PMID- 28698269 OWN - NLM STAT- MEDLINE DCOM- 20171109 LR - 20181113 IS - 1533-3450 (Electronic) IS - 1046-6673 (Print) IS - 1046-6673 (Linking) VI - 28 IP - 11 DP - 2017 Nov TI - Urinary Matrix Metalloproteinase-7 Predicts Severe AKI and Poor Outcomes after Cardiac Surgery. PG - 3373-3382 LID - 10.1681/ASN.2017020142 [doi] AB - Urinary matrix metalloproteinase-7 (uMMP-7) levels consistently reflect the activity of intrarenal Wnt/beta-catenin, which is activated in AKI models. To test the hypothesis that uMMP-7 is a predictor for severe AKI in patients after cardiac surgery, we performed a prospective, multicenter, two-stage cohort study in 721 patients undergoing cardiac surgery. In stage 1, we enrolled 323 children from three academic medical centers. In stage 2, we enrolled 398 adults at six centers. We analyzed levels of uMMP-7 and other injury biomarkers during the perioperative period. Severe AKI was defined as Kidney Disease Improving Global Outcomes stage 2 or 3. uMMP-7 level peaked within 6 hours after surgery in patients who subsequently developed severe AKI. After multivariate adjustment, the highest quintile of postoperative uMMP-7 level, compared with the lowest quintile, associated with 17-fold (in adults) and 36-fold (in children) higher odds of severe AKI. Elevated uMMP-7 level associated with increased risk of composite events (severe AKI, acute dialysis, and in-hospital death) and longer stay in the intensive care unit and hospital. For predicting severe AKI, uMMP-7 had an area under the receiver operating characteristic curve of 0.81 (in children) and 0.76 (in adults), outperforming urinary IL-18, angiotensinogen, neutrophil gelatinase-associated lipocalin, albumin-to-creatinine ratio, and tissue inhibitor of metalloproteinase-2.IGF-binding protein-7 and the clinical model. uMMP-7 significantly improved risk reclassification over the clinical model alone, as measured by net reclassification improvement and integrated discrimination improvement. In conclusion, uMMP-7 is a promising predictor for severe AKI and poor in-hospital outcomes in patients after cardiac surgery. CI - Copyright (c) 2017 by the American Society of Nephrology. FAU - Yang, Xiaobing AU - Yang X AD - Division of Nephrology, Nanfang Hospital, Southern Medical University, National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Guangzhou, China. FAU - Chen, Chunbo AU - Chen C AD - Department of Critical Care Medicine, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangdong Cardiovascular Institute, Guangzhou, China. FAU - Teng, Siyuan AU - Teng S AD - Division of Nephrology, Nanfang Hospital, Southern Medical University, National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Guangzhou, China. FAU - Fu, Xiaorui AU - Fu X AD - Division of Nephrology, Nanfang Hospital, Southern Medical University, National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Guangzhou, China. FAU - Zha, Yan AU - Zha Y AD - Department of Nephrology, Guizhou Provincial People's Hospital, Guiyang Medical University, Guiyang, China. FAU - Liu, Huafeng AU - Liu H AD - Division of Nephrology, Institute of Nephrology, Guangdong Medical College, Zhanjiang, China; and. FAU - Wang, Li AU - Wang L AD - Division of Nephrology, Sichuan Provincial People's Hospital, Chengdu, China. FAU - Tian, Jianwei AU - Tian J AD - Division of Nephrology, Nanfang Hospital, Southern Medical University, National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Guangzhou, China. FAU - Zhang, Xiangyan AU - Zhang X AD - Department of Nephrology, Guizhou Provincial People's Hospital, Guiyang Medical University, Guiyang, China. FAU - Liu, Youhua AU - Liu Y AD - Division of Nephrology, Nanfang Hospital, Southern Medical University, National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Guangzhou, China. FAU - Nie, Jing AU - Nie J AD - Division of Nephrology, Nanfang Hospital, Southern Medical University, National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Guangzhou, China. FAU - Hou, Fan Fan AU - Hou FF AD - Division of Nephrology, Nanfang Hospital, Southern Medical University, National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Guangzhou, China; ffhouguangzhou@163.com. LA - eng PT - Journal Article PT - Multicenter Study DEP - 20170711 PL - United States TA - J Am Soc Nephrol JT - Journal of the American Society of Nephrology : JASN JID - 9013836 RN - EC 3.4.24.23 (Matrix Metalloproteinase 7) SB - IM MH - Acute Kidney Injury/diagnosis/*urine MH - Adolescent MH - Adult MH - *Cardiac Surgical Procedures MH - Child MH - Child, Preschool MH - Female MH - Humans MH - Infant MH - Male MH - Matrix Metalloproteinase 7/*urine MH - Middle Aged MH - Predictive Value of Tests MH - Prospective Studies MH - Severity of Illness Index MH - Treatment Outcome PMC - PMC5661292 OTO - NOTNLM OT - Acute Kidney Injury OT - Biomarker OT - Cardiac Surgery OT - Matrix Metalloproteinase-7 EDAT- 2017/07/13 06:00 MHDA- 2017/11/10 06:00 PMCR- 2018/11/01 CRDT- 2017/07/13 06:00 PHST- 2017/02/08 00:00 [received] PHST- 2017/05/27 00:00 [accepted] PHST- 2017/07/13 06:00 [pubmed] PHST- 2017/11/10 06:00 [medline] PHST- 2017/07/13 06:00 [entrez] PHST- 2018/11/01 00:00 [pmc-release] AID - ASN.2017020142 [pii] AID - 2017020142 [pii] AID - 10.1681/ASN.2017020142 [doi] PST - ppublish SO - J Am Soc Nephrol. 2017 Nov;28(11):3373-3382. doi: 10.1681/ASN.2017020142. Epub 2017 Jul 11.