Value of urine HSP-70 in early diagnosis of acute kidney injury after cardiopulmonary bypass
Huixia Cao, Xuejing Ren, Lina Zhang, Limeng Wang, Xiaojing Jiao, Lei Yan, Leiyi Yang, Fengmin Shao
Abstract
ObjectiveTo assess the value of urine heat-shock protein-70 (HSP-70) in the early diagnosis of acute kidney injury (AKI) after cardiac cardiopulmonary bypass (CPB).
MethodsPatients with cardiopulmonary bypass from May 2018 to July 2018 in Henan Provincial People's Hospital were enrolled as subjects. Urine samples were collected before and after cardiopulmonary bypass at 0 h, 2 h, 4 h, 6 h, 8 h, 12 h, 24 h and 48 h. Patients were divided into AKI group and non-AKI group according to the Kidney Disease: Improving Global Outcomes Guide. Urinary HSP-70, tissue inhibitor of metalloproteinase-2 (TIMP-2) and insulin-like growth factor-binding protein 7 (IGFBP7) were detected by enzyme-linked immunosorbent assay (ELISA) and urine neutrophil gelatinase-associated lipocalin (NGAL) was determined by immunoturbidimetry. The receiver operating characteristic (ROC) curve was plotted to calculate the critical value, sensitivity and specificity of urine HSP-70, [TIMP-2]×[IGFBP7] and NGAL for the diagnosis of postoperative AKI after CPB.
ResultsA total of 45 patients were enrolled in the study. There were 24 cases in AKI group and 21 cases in non-AKI group. The level of urinary HSP-70, [TIMP-2]×[IGFBP7] and NGAL in AKI group were significantly higher than in the non-AKI group at each postoperative time point, with statistically significant differences (all P<0.05). The level of urinary HSP-70 in AKI group peaked at 2 h after CPB, which was significantly earlier than the peak time of urine [TIMP-2]×[IGFBP7] and urine NGAL (12 h after CBP and 4 h after CBP, respectively). Urinary HSP-70≥2.1 μg/L could predict postoperative AKI of CPB at 2 h after CPB, with the area under the curve (AUC) of 1.00, the sensitivity of 100.0% and the specificity of 100.0%. Urinary [TIMP-2]×[IGFBP7]>19.1 μg2/L2 could predict postoperative AKI of CPB at 12 h after CPB with the AUC of 0.94, the sensitivity of 87.5%, and the specificity of 100.0%. Urinary NGAL>27.4 μg/L could predict postoperative AKI of CPB at 4 h after CPB with the AUC of 0.95, the sensitivity of 95.8%, and the specificity of 85.7%. The positive predictive value of urine HSP-70≥2.1 μg/L at 2 h after CPB was 100.0%, and the negative predictive value was 100.0%.
ConclusionsThe level of urinary HSP-70 increases earlier than that of urinary [TIMP-2]×[IGFBP7] and NGAL in patients with AKI after CPB. Clinical monitoring of urinary HSP-70 level contributes to early diagnosis of AKI.
Key words:
Acute kidney injury; Cardiopulmonary bypass; HSP 70 heat-shock proteins; Early diagnosis; Neutrophil gelatinase-associated lipocalin; Tissue inhibitor of metalloproteinase-2; Insulin-like growth factor binding protein 7
Contributor Information
Huixia Cao
Department of Nephrology, Henan Provincial People's Hospital
People's Hospital of Zhengzhou University, People's Hospital of Henan University, Zhengzhou 450003, China
Henan Key Laboratory of Kidney Disease and Immunology, Zhengzhou 450003, China
Xuejing Ren
Department of Nephrology, Henan Provincial People's Hospital
People's Hospital of Zhengzhou University, People's Hospital of Henan University, Zhengzhou 450003, China
Henan Key Laboratory of Kidney Disease and Immunology, Zhengzhou 450003, China
Lina Zhang
Department of Nephrology, Henan Provincial People's Hospital
People's Hospital of Zhengzhou University, People's Hospital of Henan University, Zhengzhou 450003, China
Henan Key Laboratory of Kidney Disease and Immunology, Zhengzhou 450003, China
Limeng Wang
Department of Nephrology, Henan Provincial People's Hospital
People's Hospital of Zhengzhou University, People's Hospital of Henan University, Zhengzhou 450003, China
Henan Key Laboratory of Kidney Disease and Immunology, Zhengzhou 450003, China
Xiaojing Jiao
Department of Nephrology, Henan Provincial People's Hospital
People's Hospital of Zhengzhou University, People's Hospital of Henan University, Zhengzhou 450003, China
Henan Key Laboratory of Kidney Disease and Immunology, Zhengzhou 450003, China
Lei Yan
Department of Nephrology, Henan Provincial People's Hospital
People's Hospital of Zhengzhou University, People's Hospital of Henan University, Zhengzhou 450003, China
Henan Key Laboratory of Kidney Disease and Immunology, Zhengzhou 450003, China
Leiyi Yang
Department of Cardiopulmonary Bypass, Henan Provincial People's Hospital
Department of Cardiopulmonary Bypass of Central China Fuwai Hospital, Central China Fuwai Hospital of Zhengzhou University, Zhengzhou 450000, China
Fengmin Shao
Department of Nephrology, Henan Provincial People's Hospital
People's Hospital of Zhengzhou University, People's Hospital of Henan University, Zhengzhou 450003, China
Henan Key Laboratory of Kidney Disease and Immunology, Zhengzhou 450003, China
