title: Urinary [TIMP-2] × [IGFBP7] for risk prediction of acute kidney injury in decompensated heart failure.
abstract: BACKGROUND
  In acute decompensated heart failure (ADHF) the risk of acute kidney injury (AKI) is high. Early detection of patients at risk for AKI is important. We tested urinary [TIMP-2] × [IGFBP7], a new US Food and Drug Administration-cleared test to assess AKI risk, in a cohort of hospitalized ADHF patients.
  
  
  OBJECTIVE
  In patients with ADHF, urinary [TIMP-2] × [IGFBP7] is associated with moderate to severe AKI and related to increased mortality.
  
  
  METHODS
  We enrolled 400 patients in the emergency department at Robert-Bosch Hospital, Stuttgart, Germany. We examined the predictive ability of urinary [TIMP-2] × [IGFBP7] (units: [ng/mL]2/1000) for development of AKI stage 2 or 3 within 24 hours of sample collection in patients with ADHF. Operating characteristics were determined for the validated cutoffs of 0.3 and 2.0.
  
  
  RESULTS
  Forty patients had ADHF upon presentation and sufficient data for AKI staging. 27.5% developed AKI stage 2-3 within 7 days. Urinary [TIMP-2] × [IGFBP7] discriminated for AKI stage 2-3 over the first day with an area under the ROC curve of 0.84 (95% confidence interval: 0.72-0.93) and over 7 days with an AUC of 0.77 (95% confidence interval: 0.65-0.88). For the first day, sensitivity was 86% at the 0.3 cutoff and specificity was 95% at the 2.0 cutoff for prediction of AKI stage 2-3. There was a trend (P = 0.08) for higher mortality in patients with urinary [TIMP-2] × [IGFBP7] >2.0 and AKI 2-3.
  
  
  CONCLUSIONS
  Urinary [TIMP-2] × [IGFBP7] is a promising marker for AKI risk assessment in patients with ADHF.
authors.affiliation: Department of Internal Medicine, Division of General Internal Medicine and Nephrology, Robert-Bosch Hospital, Stuttgart, Germany.
authors.forename: Moritz
authors.initials: M
authors.lastname: Schanz
authors.affiliation: Walker Bioscience, Carlsbad, California.
authors.forename: Jing
authors.initials: J
authors.lastname: Shi
authors.affiliation: Department of Internal Medicine, Division of General Internal Medicine and Nephrology, Robert-Bosch Hospital, Stuttgart, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Wasser
authors.affiliation: Department of Internal Medicine, Division of General Internal Medicine and Nephrology, Robert-Bosch Hospital, Stuttgart, Germany.
authors.forename: Mark Dominik
authors.initials: MD
authors.lastname: Alscher
authors.affiliation: Department of Internal Medicine, Division of General Internal Medicine and Nephrology, Robert-Bosch Hospital, Stuttgart, Germany.
authors.forename: Martin
authors.identifier: http://orcid.org/0000-0003-3368-1108
authors.initials: M
authors.lastname: Kimmel
mesh_terms: D058186:Acute Kidney Injury / Q000453:epidemiology / Q000209:etiology / Q000652:urine*; D000368:Aged; D015415:Biomarkers / Q000652:urine; D018450:Disease Progression; D005260:Female; D005858:Germany / Q000453:epidemiology; D006333:Heart Failure / Q000150:complications* / Q000652:urine; D006801:Humans; D015994:Incidence; D018969:Insulin-Like Growth Factor Binding Proteins / Q000652:urine*; D008297:Male; D011379:Prognosis; D012372:ROC Curve; D018570:Risk Assessment; D015996:Survival Rate / Q000639:trends; D019716:Tissue Inhibitor of Metalloproteinase-2 / Q000652:urine*
chemical_list: D015415:Biomarkers; D018969:Insulin-Like Growth Factor Binding Proteins; C560823:TIMP2 protein, human; C102529:insulin-like growth factor binding protein-related protein 1; D019716:Tissue Inhibitor of Metalloproteinase-2
keywords: [TIMP-2]×[IGFBP7]; acute decompensated heart failure; acute kidney injury; biomarkers; insulin like-growth factor binding protein-7; tissue inhibitor of metalloproteinases-2