Abstract
Introduction. Novel urinary biomarkers, including Tissue Inhibitor Metallo-protease-2 and Insulin-like Growth Factor Binding Protein 7 ([TIMP-2]*[IGFBP7]), have been developed to identify patients at risk for acute kidney injury (AKI). We investigated the "real world" clinical utility of [TIMP-2]*[IGFBP7] in preventing AKI.Methods. We performed a prospective single-center quality improvement study of intensive care unit (ICU) patients at risk for severe (KDIGO stage 2 or 3) AKI. In the prospective cohort, ICU providers were allowed to order [TIMP-2]*[IGFBP7] for patients at their discretion, then offered AKI practice recommendations based on the result. Outcomes were compared to a historical cohort in which biomarker values were not reported to clinical teams.Results. There was no difference in 7-day progression to severe AKI between the prospective (n=116) and historical cohorts (n=63) when [TIMP-2]*[IGFBP7] & GE;0.3 (24(28%) vs 8(21%), p=0.38) despite more stage 1 AKI at time of biomarker measurement in the prospective cohort (58(67%) vs 9(23%), p<0.001). In the prospective cohort, patients with higher [TIMP-2]*[IGFBP7] values were more likely to receive a nephrology consult. Early consultation (within 24 hours of biomarker measurement, n=20) had a nonsignificant trends towards net negative volume balance (-1787mL(6716mL) vs +4974mL(15540mL)) and more diuretic use (19(95%) vs 8(80%)), and was associated with less severe AKI (9(45%) vs 10(100%), p=0.004) and inpatient dialysis (2(10%) vs 7(70%), p=0.002) compared to delayed consultation (n=10).Discussion/Conclusions. Despite the prospective cohort having more preexisting stage 1 AKI, there were equal rates of progression to severe AKI in the prospective and historical cohorts. In the setting of [TIMP-2]*[IGFBP7] reporting, there were more nephrology consults in response to elevated biomarker levels. Early nephrology consultation resulted in improved volume balance and favorable outcomes compared to delayed consultation.