| Objective Acute kidney injury(AKI)is one of the most common complications of hospitalized patients.Approximately 35% of critically ill patients have AKI,and the prognosis of these patients is poor.These patients easily progress to end-stage renal disease(ESRD).Early diagnosis and treatment may improve the prognosis.This study focuses on critically ill patients with AKI,aimed to explore the predictive and prognostic value of TIMP-2 and IGFBP7 both in serum and urine.Methods The critically ill patients who were hospitalized in the department of Sichuan Provincial People’s Hospital from November 2016 to November 2017 were screened.The serum samples were collected within 24 hours of ICU admission.The urine samples were collected within 48 hours after arrival in ICU.Patients were divided into two groups as AKI and non-AKI.The serum samples were collected from 101 cases with AKI,25 cases with non-AKI,as well as 32 healthy controls,and urine samples were collected from 44 AKI cases,as well as 30 healthy controls.The clinical and laboratory data were collected.The levels of TIMP-2,IGFBP7 and other biomarkers were analyzed by enzyme-linked immunosorbent assay(ELISA)in serum and urine samples.Receiver operating characteristic curve(ROC)was used to evaluate the value of serum and urinary TIMP-2and IGFBP7 in combination with other biomarkers to predict AKI occurrence and prognosis.Results 1.The levels of serum IGFBP7,TIMP-2,IL-18,L-FABP,NGAL,Cystatin C and KIM-1 in AKI group were significantly higher than those in healthy control group(P<0.01).The levels of serum IGFBP7,TIMP-2 and KIM-1 in AKI group were significantly higher than those in non-AKI group(P<0.01).But the serum levels of IL-18,L-FABP,NGAL and Cystatin C had no significant difference between the two groups(P>0.05).2.The levels of urinary IGFBP7,IL-18,L-FABP,NGAL,Cystatin C and KIM-1 in AKI group were higher than those in healthy control group(P<0.05).But the levels of TIMP-2had no significant difference between two groups(P>0.05).3.The patients were divided into infection group(33 cases)and non-infection group(68cases).The levels of serum IGFBP7,TIMP-2,IL-18,L-FABP,NGAL,Cystatin C and KIM-1 had no significant difference between the infected and non-infected groups(P>0.05).4.The ROC curve was used to analyze the predictive values of serum TIMP-2,IGFBP7,as well as other biomarkers in critically ill patients with AKI compared with the healthy control group.The area under the curve(AUC)of serum IGFBP7,TIMP-2,IL-18,L-FABP,NGAL,Cystatin C and KIM-1 within 24 hours after arrival in ICU were 0.697,0.960,0.877,0.969,0.924,0.734 and 0.886,respectively.The AUC of combined analysis of serum IGFBP7 and TIMP-2 was 0.976,and 0.992 for serum IGFBP7,TIMP-2 and KIM-1,0.994 for serum IGFBP7,TIMP-2 and L-FABP,0.983 for serum IGFBP7,TIMP-2 and NGAL.The AUC of urinary IGFBP7,IL-18,L-FABP,NGAL,Cystatin C and KIM-1 were0.634,0.809,0.863,0.751,0.986 and 0.780,respectively.But the AUC of urinary TIMP-2was less than 0.5.5.The ROC curve was used to analyze the predictive values of serum TIMP-2,IGFBP7,as well as other biomarkers in critically ill patients with AKI compared with the non-AKI group.The AUC of serum IGFBP7,TIMP-2,KIM-1 within 24 hours after arrival in ICU were 0.808,0.705 and 0.676,respectively.But the AUC of serum IL-18,L-FABP,NGAL and Cystatin C were less than 0.5.The AUC of combined analysis of serum IGFBP7 and TIMP-2 was 0.879,and 0.883 for serum IGFBP7,TIMP-2 and KIM-1.6.While compared to healthy controls,the levels of serum IGFBP7 and TIMP-2 were independent risk factors for predicting the occurrence of AKI by logistic regression analysis compared to healthy controls.The odd ratio(OR)values were 1.947 and 8.403,respectively.After the adjusted by age,the OR value were 1.830 and 7.020,respectively.While compared to non-AKI patients,the levels of serum IGFBP7 and TIMP-2 were independent risk factors for predicting the occurrence of AKI.The OR values were 4.292 and 1.516 respectively.After the adjustment of the level of sex and the underlying disease,the OR values were 5.258 and 1.442,respectively.7.101 cases of AKI patients,66 patients of them entered the endpoint event and 35 patients did not enter the endpoint event.IGFBP7 and TIMP-2 were independent risk factors for predicting the prognosis of AKI.The OR values were 1.203 and 1.278 respectively.After the adjusted by age,serum albumin,hemoglobin level and SOFA,the OR valueswere1.317 and 1.251,respectively.The ROC curve was used to analyze prognostic value of serum level of TIMP-2,IGFBP7 and other biomarkers in critically ill patients with AKI.The AUC of serum IGFBP7,TIMP-2,KIM-1and Cystatin C were 0.629,0.654,0.697,0.542.The AUC of combined detection of serum IGFBP7 and TIMP-2 was 0.731.The AUC of combined detection of serum IGFBP7,TIMP-2 and KIM-1was 0.783.But the AUC of serum IL-18,L-FABP and NGAL were less than 0.5.Conclusions 1.Serum IGFBP7 and TIMP-2 were useful markers for the diagnosis of AKI in critically ill patients.But the values of urine IGFBP7 and TIMP-2 for the diagnosis of AKI were limited.2.The combined detection of serum IGFBP7 and TIMP-2,as well as other traditional markers were more advantageous for the diagnosis of AKI.3.The increased serum levels of IGFBP7 and TIMP-2 were related to the poor outcomes of AKI in critically ill patients. |
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