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Abstract: TH-PO022

Comparison of Outcomes in Prospective and Retrospective Studies of Biomarker for AKI Risk

Session Information

Category: Acute Kidney Injury

  • 102 AKI: Clinical‚ Outcomes‚ and Trials

Authors

  • La, Ashley, The University of Chicago Medicine, Chicago, Illinois, United States
  • Gunning, Samantha, The University of Chicago Medicine, Chicago, Illinois, United States
  • Koyner, Jay L., The University of Chicago Medicine, Chicago, Illinois, United States
Background

Novel urinary biomarkers, including Tissue Injury Metallo-protease-2 and Insulin-like Growth Factor Binding Protein 7 ([TIMP-2]*[IGFBP7] or T2*I7), have been developed to predict patients at risk for developing severe AKI. While T2*I7 has been approved as an AKI risk stratification tool, “real world” data on its clinical utility in preventing AKI is minimal.

Methods

We conducted a single-center quality improvement study of University of Chicago ICU patients at risk for severe (KDIGO stage 2 or 3) AKI by comparing patients previously enrolled in retrospective clinical trials of T2*I7 in which clinical teams were not aware of biomarker values (n=59) with a prospective cohort of at-risk and stage 1 AKI patients. In the prospective cohort (n=105), ICU providers were given the biomarker values with KDIGO-based care guidelines based on biomarker values. We analyzed the patients’ charts for data on the use of these guidelines and clinical outcomes.

Results

More patients in the prospective cohort had stage 1 AKI at the time of biomarker measurement (66(63.5%) vs 10(17.0%), p < 0.001). The peak change in serum creatinine (SCr, mean(SD)) within 7 days of ICU admission was lower in the prospective study compared to the retrospective studies among the entire cohort (0.27(0.78) vs 0.93(1.50), p < 0.001) as well as only in those at higher risk for AKI (T2*I7 >0.3) (0.34(0.87) vs 1.02(1.41), p = 0.004). AUC(SE) for T2*I7 as a predictor of severe AKI in 48 hours was 0.644(0.40), p=0.057, in the prospective cohort and 0.720(0.66), p=0.077, in the retrospective cohort.

Conclusion

The use of T2*I7 coupled with practice guidelines is associated with a smaller increase in SCr in ICU patients at high risk for AKI despite more baseline AKI. Given these findings, the impact of T2*I7 reporting on clinical care warrants continued investigation.

Outcomes of ICU patients with urinary [TIMP-2]*[IGFBP7] >0.3 by study cohort
 Prospective (n = 78)Retrospective (n = 37)p-value
Nephrology consults22 (28.2%)2 (5.4%)0.006
Net intake/output (mL) (SD)-1044 (8190)-1343 (8403)0.85
Incidence of nephrotoxin exposure (SD)4.99 (4.14)4.32 (3.54)0.44
Peak change in SCr in 7 days (mg/dL) (SD)0.34 (0.87)1.02 (1.41)0.004
Inpatient mortality8 (10.3%)9 (24.3%)0.09
Inpatient dialysis8 (10.3%)3 (8.1%)>0.99