The Impact of The [TIMP-2] × [IGFBP7]-Guided Checklist for Early Recognition and Treatment of Acute Illness on The Prevention of Acute Kidney Injury In Patients With Septic Shock

Abstract

Background: Sepsis is the main aetiology of acute kidney injury (AKI) in critically ill patients, with high morbidity and mortality. The early identification of septic patients at high risk for AKI, followed by the timely implementation of appropriate interventions, is crucial for improving patient outcomes. Tissue inhibitor of metalloproteinase-2 and insulin-like growth factor-binding protein 7 ([TIMP-2] × [IGFBP7]) are promising biomarkers for AKI. Furthermore, the Checklist for Early Recognition and Treatment of Acute Illness (CERTAIN) is a tool for evaluating and treating acute illness in a timely manner based on best practices. We hypothesized that the use of this biomarker-guided point-of-care tool would improve the prognosis of patients with sepsis-associated acute kidney injury (SA-AKI).Methods: This was a single-centre prospective before-and-after study in the ICU of a comprehensive tertiary hospital. From June 2015 to December 2020, we assessed and managed patients with septic shock based on the biomarker-guided CERTAIN checklist. A checklist based on the Sepsis 3.0 bundle and urinary [TIMP-2] × [IGFBP7]>0.3(ng/mL)2/1000 within 12 hours were used as the inclusion criteria. The CERTAIN checklist includes the care bundles recommended in the Sepsis 3.0 bundle and Kidney Disease: Improving Global Outcomes (KDIGO) 2012 guidelines. The primary outcome was the incidence of moderate-to-severe AKI on the first day and within seven days after enrolment and mortality at 90 days after discharge from the hospital. The secondary outcomes were the ICU length of stay, non-mechanical ventilation duration, and the proportions of patients with the recovery of renal function and major adverse kidney events (MAKEs) at 90 days after exposure to events initiating AKI.Results: At the end of the study, 124 patients had been treated based on the checklist. When compared to a cohort of 112 patients matched for disease, the CERTAIN group had a lower proportion of patients needing mechanical ventilation, a lower proportion of patients needing vasoactive agents, a shorter ICU length of stay, and a higher proportion of patients with recovered kidney function. Furthermore, there was a trend towards a higher 90-day survival rate in the CERTAIN group.Conclusions: Implementation of the CERTAIN checklist was associated with improvements in the short-term recovery of kidney function, airway and haemodynamic management and mortality in patients with SA-AKI.Trial registration: NCT01973829; Date of registration: November 1, 2013.