Abstract: Objective: Early detection of acute kidney injury in acute pancreatitis is of great significance for treatment and prognosis. The objective of this study was to investigate the predictive value and optimal cut-off value of tissue inhibitor of metalloproteinases-2 (TIMP-2)insulin-like growth factor-binding protein 7 (IGFBP-7) for the occurrence of acute kidney injury (AKI) after admission in patients with acute pancreatitis (AP).
Methodology: The study was a posthoc analysis of a multicenter clinical trial. The clinical data of AP patients who met the eligibility criteria and were admitted to 11 emergency and critical care centers across the country from April 2021 to April 2022 were selected. After admission, blood samples of the patients were collected to measure the levels of [TIMP-2][IGFBP-7]. The area under curve (AUC) was used to evaluate the predictive value of this biomarker for AKI, and the optimal cut-off value in this study was evaluated. Multivariate logistic regression model was used to evaluate the independent risk factors for AKI. The differences in clinical outcomes between the high and low marker groups were compared, which were distinguished by the optimal cut-off value.
Results: A total of 84 patients with AP were included in this study, among whom 19 patients (22.6%) developed AKI. The AUC predicted by [TIMP-2][IGFBP-7] for AKI was 0.83 (the optimal cut-off value was 2.46), the sensitivity was 88.9%, and the specificity was 66.1%. Multivariate logistic regression showed that the Acute Physiology and Chronic Health Evaluation System Ⅱ (APACHE Ⅱ) score and the levels of [TIMP-2][IGFBP-7] were associated with AKI. The proportion of organ failure occurring on the third day of admission was higher in the high-marker group (≥2.46) (P=0.019) and the length of intensive care unit (ICU) stay was longer (P=0.030).
Conclusion: Renal injury biomarker ([TIMP-2]*[IGFBP-7]) can predict the occurrence of AKI after admission in AP patients. The population above the cut-off value was associated with an increased length of stay in the ICU and a higher incidence of organ failure. In the future, this biomarker may help to identify high-risk patients with AKI in AP at an early stage, prompt clinical attention, and enable early intervention, ultimately improving prognosis.

Key words: font-family:Inter, -apple-system, BlinkMacSystemFont, ", font-size:16px, background-color:#F9FAFB, ">acute pancreatitis, acute kidney injury, biomarker, predictive value