TIMP-2][IGFBP7] values followed by sepsis. Urinary [TIMP-2][IGFBP7] was significantly increased in mechanically ventilated and patients who received inotropic medications.

Conclusions: [TIMP-2]·[IGFBP7] was higher in AKI patients compared with non-AKI ones especially cases with hypovolemia and sepsis. It may predict severe morbidity and mortality because its higher levels in mechanically ventilated children and those on positive inotropic support.

How to cite this article: Ismail M, Abdelhamid N, Hasanin HM, Hamed HM, Motawie A, Kamel S, et al. Early Diagnostic and Prognostic Value of the Urinary TIMP-2 and IGFBP-7 in Acute Kidney Injury in Critically Ill Children. Indian J Crit Care Med 2024;28(10):970-976.

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尿液 TIMP-2 和 IGFBP-7 对重症儿童急性肾损伤的早期诊断和预后价值

背景：目的：评估尿液[TIMP-2][IGFBP7]对检测PICU患者急性肾损伤（AKI）的早期预测和诊断价值：方法：对112名儿童（72名入住PICU，40名健康对照）进行病例对照研究，在PICU入院24小时内测量尿液[TIMP-2][IGFBP7]：72名重症患者中有52名（72.2%）出现急性肾损伤。AKI 组患者的血清肌酐、CRP 和儿科序贯器官衰竭评估评分 (pSOFA) 分值明显更高（p = 0.001、0.01 和 0.001），估计肌酐清除率 (eCCl) 明显更低（p = 0.001）。与非 AKI 组相比，AKI 组的尿液[TIMP-2][IGFBP7]明显更高（p = 0.007）。AKI 组的 PICU 住院时间是非 AKI 组的 1.8 倍（p = 0.004）。加入研究时，7 名患者（13.5%）的初始 eCCl 正常。26 名患者（50.0%）符合 "风险 "标准，18 名患者（34.6%）符合 "损伤 "标准，1 名患者（1.9%）符合 "失败 "标准，0 名患者（0%）符合 "损失 "标准。9名患者（17%）发展到了下一个更高的儿科风险、损伤、衰竭、损失、终末期肾病（pRIFLE）阶段。尿液[TIMP-2][IGFBP7]在 "衰竭 "阶段明显较高，其次是 "损伤 "阶段，然后是 "风险 "阶段（p = 0.001）。低血容量/脱水的[TIMP-2][IGFBP7]值最高，其次是败血症。尿液中的[TIMP-2][IGFBP7]在机械通气和接受肌力药物治疗的患者中明显增加：结论：与非 AKI 患者相比，AKI 患者的[TIMP-2]-[IGFBP7]更高，尤其是低血容量和脓毒症患者。由于机械通气和使用正性肌力支持的儿童体内[TIMP-2]-[IGFBP7]水平较高，因此它可能预示着严重的发病率和死亡率：Ismail M, Abdelhamid N, Hasanin HM, Hamed HM, Motawie A, Kamel S, et al. Urinary TIMP-2 and IGFBP-7 in Acute Kidney Injury in Critically Ill Children.Indian J Crit Care Med 2024;28(10):970-976.

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来源期刊

Indian Journal of Critical Care Medicine CRITICAL CARE MEDICINE-

CiteScore

3.50

自引率

10.00%

发文量

299

期刊介绍： Indian Journal of Critical Care Medicine (ISSN 0972-5229) is specialty periodical published under the auspices of Indian Society of Critical Care Medicine. Journal encourages research, education and dissemination of knowledge in the fields of critical and emergency medicine.