The role of interleukin-18 (IL-18), tissue inhibitory metalloproteinase-2 (Timp-2), insulin-like growth factor binding protein-7 (IGFBP7) biomarkers in the early diagnosis of acute renal failure in intensive care patients

ABSTRACT The Role of Interleukin-18 (IL-18), Tissue Inhibitory Metalloproteinase-2 (TIMP-2), Insulin-Like Growth Factor Binding Protein-7 (IGFBP7) Biomarkers in the Early Diagnosis of Acute Renal Failure in Intensive Care Patients Objective: Acute renal failure is a heterogeneous and complex process with high morbidity and mortality. It is seen at high rate in patients hospitalized in intensive care units. The serum creatinine level based diagnostic criteria used in clinical practice lack sensitivity and specifity for the diagnosis of structural kidney injury. New biomarkers are needed to improve the early detection, differential diagnosis and prognostic evaluation of acute renal failure. In this study, we aimed to examine the biomarkers that we think will enable the early detection of acute renal failure. Material and Methods: A total of 53 patients who were hospitalized in the Internal Medicine Intensive Care Unit of Çukurova University Medical Faculty Hospital between August 1, 2021 and July 31, 2022 with various etiologies and without a history of kidney disease were included in this study. At the admission to intensive care unit, 12th and 24th hours urine samples were collected to study IL-18, TIMP-2, IGFBP7 biomarkers in the urine and to determine the AKIRısk score based on ([TIMP-2] x [IGFBP7])/1000 calculation. The patients included in the study were divided into two groups as developing acute renal failure (case group) and non-developing (control group) according to KDIGO criteria. During the intensive care follow-up of the patients, routine creatinine values were recorded. APACHE II scores and daily SOFA scores, which are among the intensive care scoring systems of the patients, were calculated. Results: There was no significant difference between the case and control groups in the terms of demographic data (age and gender). A significant difference was found between the 2 groups in terms of SOFA scores on the 1st, 2nd, 3rd, 4th, 6th and 7th days (respectively p=0,013; p<0,001; p=0,005; p=0,024; p=0,032, p=0,005). The presence of malignancy and higher drug use rates were found to be significant in the case group (respectively p=0,041; p=0,046). There was no significant difference between the groups in terms of IL-18, TIMP-2, IGFBP7 values at all hours. There was a significant difference between the groups in terms of 0 hours [TIMP-2].[IGFBP7] value (p=0,007). Predicting the development of acute renal failure at 0 hour [TIMP-2].[IGFBP7] values above 0.25 were found to be significant with 88.89% sensitivity and 65.79% specifity (p=0.001). The 24th hour [TIMP-2].[IGFBP7] values above 0.26 were found to predict the development of acute renal failure with 37.5% sensitivity and 85.71% specifity (p=0.029). Conclusion: SOFA score can be used as early predictors of acute renal failure in intensive care patients. 0 and 24th hours [TIMP-2].[IGFBP7] values were found to be significantly higher in the case group compared to the control group and significant in terms of the risk of developing acute renal failure. Keywords: AKIRısk, Acute renal failure, Creatinine, IGFBP7, IL-18, TIMP-2