Abstract: SA-PO544
Real Time Utilization of TIMP2*IGFBP7 in ICU Patients: A Quality Initiative
Session Information
- AKI: Clinical, Outcomes, Trials - II
October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Acute Kidney Injury
- 102 AKI: Clinical, Outcomes, and Trials
Authors
- Koyner, Jay L., University of Chicago, Chicago, Illinois, United States
- Gunning, Samantha, University of Chicago, Chicago, Illinois, United States
- Kunczt, Alissa, University of Chicago, Chicago, Illinois, United States
- Trevino, Sharon A., University of Chicago, Chicago, Illinois, United States
- Chan, Siaw li, Rochester Regional Health, Rochester, New York, United States
- Groboske, Sarah E., University of Chicago, Chicago, Illinois, United States
- Leung, Edward Ki yun, The University of Chicago, Chicago, Illinois, United States
- Yeo, Kiang-Teck Jerry, University of Chicago, Chicago, Illinois, United States
Background
Little is known about the real-time clinical use of urinary [tissue inhibitor of metalloproteinase-2]*[insulin-like growth factor binding protein 7] (Nephrocheck, Astute Medical) (NC) in mixed ICU patients at risk for acute kidney injury (AKI).
Methods
We conducted a single center before and after quality initiative assessing outcomes in ICU patients at risk for severe AKI (defined as elevated cardiovascular or pulmonary SOFA score or having KDIGO Stage 1 AKI). We compared 70 retrospective patients who had NC measured but never clinically reported with 60 prospective patients who had NC reported with clinical guidance about their severe AKI risk. We assessed patient outcomes including maximal AKI stage, need for RRT, nephrotoxin exposure and need for nephrology consult.
Results
There was no difference in age, race, gender, baseline hypertension, diabetes, CKD, baseline serum creatinine (SCr) between the retrospective and prospective cohorts. Compared to prospective patients, retrospective patients had higher APACHE II scores(p<0.001), but there was no difference in the need for vasoactive medications(p=0.87). On the day the biomarker was measured both SCr and NC were higher in the prospective cohort.(Table) Despite higher NC values in the prospective cohort there was no difference in the development of Stage 2/3 AKI (p=0.72) or the need for RRT (p=0.68). There was a trend toward decreased mortality in the prospective group (p=0.08). The prospective cohort was more likely to have a nephrology consult in the 24 hours following NC measurement. Prospective patients with a NC>2.0 (n=19) were less likely to be exposed to a nephrotoxins (NSAIDs, Aminoglycosides, amphotericin,r adiocontrast and diuretics) over the first 48 hours compared to retrospective patients with NC>2.0 (n=12)(p<0.01).
Conclusion
Real-time NC measurement decreases nephrotoxin exposure in at risk patients, increases nephrology-based care and improves ICU patient outcomes.
TIMP2*IGFBP7 Outcomes
| Variable (either median(IQR) or n(%)) | Retrospective Cohort (n=70) | Prospective Cohort (n=60) | p-value |
| Baseline Serum Creatinine (mg/dl) | 1.0 (0.7 - 1.4) | 1.0 (0.7 - 1.3) | 0.93 |
| Serum Creatinine on Day of NC Measurement | 1.1 (0.7 - 1.7) | 1.4 (1.0 - 2.1) | 0.012 |
| Nephrocheck value | 0.33 (0.1 - 1.6) | 0.74 (0.24 - 2.3) | 0.06 |
| Reached Stage 2 or 3 AKI | 18 (24%) | 17 (28%) | 0.72 |
| Inpatient Mortality | 16 (23%) | 7 (11%) | 0.08 |
| Nephrology Consult within 24 hour of NC measurement | 4 (5.7%) | 11 (18%) | 0.03 |