Objectives: 

Cell cycle arrest urine biomarkers have recently been shown to be early indicators of acute kidney injury in various clinical settings in critically ill adults and children. The product of tissue inhibitor metalloproteinase -1 and insulin-like growth factor binding protein-7 concentrations/1,000 (TIMP-1) × (IGFBP-7) provides stratification of acute kidney injury-risk in adults with critical illness. The present study explores the predictive accuracy of (TIMP-1) × (IGFBP-7) measured early after cardiopulmonary bypass for cardiac surgery-related acute kidney injury in neonates and infants, a population in whom such data are not yet available.

Design: 

Prospective, observational.

Setting: 

A tertiary referral pediatric cardiac ICU.

Patients: 

Fifty-seven neonates and 110 infants undergoing surgery with cardiopulmonary bypass.

Interventions: 

None.

Measurements and Main Results: 

(TIMP-1) × (IGFBP-7) was measured on the NephroCheck (Astute Medical, San Diego, CA) platform preoperatively, less than 1 hour of cardiopulmonary bypass and 1–3 hours of cardiopulmonary bypass. The incidence of postoperative acute kidney injury, dialysis, and/or death were compared among quintiles of postoperative (TIMP-1) × (IGFBP-7). Multivariable regression was used to assess the added predictive value for renal events of (TIMP-1) × (IGFBP-7) over clinical models. Basal (TIMP-1) × (IGFBP-7) increased with age at surgery (regression coefficient = 0.004 ± 0.001; p = 0.005). (TIMP-1) × (IGFBP-7) increased after cardiopulmonary bypass. Neonates had lower postoperative (TIMP-1) × (IGFBP-7) compared with older infants, despite undergoing longer surgeries and experiencing a higher incidence of postoperative renal events. (TIMP-1) × (IGFBP-7) was not associated with acute kidney injury, dialysis, and/or death and was not a predictor of the aforementioned events when added to a clinical acute kidney injury model including age, duration of cardiopulmonary bypass, and mechanical ventilation prior to surgery.

Conclusions: 

These findings question the usefulness of (TIMP-1) × (IGFBP-7) for the prediction of cardiac surgery-related acute kidney injury in neonates and infants when measured within 3 hours of cardiopulmonary bypass.

中文翻译：

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细胞周期阻滞生物标志物：对新生儿和婴儿心脏手术相关急性肾损伤的有用性。

目标： 

细胞周期阻滞尿液生物标志物最近已被证明是危重成人和儿童各种临床环境中急性肾损伤的早期指标。组织抑制剂金属蛋白酶 -1 和胰岛素样生长因子结合蛋白 7 浓度/1,000 (TIMP-1) × (IGFBP-7) 的乘积提供了危重病成人急性肾损伤风险的分层。本研究探讨了体外循环后早期测量的 (TIMP-1) × (IGFBP-7) 对新生儿和婴儿心脏手术相关急性肾损伤的预测准确性，目前尚无此类数据的人群。

设计： 

前瞻性的，观察性的。

环境： 

三级转诊儿科心脏 ICU。

患者： 

57 名新生儿和 110 名婴儿接受体外循环手术。

干预： 

没有任何。

测量和主要结果： 

(TIMP-1) × (IGFBP-7) 是术前在 NephroCheck (Astute Medical, San Diego, CA) 平台上测量的，体外循环时间不到 1 小时，体外循环时间不到 1-3 小时。比较术后（TIMP-1）×（IGFBP-7）的五分之一患者术后急性肾损伤、透析和/或死亡的发生率。多变量回归用于评估 (TIMP-1) × (IGFBP-7) 对临床模型的肾脏事件的附加预测值。基础 (TIMP-1) × (IGFBP-7) 随着手术年龄的增长而增加（回归系数 = 0.004 ± 0.001；p= 0.005)。(TIMP-1) × (IGFBP-7) 体外循环后增加。与年龄较大的婴儿相比，新生儿的术后 (TIMP-1) × (IGFBP-7) 较低，尽管手术时间较长且术后肾脏事件的发生率较高。(TIMP-1) × (IGFBP-7) 与急性肾损伤、透析和/或死亡无关，并且当添加到包括年龄、体外循环持续时间在内的临床急性肾损伤模型时，也不是上述事件的预测因子，以及手术前的机械通气。

结论： 

这些发现质疑 (TIMP-1) × (IGFBP-7) 在体外循环 3 小时内测量时预测新生儿和婴儿心脏手术相关急性肾损伤的有用性。