Biomarker rule-in or rule-out in patients with acute diseases for validation of acute kidney injury in the emergency department (brava): A multicenter study evaluating urinary timp-2/igfbp7

• Main Authors: Hyun Suk Yang, Mina Hur, Kyeong Ryong Lee, Hanah Kim, Hahn Young Kim, Jong Won Kim, Mui Teng Chua, Win Sen Kuan, Horng Ruey Chua, Chagriya Kitiyakara, Phatthranit Phattharapornjaroen, Anchalee Chittamma, Thiyapha Werayachankul, Urmila Anandh, Sanjeeva Herath, Zoltan Endre, Andrea Rita Horvath, Paola Antonini, Salvatore Di Somma
• Other Authors: Ramathibodi Hospital
• Format: Article
• Published: 2022
• Subjects: Medicine
• Online Access: https://repository.li.mahidol.ac.th/handle/123456789/75148
• Institution: Mahidol University

Background: Urine tissue inhibitor of metalloproteinases-2/insulin-like growth factor-binding protein 7 (TIMP-2/IGFBP7) (NephroCheck, Ortho Clinical Diagnostics, Raritan, NJ, USA) is a US Food and Drug Administration-approved biomarker for risk assessment of acute kidney injury (AKI) in critically ill adult patients in intensive care units; however, its clinical impact in the emergency department (ED) remains unproven. We evaluated the utility of NephroCheck for predicting AKI development and short-term mortality in the ED. Methods: This was a prospective, observational, five-center international study. We consecutively enrolled ED patients admitted with ≥30% risk of AKI development (assessed by ED physician: ED score) or acute diseases. Serum creatinine was tested on ED arrival (T0), day 1, and day 2 (T48); urine for NephroCheck was collected at T0 and T48. We performed ROC curve and reclassification analyses. Results: Among the 529 patients enrolled (213 females; median age, 65 years), AKI developed in 59 (11.2%) patients. The T0 NephroCheck value was higher in the AKI group than in the non-AKI group (median 0.77 vs. 0.29 (ng/m)2/1,000, P=0.001), and better predicted AKI development than the ED score (area under the curve [AUC], 0.64 vs. 0.53; P=0.04). In reclassification analyses, adding NephroCheck to the ED score improved the prediction of AKI development (P<0.05). The T0 NephroCheck value predicted 30-day mortality (AUC, 0.68; P<0.001). Conclusions: NephroCheck can predict both AKI development and short-term mortality in at-risk ED patients. NephroCheck would be a useful biomarker for early ruling-in or ruling-out of AKI in the ED.