Postoperative acute kidney injury in major abdominal surgery. Utility of the urinary biomarker [TIMP-2] × [IGFBP7] (NephroCheck™)

Abstract

Background

The urinary biomarker [TIMP-2] × [IGFBP7] enables the prediction of postoperative acute kidney injury (PO-AKI). Our study aimed to assess the incidence of PO-AKI in high-risk patients undergoing major abdominal surgery and to evaluate the impact of implementing KDIGO renal optimization measures in those with renal stress identified by [TIMP-2]×[IGFBP7].

Materials and methods

This was a prospective study including 182 patients who underwent major abdominal surgery. Perioperative data, [TIMP-2] × [IGFBP7] levels, and the implementation of KDIGO renal protection strategies in the ICU were collected. Predictors of PO-AKI were identified through multivariate analysis.

Results

The overall incidence of PO-AKI was 25.3%, reaching 42.7% in ICU patients. [TIMP-2] × [IGFBP7] showed moderate predictive ability (AUROC = 0.74), with a PO-AKI incidence of 47.5% in patients with elevated levels. Despite the implementation of KDIGO measures in the ICU, the incidence of PO-AKI in patients with elevated [TIMP-2] × [IGFBP7] was 65.6%. In multivariate analysis, the main predictors of PO-AKI were elevated [TIMP-2] × [IGFBP7] (OR = 6.3; 95% CI: 2.6–15.6; p < 0.001), male sex (OR = 6.1; 95% CI: 1.9–19.6; p = 0.002), and ICU admission (OR = 4.5; 95% CI: 1.5–13.6; p = 0.009).

Conclusions

PO-AKI is common after major abdominal surgery, particularly in ICU patients. The [TIMP-2] × [IGFBP7] biomarker allows for early identification of at-risk patients, although the implementation of KDIGO measures in the ICU did not significantly reduce its incidence.

Resumen

Antecedentes

El biomarcador urinario [TIMP-2] × [IGFBP7] permite predecir la lesión renal aguda postoperatoria (LRA-PO). Nuestro estudio tuvo como objetivos evaluar la incidencia de LRA-PO en pacientes de riesgo renal sometidos a cirugía mayor abdominal e investigar el impacto de la implementación de medidas de optimización renal KDIGO en aquellos con estrés renal identificado por [TIMP-2] × [IGFBP7].

Materiales y métodos

Estudio prospectivo en 182 pacientes sometidos a cirugía mayor abdominal. Se recogieron datos perioperatorios, niveles de [TIMP-2] × [IGFBP7] y la aplicación de estrategias de protección renal KDIGO en la UCI. Se identificaron predictores de LRA-PO mediante análisis multivariante.

Resultados

La incidencia global de LRA-PO fue del 25,3%, alcanzando el 42,7% en los ingresados en UCI. [TIMP-2] × [IGFBP7] mostró una capacidad predictiva moderada (AUROC = 0,74), con una incidencia de LRA-PO del 47,5% en pacientes con niveles elevados. A pesar de la implementación de medidas KDIGO en la UCI, la incidencia de LRA-PO en pacientes con [TIMP-2] × [IGFBP7] elevado fue del 65,6%. En el análisis multivariante, los principales predictores de LRA-PO fueron: un [TIMP-2] × [IGFBP7] elevado (OR = 6,3; IC 95%: 2,6–15,6; p < 0,001), el sexo masculino (OR = 6,1; IC95%:1,9–19,6; p = 0,002) y el ingreso en UCI (OR = 4,5; IC95%:1,5–13,6; p = 0,009).

Conclusiones

La LRA-PO es frecuente tras cirugía mayor abdominal, especialmente en pacientes ingresados en UCI. El biomarcador [TIMP-2] × [IGFBP7] permite la identificación temprana de pacientes en riesgo, aunque la implementación de medidas KDIGO en la UCI no logró reducir significativamente su incidencia.