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Abstract: PO0007

TIMP-2/IGFBP7 and N-Gal Are Strongly Associated with the Development of AKI in Patients with Severe Pneumonia Caused by SARS-CoV-2

Session Information

Category: Coronavirus (COVID-19)

  • 000 Coronavirus (COVID-19)

Authors

  • Casas-Aparicio, Gustavo Alejandro, Instituto Nacional Enfermedades Respiratorias, Cuidad Mexico, Mexico
  • Escamilla-Illescas, David, Instituto Nacional Enfermedades Respiratorias, Cuidad Mexico, Mexico

Group or Team Name

  • Departamento Investigacion Enfermedades Infecciosas - INER
Background

The cut-off points for the urinary kidney biomarkers (BM): TIMP2*IGFBP7 (Tissue Inhibitor of Metalloproteinase-2 *Insulin-Like Growth Factor Binding Protein-7 and Neutrophil Gelatinase associated lipocalin (NGal) in patients with AKI by SARS-CoV-2 are not defined.

Methods

Between May-August 2020 prospectively included patients with severe pneumonia caused by SARS-CoV-2 without AKI at the moment of enrollement. Fresh urine was collected at admission of critical care and was immediately frozen at -80 grades Celcius. NGal and TIMP-2*IGFBP-7 were measured in urine. We derived cutoffs based on sensitivity (S) and specificity (E) for predicting AKI using K-DIGO criteria of urinary kidney BM and some serum BM.
The better cut-off of N-Gal and TIMP-2*IGFBP7 were used to construct Kaplan Meier curves to assess differences in the risk of AKI. We performed a logistic regression model for significant variables to AKI. The analysis was conducted by SPSS V25.

Results

We included 51 patients, 20 AKI and 31 matched controls. Hypertension in the AKI group was 50% vs 12.9% p=0.009.
Mortality in the group with AKI was 8 (15.7%) vs 2 NO-AKI (3.9%) p=0.013. Table 1 shows AUC of urinary and serum clinical BM for predicting AKI. TIMP2/IGFBP7 cut-off point of 0.2 ng/ml had S= 50%, E = 90%, and N-Gal 45 ng/ml had S=70.5%, E 80.6%. Survival curves for AKI were constructed after stratifying TIMP-2 IGFBP7 >0.2 vs <0.2 and N-Gal >45 vs <45 ng/ml, cut-off <0.2 of TIMP2*IGFBP7 had lower risk for AKI during (Log-rank test p = 0.002), lower risk for AKI was also observed with the cut-off <45 ng/ml for N-Gal ( Log-rank test p = 0.001).
Multivariate analysis indicated risk factor for AKI was higher when TIMP2*IGFBP7 >0.2 (ng/ml)2/1000 (OR 10.29, 95% CI=1.26-83.60, p=0.029); and higher N-Gal >45 ng/ml (OR 5.57, 95% CI 1.00-30.87) p=0.038.

Conclusion

TIMP2*IGFBP7 and NGal in urine are excellent predictors of AKI in patients with severe pneumonia caused by SARS-CoV-2.

Prediction of AKI using urinary and serum clinical biomarkers
Urinary (u) and Serum (s) BiomarkersAUCp95% CI
TIMP-2*IGFBP7 u0.6950.0210.537-0.853
N-Gal u0.7840.0010.646-0.921
Creatine Phosphokinase (s)0.6940.0210.548-0.840
Procalcitonine (s)0.7520.0030.611-0.894
Troponine (s)0.7420.0070.595-0.890

AUC= Area under the curve

Funding

  • Government Support – Non-U.S.