ArticleAnnals of intensive care2026
Use of [TIMP-2] • [IGFBP7] to identify sepsis-related acute kidney injury in the emergency department.
Article in Annals of intensive care, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Acute kidney injury (AKI) is a common and harmful syndrome associated with sepsis. It is difficult to predict and has an adverse impact on both short- and long-term prognosis. Two urinary biomarkers, tissue inhibitor of metalloproteinases-2 (TIMP-2), and insulin-like growth factor-binding protein 7 (IGFBP7) have been validated for predicting moderate and severe AKI and improving the recognition of organ failure in critically ill patients with sepsis. We aimed to evaluate the performance of these markers for predicting sepsis-related AKI and its evolution in a cohort of patients admitted to the Emergency Department with infectious disease and high risk of sepsis. This single-centre, prospective, observational study included adult patients presenting to the Emergency Department (ED) with suspected infection. Patients were included in the study if they had a National Early Warning Score 2 (NEWS 2) of 3 or higher. Three blood samples were drawn during the first 24 h, and we defined AKI according to the Kidney Disease: Improving Global Outcomes (KDIGO) definition. The first urine sample during ED stay was collected for urinary [TIMP-2]•[ IGFBP7] determination. Higher admission levels of urinary [TIMP-2]•[IGFBP7] were associated with the development of AKI moderate-severe within 24 h (adjusted Odds Ratio 1.24; 95% Confidence Interval 1.07-1.43; p < 0.01). The biomarker showed only modest overall discrimination (AUC 0.67). Still, predefined cut-offs revealed complementary diagnostic roles: low values (<0.3) may help exclude AKI with a negative predictive value of 0.86, whereas the highest values (>2.0) increase its likelihood. Creatinine trajectories and inflammatory profiles were largely similar across groups, except for elevations in IL-10 and IL-1RN in high-risk patients. In conclusion, urinary [TIMP-2]•[IGFBP7] measured on presentation to the ED had only moderate discrimination for sepsis-associated AKI. However, values (<0.3 units) could help to rule out the risk of developing AKI, while values >2.0 indicated high risk.
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