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Crit Care. 2019 Jun 20;23(1):225. doi: 10.1186/s13054-019-2504-8.

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

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Florida Hospital, 601 E. Rollins Street, Orlando, FL, 32803, USA.
University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany.
Baystate Medical Center, 759 Chestnut Street, Springfield, MA, 01107, USA.
The Royal Surrey County Hospital NHS Foundation Trust, Egerton Rd, Guildford, Surrey, GU2 7XX, UK.
University of Surrey, 388 Stag Hill, Guildford, Surrey, GU2 7XH, UK.
Swedish Covenant Hospital, 5145 N California Ave, Chicago, IL, 60625, USA.
Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria.
Section of Nephrology, Department of Medicine, University of Chicago, 5841 South Maryland Ave, Suite S-507, MC5100, Chicago, IL, 60637, USA.
Tristar Centennial Medical Center, 2400 Patterson St #307, Nashville, TN, 37203, USA.
Hospices Civils de Lyon, Edouard Herriot Hospital, 5 Place d'Arsonval, 69003, Lyon, France.
Department of Nephrology University of Padua, Padua Italy; San Bortolo Hospital, Vicenza, Italy; International Renal Research Institute Vicenza, Vicenza, Italy.
bioMérieux, 5 Place d'Arsonval, 69003, Lyon, France.
University Hospital Münster, Albert-Schweitzer Campus 1, Building A1, 48149, Münster, Germany.
The Center for Critical Care Nephrology, Department of Critical Care Medicine, University of Pittsburgh, 3347 Forbes Avenue, Suite 220, Pittsburgh, PA, 15213, USA.
Critical Care Medicine, Clinical & Translational Science, and Bioengineering, Center for Critical Care Nephrology, 3347 Forbes Avenue, Suite 220, Pittsburgh, PA, 15213, USA.



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.


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.


Acute kidney injury; Biomarker technology; Biomarker testing; Clinical guidelines; Critical care; Diagnosis; Expert panel; Insulin-like growth factor binding protein 7; Protocols; Tissue inhibitor of metalloproteinases-2

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