Predictive enrichment for the need of renal replacement in sepsis-associated acute kidney injury: combination of furosemide stress test and urinary biomarkers TIMP-2 and IGFBP-7
Authors' conclusion
The combined application of an upstream FST followed by urinary TIMP-2*IGFBP-7 measurements supports highly specific identification of SA-AKI patients requiring RRT.
Study context
- Population
- Patients with sepsis (diagnosed < 48h), AKI stage ≥ 2 and an indication for negative fluid balance
- Participants
- 100 patients
- Comparison
- Furosemide Stress Test (FST) + TIMP-2*IGFBP-7 vs FST
- Outcome
- RRT requirement
- Follow-up
- Within 7 days after inclusion
Methodological detailsprospective, multicentre
- Prospective
- Multicentre
Performance
As reported in the abstract
Accuracy in predicting RRT requirement · within 7 days
| Test or model | Specificity | PPV | Accuracy |
|---|---|---|---|
| FST + TIMP-2*IGFBP-7 | 0.96 (95%-CI 0.88-0.99) | 0.86 (95%-CI 0.64-0.97) | 0.83 (95%-CI 0.74-0.90) |
| FST | — not stated in the abstract | — not stated in the abstract | 0.74 (95%-CI: 0.64-0.82) |
| TIMP-2*IGFBP-7 before FST | — not stated in the abstract | — not stated in the abstract | 0.66 (95%-CI 0.55-0.78) |
Specificity
FST + TIMP-2*IGFBP-70.96 (95%-CI 0.88-0.99)
FST— not stated in the abstract
TIMP-2*IGFBP-7 before FST— not stated in the abstract
PPV
FST + TIMP-2*IGFBP-70.86 (95%-CI 0.64-0.97)
FST— not stated in the abstract
TIMP-2*IGFBP-7 before FST— not stated in the abstract
Accuracy
FST + TIMP-2*IGFBP-70.83 (95%-CI 0.74-0.90)
FST0.74 (95%-CI: 0.64-0.82)
TIMP-2*IGFBP-7 before FST0.66 (95%-CI 0.55-0.78)
— not stated in the abstract
- FST + TIMP-2*IGFBP-7 vs FST: P = 0.03 — improved predictive accuracy
Further findings
Renal replacement therapy (RRT) requirement (incidence) · within 7 days
- Sepsis-associated acute kidney injury (SA-AKI) patients requiring RRT
- 32% (n = 32/99)
Urine TIMP-2*IGFBP-7 change within 2 h of FST
- RRT: from 3.26 (IQR: 1.38-5.53) to 2.36 (IQR: 1.61-4.87) ng2/mL2/1000
- Non-RRT: from 1.68 (IQR: 0.56-2.94) to 0.27 (IQR: 0.12-0.89) ng2/mL2/1000
- Remained low up to 12 h in non-RRT; rebound in RRT after 6 h
Original publication
Predictive enrichment for the need of renal replacement in sepsis-associated acute kidney injury: combination of furosemide stress test and urinary biomarkers TIMP-2 and IGFBP-7. Ann Intensive Care. Published 13 July 2024. doi:10.
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