Evidence of Uncoupling between Renal Dysfunction and Injury in Cardiorenal Syndrome: Insights from the BIONICS Study

Legrand, Matthieu; Berardinis, Benedetta De; Gaggin, Hanna K.; Magrini, L.; Belcher, Arianna M.; Zancla, Benedetta; Femia, Alexandra; Simon, Mandy L.; Motiwala, Shweta R.; Sambhare, Rasika; Somma, Salvatore Di; Mebazaa, Alexandre; Vaidya, Vishal S.; Januzzi, James L.

doi:10.1371/journal.pone.0112313

Cited by 33 publications

(21 citation statements)

References 27 publications

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“…Several biomarkers other than TIMP‐2 and IGFBP7 have been studied previously in ADHF patients, but the overall performance was low . For example, Legrand et al found no significant AUC for a number of renal biomarkers, such as plasma neutrophil gelatinase–associated lipocalin (NGAL), urinary kidney injury molecule 1 (KIM‐1), urinary N ‐acetyl‐β‐d‐glucosaminidase (NAG), and urinary cystatin C . Recently, urinary angiotensinogen was reported to be a stronger predictor of acute cardiorenal syndrome than either urinary NGAL or urinary albumin/Cr ratio, with a ROC‐AUC of 0.84 .…”

Section: Discussionmentioning

confidence: 99%

“…1 (KIM-1), urinary N-acetyl-β-d-glucosaminidase (NAG), and urinary cystatin C. 23 Recently, urinary angiotensinogen was reported to be a stronger predictor of acute cardiorenal syndrome than either urinary NGAL or urinary albumin/Cr ratio, with a ROC-AUC of 0.84. 17 For urinary [TIMP-2] × [IGFBP7], no significant impairment in diagnostic performance due to comorbidities such as chronic heart failure was described by Heung et al 24 Our study is the first to investigate the performance of the new, FDA-cleared renal AKI biomarkers urinary TIMP-2 and IGFBP7 in a cohort of ADHF patients.…”

Section: Discussionmentioning

confidence: 99%

“…12 Serum creatinine values and urine output were recorded for AKI staging by KDIGO criteria. Urinary [TIMP-2] × [IGFBP7] was analyzed in samples collected at enrollment, after 6 hours, on the morning after enrollment (12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27) hours), and daily thereafter. The study was approved by the Ethics Committee of the University of Tübingen, Germany and all subjects provided written informed consent.…”

Section: Methodsmentioning

confidence: 99%

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Urinary [TIMP‐2] × [IGFBP7] for risk prediction of acute kidney injury in decompensated heart failure

Schanz

Shi

Wasser

et al. 2017

Clinical Cardiology

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Background In acute decompensated heart failure (ADHF) the risk of acute kidney injury (AKI) is high. Early detection of patients at risk for AKI is important. We tested urinary [TIMP‐2] × [IGFBP7], a new US Food and Drug Administration–cleared test to assess AKI risk, in a cohort of hospitalized ADHF patients. Hypothesis In patients with ADHF, urinary [TIMP‐2] × [IGFBP7] is associated with moderate to severe AKI and related to increased mortality. Methods We enrolled 400 patients in the emergency department at Robert‐Bosch Hospital, Stuttgart, Germany. We examined the predictive ability of urinary [TIMP‐2] × [IGFBP7] (units: [ng/mL]2/1000) for development of AKI stage 2 or 3 within 24 hours of sample collection in patients with ADHF. Operating characteristics were determined for the validated cutoffs of 0.3 and 2.0. Results Forty patients had ADHF upon presentation and sufficient data for AKI staging. 27.5% developed AKI stage 2–3 within 7 days. Urinary [TIMP‐2] × [IGFBP7] discriminated for AKI stage 2–3 over the first day with an area under the ROC curve of 0.84 (95% confidence interval: 0.72‐0.93) and over 7 days with an AUC of 0.77 (95% confidence interval: 0.65‐0.88). For the first day, sensitivity was 86% at the 0.3 cutoff and specificity was 95% at the 2.0 cutoff for prediction of AKI stage 2–3. There was a trend (P = 0.08) for higher mortality in patients with urinary [TIMP‐2] × [IGFBP7] >2.0 and AKI 2–3. Conclusions Urinary [TIMP‐2] × [IGFBP7] is a promising marker for AKI risk assessment in patients with ADHF.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Urinary [TIMP‐2] × [IGFBP7] for risk prediction of acute kidney injury in decompensated heart failure

Schanz

Shi

Wasser

et al. 2017

Clinical Cardiology

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“…A study of 34 general ICU patients showed that AKI patients had elevated BNP-levels compared to non-AKI patients at admission, 24 hours and 48 hours after admission (17). Two prospective studies of 87 and 126 patients resulted in opposite conclusions of the ability of NT-proBNP to predict worsening of kidney function in patients, who were admitted to hospital for acute decompensated heart failure (cardio-renal syndrome) (18,19). We observed aberrantly high NT-proBNP values (> 800 ng/ml) in two patients (both diagnosed with AKI) on days four and five.…”

Section: Nt-probnp and Akimentioning

confidence: 99%

“…However studies in decompensated heart failure patients have shown opposite results in predicting cardio-renal syndrome (18,19). Previous studies have observed, that the elimination of plasma BNP is independent of kidney function whereas plasma NT-proBNP tends to rise with decreased glomerular filtration rate (GFR) (20).…”

Section: Introductionmentioning

confidence: 99%

N-Terminal Brain Natriuretic Peptide First Week After Burn Injury

Rakkolainen

Elmasry

Steinvall

et al. 2018

Journal of Burn Care &Amp; Research

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B-type natriuretic peptide has shown promising results as a biomarker for acute kidney injury in general intensive care patients. It may also indirectly reflect fluid balance of the circulation. Among burn patients, it has been observed to indicate excessive fluid resuscitation and organ dysfunction, although its clinical use to indicate acute kidney injury or guide fluid resuscitation has not been validated. The aim of this study was to evaluate whether the N-terminal pro-brain natriuretic peptide values are related to the amount of fluids given after severe burn injury and whether it can act as a novel biomarker for acute kidney injury in these patients. Nineteen consecutive burn patients were included. Plasma N-terminal pro-brain natriuretic peptide was measured daily during 1 week from admission. Other variables such as laboratory values and intravenous infusions were also recorded. The association between acute kidney injury and N-terminal pro-brain natriuretic peptide values was analyzed with a multivariable panel regression model, adjusted for burned total body surface area, age, body mass index, and laboratory values. N-terminal pro-brain natriuretic peptide values varied between single patients, and even more between the patients who developed acute kidney injury. Older age, lower body mass index, and cumulative infusions were independently associated with higher N-terminal pro-brain natriuretic peptide values, whereas acute kidney injury was not. N-terminal pro-brain natriuretic peptide values correlated with cumulative infusions given during the first week. The authors could not validate the role of N-terminal pro-brain natriuretic peptide as a biomarker for acute kidney injury in burns.

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