Abstract: TH-OR100

Urinary Matrix Metalloproteinase-7 Predicts Severe AKI and Poor Outcomes after Cardiac Surgery

Session Information

  • Predicting AKI
    November 02, 2017 | Location: Room 282, Morial Convention Center
    Abstract Time: 04:54 PM - 05:06 PM

Category: Acute Kidney Injury

  • 003 AKI: Clinical and Translational

Authors

  • Yang, Xiaobing, Nanfang Hospital, Southern Medical University, Guangzhou, China
  • Hou, Fan Fan, Nanfang Hospital, Guangzhou, China
Background

Urinary matrix metalloproteinase (uMMP)-7 levels faithfully reflect the activity of intrarenal Wnt/β-catenin which is activated in AKI models. uMMP-7 level might be used as a noninvasive biomarker for early predicting AKI after cardiac surgeries.

Methods

we performed a prospective, multicenter, two-stage cohort study in 721 patients undergoing cardiac surgery. In stage 1, 323 children were recruited from 3 academic medical centers. In stage 2, 398 adults were enrolled at 6 centers. The levels of uMMP-7 and other injury biomarkers were analyzed during the perioperative period. Severe AKI was defined as Kidney Disease Improving Global Outcomes stage 2 or 3.

Results

uMMP-7 peaked within 6 hours after surgery in patients who subsequently developed severe AKI. After multivariate adjustment, the highest quintile of uMMP-7 was associated with 17-fold (in adults) and 36-fold (in children) higher odds of severe AKI compared with the lowest quintile. Elevated uMMP-7 associated with increased risk of composite events (severe AKI, acute dialysis, and in-hospital death) and longer stay in intensive care unit and hospital. For predicting severe AKI, uMMP-7 had an area under the receiver-operating characteristic curve (AUC) of 0.81 (in children) and 0.76 (in adults), outperforming urinary interleukin-18, urinary angiotensinogen, urinary neutrophil gelatinase-associated lipocalin, urinary albumin to creatinine ratio, urinary tissue inhibitor metalloproteinase-2×IGF-binding protein-7, and the clinical model. uMMP-7 significantly improved risk reclassification over the clinical model alone as measured by net reclassification improvement and integrated discrimination improvement.

Conclusion

uMMP-7 is a promising predictor for severe AKI and poor in-hospital outcomes in patients after cardiac surgery.

Funding

  • Government Support - Non-U.S.