الفهرس 
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Abstract
• Introduction: AKI is a multifactorial clinical entity representing a major health problem. In critical care, AKI remains highly prevalent, complicating the clinical course of patients, extending the need for ICU hospitalization, requiring RRT, and carrying high mortality. TIMP2 is one biomarker for cellular stress in the early phase of tubular cell injury caused by a wide variety of insults (oxidative stress, inflammation, ischemia, drugs, and toxins). When DNA damage occurs, the level of protein TIMP-2 would increase in renal tubular cells. TIMP-2 is a G1 phase blocker that can induce a temporary G1 arrest, thus avoiding the possibility of cell damage. • Aim of the work: The aim of this study was to identify how useful TIMP-2 as a novel biomarker in predicting AKI in critically ill patient admitted to medical ICU. • Subjects and methods:. This prospective case control study was conducted on 80 critically ill patients above the age of 18 years old admitted to medical critical care unit in Specialized Medical Hospital, Mansoura University. All the studied patients were subjected to thorough medical history taking and clinical examination. Routine laboratory investigations were performed including CBC, ABG, Liver function tests, SCr, ACR, 24 h urinary protein concentration, ESR, CRP, calculation of APACHE II and SOFA scores .Urinary TIMP-2 measured within 12 hour of admission. Then all patients were reviewed for the development of AKI during the period of their admission stay and divided into two groups: AKI group and non AKI group. • Results : AKI was associated with significant in-hospital mortality.Older age (p=0.041), urinary RBCs > 5 / HPF (p=0.014), high INR (p=0.027), pneumonia (p=0.044) and high CRP (p=0.005) were significant independent predictors of the occurrence of AKI .There was significant positive correlation between TIMP-2 level and male sex, high urine RBCs, age, INR, ACR, SCr, APACHE II score and SOFA score.TIMP2 at cutoff value ≥ 69 ng/ml was a perfect discriminator between AKI and non-AKI groups (sensitivity, specificity, PPV and NPV of 100%).Also,TIMP-2 was significantly higher in stage 2 vs stage1 AKI (p<0.001) and at cutoff value of ≥ 76 ng/ml had 87.5% sensitivity and100% specificity to discriminate stage 2 from stage 1 (marker of severity). TIMP-2 was significantly higher in non survivors and at cut off value ≥ 67 ng/ml had 66.7% sensitivity and 79.5% specificity to predict In-hospital mortality (p<0.001). • Conclusion: urinary TIMP-2 showed significant increase before SCr show significant change . So,TIMP-2 could be used as a reliable biomarker for early detection of AKI and also prediction of mortality especially in critically ill patients admitted to medical ICU with high sensitivity and specificity. selection of patients with higher risk of AKI to be investigated and followed up by TIMP-2 may contribute to improve outcome in ICU.