Incidence of Acute Kidney Injury in Polytrauma Patients and Predictive Performance of TIMP2 × IGFBP7 Biomarkers for Early Identification of Acute Kidney Injury

Gianlorenzo Golino; Massimiliano Greco; Alessandro Rigobello; Vinicio Danzi; Massimo De Cal; Nicola Malchiorna; Monica Zannella; Paolo Navalesi; Rahul Costa-Pinto; Claudio Ronco; Silvia De Rosa

doi:10.3390/diagnostics12102481

Incidence of Acute Kidney Injury in Polytrauma Patients and Predictive Performance of TIMP2 × IGFBP7 Biomarkers for Early Identification of Acute Kidney Injury

Diagnostics (Basel). 2022 Oct 13;12(10):2481. doi: 10.3390/diagnostics12102481.

Authors

Gianlorenzo Golino^{1

2

3}, Massimiliano Greco^{4

5}, Alessandro Rigobello², Vinicio Danzi², Massimo De Cal^{1

6}, Nicola Malchiorna^{1

6}, Monica Zannella^{1

6}, Paolo Navalesi³, Rahul Costa-Pinto^{7

8}, Claudio Ronco^{1

6}, Silvia De Rosa^{1

2}

Affiliations

¹ International Renal Research Institute of Vicenza, 36100 Vicenza, Italy.
² Department of Anesthesiology and Intensive Care, San Bortolo Hospital, 36100 Vicenza, Italy.
³ Department of Medicine-DIMED, Section of Anesthesiology and Intensive Care Medicine, University of Padova, 35100 Padova, Italy.
⁴ Department of Anesthesiology and Intensive Care, IRCCS Humanitas Research Hospital, 20100 Milan, Italy.
⁵ Department of Biomedical Science, Humanitas University, 20100 Milan, Italy.
⁶ Department of Nephrology, Dialysis and Transplantation and International Renal Research Institute of Vicenza, San Bortolo Hospital, 36100 Vicenza, Italy.
⁷ Department of Intensive Care, Austin Hospital, 145 Studley Road, Melbourne, VIC 3084, Australia.
⁸ Department of Critical Care, the University of Melbourne, Melbourne, VIC 3010, Australia.

Abstract

Background: Acute kidney injury (AKI) is a common cause of organ failure in trauma patients who survive their initial injuries. It is independently associated with increased morbidity and mortality and prolongs the length of hospital stays. The objectives of this study were to describe the incidence of early AKI and influence of risk factors in polytrauma patients and evaluate the predictive potential of TIMP2 × IGFBP7 biomarkers in this patient cohort. Methods: We conducted a retrospective cohort study of severely injured adult patients who were consecutively admitted to a multidisciplinary ICU from May 2017 to May 2019. Detailed patient data was retrieved from ICU medical records. Fluid balance, urinary output, and sCr values up to 72 h were collected. Urine samples for measuring TIMP2 × IGFBP7 concentrations were obtained and analyzed from ICU admission to 72 h. Results: Among the 153 patients eligible for analysis, 45 were included in the AKI, and 108 in the no AKI cohorts. The incidence of AKI within 72 h, based on KDIGO criteria, was 28.8%. There were no differences in ISS, type and mechanism of injury, heart rate, and systolic BP at admission between groups. Patients with early AKI were older (68 vs. 49 years, p < 0.001), obese (BMI 26.2 vs. 24.7, p < 0.048), and more likely to have previous cardiac disease (27% vs. 5.6%, p < 0.001). TIMP2 × IGFBP7 values on ICU admission were associated with subsequent AKI in patients without evidence of AKI at the time of ICU admission. They were also higher in the AKI cohort and significantly correlated with renal replacement therapy (RRT) and episodes of hypotension. Multivariable analysis confirmed age, previous cardiac disease, and NephroCheck as the variables mostly associated with AKI, with AUC 0.792. Conclusions: TIMP2 × IGFBP7 may help identify trauma patients with tubular damage that may evolve into a clinically manifested syndrome. Prospective studies of TIMP2 × IGFBP7, as a trigger for early AKI bundle care, are warranted.

Keywords: IGFBP7; TIMP2; acute kidney injury; intensive care unit; outcomes; trauma.

Grants and funding

This research received no external funding.