Diagnostic Precision of Urinary Tissue Inhibitor of Metalloproteinases-2 versus Plasma Creatinine for the Early Detection of Cardiac Surgery-Associated Acute Kidney Injury

International Journal of Medicine and Medical Sciences | Vol. 14, No. 8, August 2024 | pp. 57–64

DOI: 10.46882/2024/IJMMS/140057

Original Research Article

Diagnostic Precision of Urinary Tissue Inhibitor of Metalloproteinases-2 versus Plasma Creatinine for the Early Detection of Cardiac Surgery-Associated Acute Kidney Injury

Charles O. Igwe¹, Rachel L. Sanon², Anthony D. Boateng¹*

¹Department of Anesthesiology and Intensive Care, Faculty of Clinical Sciences, College of Health Sciences, University of Abuja, Abuja, Nigeria.

²Department of Nephrology, Faculty of Health Sciences, Université de Ouagadougou, Ouagadougou, Burkina Faso.

Abstract:

Acute kidney injury (AKI) is a severe complication following cardiac surgery with cardiopulmonary bypass, but classic plasma creatinine rises slowly. This prospective diagnostic study evaluated the accuracy of the urinary biomarker combination of tissue inhibitor of metalloproteinases-2 and insulin-like growth factor-binding protein 7 [TIMP-2]•[IGFBP7] for early detection of cardiac surgery-associated AKI (CSA-AKI). We evaluated 110 adult patients undergoing elective coronary artery bypass graft or valvular replacement surgery. Urinary [TIMP-2]•[IGFBP7] concentrations were quantified at baseline, 4, 12, and 24 hours post-bypass, while plasma creatinine was monitored daily for 5 days. AKI was defined according to the KDIGO criteria. Twenty-six patients developed confirmed AKI (23.6%) within 48 hours. In the AKI group, urinary [TIMP-2]•[IGFBP7] values rose significantly from a baseline of 0.12 ± 0.04 (ng/mL)²/1000 to 1.85 ± 0.34 (ng/mL)²/1000 at 4 hours post-bypass (p < 0.01), long before plasma creatinine variations occurred. Receiver Operating Characteristic (ROC) analysis showed that 4-hour urinary [TIMP-2]•[IGFBP7] at a cutoff value of 1.0 (ng/mL)²/1000 had a sensitivity of 88.5%, a specificity of 83.3%, and an Area Under the Curve (AUC) of 0.90 (95% CI = 0.83–0.96). In contrast, 24-hour plasma creatinine achieved an AUC of only 0.62. Urinary [TIMP-2]•[IGFBP7] serves as a sensitive and precise early diagnostic biomarker for cell cycle arrest during acute renal injury, allowing for early therapeutic optimization in postoperative intensive care settings.

Keywords: Acute Kidney Injury, Cardiac Surgery, Cardiopulmonary Bypass, Biomarkers, [TIMP-2]•[IGFBP7], Diagnostic Accuracy

Manuscript Timeline: Received: May 12, 2024; Revised: June 18, 2024; Accepted: July 11, 2024; Published: August 14, 2024.

Citation: Igwe CO, Sanon RL, Boateng AD. Diagnostic Precision of Urinary Tissue Inhibitor of Metalloproteinases-2 versus Plasma Creatinine for the Early Detection of Cardiac Surgery-Associated Acute Kidney Injury. International Journal of Medicine and Medical Sciences, 2024, 14(8): 57–64. DOI: 10.46882/2024/IJMMS/140057

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