ABSTRACT
Objective:To evaluate the early diagnostic value of tissue inhibitor of matrix metalloproteinase-2 (TIMP-2) and insulin-like growth factor binding protein-7 (IGFBP-7) in acute kidney injury induced by sepsis.Methods:A total of 85 sepsis patients admitted to the EICU and GICU in Shanghai East Hospital from September 2017 to June 2019 were divided into theAKI group ( n=37) and the non-AKI group ( n=48) according to KIDGO diagnostic criteria, and 20 healthy volunteers were served as the control group. The clinical data were recorded and samples of urine were collected at 0 h, 6 h, 12 h, 1 d, 3 d and 7 d post sepsis. The levels of TIMP-2 and IGFBP-7 in the urine were analyzed with ELISA at different time points. Based on the receiver operating characteristic curve (ROC) and the area under the curve (AUC), the early diagnostic value of urinary TIMP-2 and IGFBP-7 in sepsis-induced AKI patients was determined. Results:Compared with the control group, the levels of TIMP-2 and IGFBP-7 of the AKI group were significantly higher at the above time points ( P<0.05), while those of the non-AKI group showed no significant differences. The levels of TIMP-2 and IGFBP-7 of the AKI group were significantly higher than the those of the non-AKI group ( P<0.05). ROC analysis showed that when the AUC of urine TIMP-2 peaked at 1 d, the sensitivity and specificity reached 97.5% and 81.2%, separately with the cutoff value of 151.23 ng/mL. Furthermore, when the AUC of urine IGFBP-7 peaked at 12 h, the sensitivity and specificity reached 100% and 72.8%, separately with the cutoff value of 14.91 ng/mL. Interestingly, when the AUC of combined TIMP-2×IGFBP-7 peaked at 12 h, the sensitivity reached 98.0% and specificity reached 91.5% with the cutoff value of 2.09 [(ng/mL) 2/1 000]. There was no significant correlation between the levels of TIMP-2 and IGFBP-7 with SOFA and APACHEⅡ score at 1 d, 3 d and 7 d post sepsis in the AKI group ( P>0.05). Conclusions:Urine TIMP-2 and IGFBP-7 have early diagnostic value in sepsis-induced AKI. Besides, the combination of the two biomarkers have superior predictive value than each single of them.
ABSTRACT
Objective To investigate the value of ischemia modified albumin (IMA) detection in preliminary diagnosis of acute myocardial infarction (AMI).Methods The levels and variations of IMA,cTnI and CK-MB in 103 patients with acute chest pain were measured continuously at 0,4,6,12,24 hours after admission respectively.Thirty healthy subjects were observed as normal controls.Results Twenty three patients were diagnosed as AMI in the end,the sensitivity and specificity rates right after admission were 89.3％ and91.3％ for IMA,48.4％ and 92.3％ for CK-MB,30.6％ and 93.7％ for cTnI respectively.The sensitivity values at the 6th hours after admission were 91.3％ for IMA,52.2％ for CTnI and 34.8％ for CK-MB respectively.The specificity was 100.0％ when the IMA was detected in combination with CK-MB or cTnI.The sensitivity of co-detection was significantly higher than that any single detection at sixth hours after admission (x2 =15.99,P ＜ 0.01 ).Conclusion Plasma IMA assessment is helpful for early diagnosis of AMI,and will significantly improve the sensitivity early diagnosis of AMI.The co-detection of IMA and CK-MB or cTnI obviously surpasses any single detection,and has extremely vital clinical significance.
ABSTRACT
Objective To discuss the value of ischemia modified albumin (IMA) in the early diagnosis of acute coronary syndrome (ACS). Methods The IMA,cTnI, CK-MB and ECG were detected in 103 patients with suspected ACS (45 cases of NICP and 58 cases of ACS) within 5 hours of acute chest pain onset respectively. 30 healthy subjects were served as normal controls. Receiver operating characteristic (ROC) analysis was used to determine the optimal cutoff of this assay for identifying individuals with ACS from non-ischemic individuals (nonischemic chest pain, NICP). Results of IMA,cTnI,CK-MB and ECG were correlated with the final diagnosis and their diagnostic sensitivities for ACS were evaluated. Results The results suggested that acute phase IMA values between those with ACS and NICP were (89.66 ± 25.82) U/ml, (46.79 ± 17.20) U/ml respectively and showed significant difference. Area under the curve (AUC) of the ROC was 0.935. As the Cut-off point was 71.6 U/ml, the sensitivity, specificity, PPV and NPV of IMA were 90.6%, 71.4% , 82.8% and 83.3%, respectively. The simutanious positive rate of IMA for ischemia origin were 29.3% of cTnI,27.6% of CK-MB and 48.3% of ECG(P＜ 0.01). Conclusions Plasma IMA assessment is valuable for early diagnosis of acute coronary ischemia, and will improve the early diagnostic sensitivity of ACS significantly.