Potential of Urine Biomarkers CHI3L1, NGAL, TIMP-2, IGFBP7, and Combinations as Complementary Diagnostic Tools for Acute Kidney Injury after Pediatric Cardiac Surgery: A Prospective Cohort Study

Wim Vandenberghe; Jorien De Loor; Katrien Francois; Kristof Vandekerckhove; Ingrid Herck; Johan Vande Walle; Harlinde Peperstraete; Thierry Bové; Daniël De Wolf; Lieve Nuytinck; Jan J De Waele; Evelyne Meyer; Eric A J Hoste

doi:10.3390/diagnostics13061047

Potential of Urine Biomarkers CHI3L1, NGAL, TIMP-2, IGFBP7, and Combinations as Complementary Diagnostic Tools for Acute Kidney Injury after Pediatric Cardiac Surgery: A Prospective Cohort Study

Diagnostics (Basel). 2023 Mar 9;13(6):1047. doi: 10.3390/diagnostics13061047.

Authors

Wim Vandenberghe¹, Jorien De Loor¹, Katrien Francois², Kristof Vandekerckhove^{3

4}, Ingrid Herck¹, Johan Vande Walle^{4

5}, Harlinde Peperstraete¹, Thierry Bové², Daniël De Wolf^{3

4}, Lieve Nuytinck⁶, Jan J De Waele^{1

4}, Evelyne Meyer⁷, Eric A J Hoste^{1

4

8}

Affiliations

¹ Department of Intensive Care Medicine, Ghent University Hospital, Ghent University, 9000 Ghent, Belgium.
² Department of Cardiac Surgery, Ghent University Hospital, Ghent University, 9000 Ghent, Belgium.
³ Department of Pediatric Cardiology, Ghent University Hospital, Ghent University, 9000 Ghent, Belgium.
⁴ Department of Internal Medicine and Pediatrics, Faculty of Medicine and Health Sciences, Ghent University, 9000 Ghent, Belgium.
⁵ Department of Pediatric Nephrology, ERKNET Centre, Ghent University Hospital, Ghent University, 9000 Ghent, Belgium.
⁶ Health, Innovation and Research Institute UZ Gent, Ghent University Hospital, 9000 Ghent, Belgium.
⁷ Laboratory of Biochemistry, Department of Veterinary and Biosciences, Faculty of Veterinary Medicine, Ghent University, 9000 Ghent, Belgium.
⁸ Research Foundation-Flanders (FWO), 1000 Brussels, Belgium.

Abstract

Acute kidney injury (AKI) is common after pediatric cardiac surgery (CS). Several urine biomarkers have been validated to detect AKI earlier. The objective of this study was to evaluate urine CHI3L1, NGAL, TIMP-2, IGFBP7, and NephroCheck^® as predictors for AKI ≥ 1 in pediatric CS after 48 h and AKI ≥ 2 after 12 h. Pediatric patients (age < 18 year; body weight ≥ 2 kg) requiring CS were prospectively included. Urine CHI3L1, NGAL, TIMP-2, IGFBP7, and NephroCheck^® were measured during surgery and intensive care unit (ICU) stay and corrected for urine dilution. One hundred and one pediatric patients were included. AKI ≥ 1 within 48 h after ICU admission occurred in 62.4% and AKI ≥ 2 within 12 h in 30.7%. All damage biomarkers predicted AKI ≥ 1 within 48 h after ICU admission, when corrected for urine dilution: CHI3L1 (AUC-ROC: 0.642 (95% CI, 0.535-0.741)), NGAL (0.765 (0.664-0.848)), TIMP-2 (0.778 (0.662-0.868)), IGFBP7 (0.796 (0.682-0.883)), NephroCheck^® (0.734 (0.614-0.832)). Similarly, AKI ≥ 2 within 12 h was predicted by all damage biomarkers when corrected for urine dilution: uCHI3L1 (AUC-ROC: 0.686 (95% CI, 0.580-0.780)), NGAL (0.714 (0.609-0.804)), TIMP-2 (0.830 (0.722-0.909)), IGFBP7 (0.834 (0.725-0.912)), NephroCheck^® (0.774 (0.658-0.865)). After pediatric cardiac surgery, the damage biomarkers urine CHI3L1, NGAL, TIMP-2, IGFBP7, and NephroCheck^® reliably predict AKI after correction for urine dilution.

Keywords: AKI; cardiac surgery; pediatric; urine biomarker.

Grants and funding

F2012/IOF-Advanced/001/Ghent University