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Clinical use of [TIMP-2]•[IGFBP7] biomarker testing to assess risk of acute kidney injury in critical care: Guidance from an expert panel

Guzzi, L.M., Bergler, T., Binnall, B., Engelman, D.T., Forni, Lui, Germain, M.J., Gluck, E., Göcze, I., Joannidis, M., Koyner, J.L. , Reddy, V.S., Rimmelé, T., Ronco, C., Textoris, J., Zarbock, A. and Kellum, J.A. (2019) Clinical use of [TIMP-2]•[IGFBP7] biomarker testing to assess risk of acute kidney injury in critical care: Guidance from an expert panel Critical Care, 23 (1), 225.

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The first FDA-approved test to assess risk for acute kidney injury (AKI), [TIMP-2]•[IGFBP7], is clinically available in many parts of the world, including the USA and Europe. We sought to understand how the test is currently being used clinically.


We invited a group of experts knowledgeable on the utility of this test for kidney injury to a panel discussion regarding the appropriate use of the test. Specifically, we wanted to identify which patients would be appropriate for testing, how the results are interpreted, and what actions would be taken based on the results of the test. We used a modified Delphi method to prioritize specific populations for testing and actions based on biomarker test results. No attempt was made to evaluate the evidence in support of various actions however.


Our results indicate that clinical experts have developed similar practice patterns for use of the [TIMP- 2]•[IGFBP7] test in Europe and North America. Patients undergoing major surgery (both cardiac and non-cardiac), those who were hemodynamically unstable, or those with sepsis appear to be priority patient populations for testing kidney stress. It was agreed that, in patients who tested positive, management of potentially nephrotoxic drugs and fluids would be a priority. Patients who tested negative may be candidates for “fast-track” protocols. Conclusion: In the experience of our expert panel, biomarker testing has been a priority after major surgery, hemodynamic instability, or sepsis. Our panel members reported that a positive test prompts management of nephrotoxic drugs as well as fluids, while patients with negative results are considered to be excellent candidates for “fast-track” protocols.

Item Type: Article
Divisions : Faculty of Health and Medical Sciences > School of Biosciences and Medicine
Authors :
Guzzi, L.M.
Bergler, T.
Binnall, B.
Engelman, D.T.
Germain, M.J.
Gluck, E.
Göcze, I.
Joannidis, M.
Koyner, J.L.
Reddy, V.S.
Rimmelé, T.
Ronco, C.
Textoris, J.
Zarbock, A.
Kellum, J.A.
Date : 20 June 2019
DOI : 10.1186/s13054-019-2504-8
Copyright Disclaimer : © The Author(s). 2019 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (, which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.
Uncontrolled Keywords : Biomarker testing; Acute kidney injury; Critical care; Expert panel; Protocols; Clinical guidelines; Tissue inhibitor of metalloproteinases-2; Insulin-like growth factor binding protein 7; Biomarker technology; Diagnosis
Depositing User : Diane Maxfield
Date Deposited : 28 Oct 2019 14:58
Last Modified : 28 Oct 2019 15:03

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