Abstract
BACKGROUND: This study seeks to evaluate the role of the combination of cell cycle arrest urine biomarkers, Tissue inhibitor of metalloproteinase-2 (TIMP2) and insulin-like growth factor binding protein 7 (IGFBP7) for early prediction of AKI in critically ill obstetrics patients. METHODOLOGY: This prospective observational study was conducted at Obstetrics Intensive Care Unit. Blood and urine samples were taken from critically sick obstetric patients on the day of admission, and the second urine sample was taken after 48 hours. Following admission, the APACHE 2 score was determined. According to the manufacturer's instructions, an ELISA kit was used to perform the final estimation of [TIMP2]*[IGFBP7]. AKI was diagnosed and staged as per KDIGO 2012 guidelines. RESULTS: At the time of admission, AKI was not present in any of the 131 critically ill obstetric patients who met the study's inclusion requirements. Only 127 out of the 131 patients were analysed, four patients were excluded, 3 patients died within 48 hours, and 1 patient left against medical advice. Pregnancy-related hypertensive disorders accounted for the majority of AKI as risk factors (57.1%), followed by haemorrhage (48.1%), which included abruption in 19.5%, placenta previa/accreta/percreta (10.4%), and PPH (14.3%).Patients who developed AKI had a substantially higher mean [TIMP2]*[IGFBP7] on the day of admission (3.47±3.66 (ng/ml)(2)/1000) than those who did not (0.22±0.12 ng/ml)(2)/1000). ROC curve analysis was used to determine the diagnostic accuracy of [TIMP2]*[IGFBP7] levels on Day 1. [TIMP2]*[IGFBP7] exhibited a sensitivity of 94.8% and specificity of 94% for predicting AKI at a cutoff value of ≥0.41(ng/ml)(2)/1000, with a 95% confidence interval and an AUC of 0.990. CONCLUSION: Patient risk of developing AKI was accurately predicted by the urine biomarker [TIMP-2]*[IGFBP7]. It also has good prognostic value.