• Eric A J Hoste, Peter A McCullough, Kianoush Kashani, Lakhmir S Chawla, Michael Joannidis, Andrew D Shaw, Thorsten Feldkamp, Denise L Uettwiller-Geiger, Paul McCarthy, Jing Shi, Michael G Walker, John A Kellum, and Sapphire Investigators.
• Intensive Care Unit, Ghent University Hospital, Ghent University, and Research Foundation-Flanders (FWO), Belgium.
• Nephrol. Dial. Transplant. 2014 Nov 1;29(11):2054-61.

BackgroundAcute kidney injury (AKI) remains a deadly condition. Tissue inhibitor of metalloproteinases (TIMP)-2 and insulin-like growth factor binding protein (IGFBP)7 are two recently discovered urinary biomarkers for AKI. We now report on the development, and diagnostic accuracy of two clinical cutoffs for a test using these markers.MethodsWe derived cutoffs based on sensitivity and specificity for prediction of Kidney Disease: Improving Global Outcomes Stages 2-3 AKI within 12 h using data from a previously published multicenter cohort (Sapphire). Next, we verified these cutoffs in a new study (Opal) enrolling 154 critically ill adults from six sites in the USA.ResultsOne hundred subjects (14%) in Sapphire and 27 (18%) in Opal met the primary end point. The results of the Opal study replicated those of Sapphire. Relative risk (95% CI) in both studies for subjects testing at ≤0.3 versus >0.3-2 were 4.7 (1.5-16) and 4.4 (2.5-8.7), or 12 (4.2-40) and 18 (10-37) for ≤0.3 versus >2. For the 0.3 cutoff, sensitivity was 89% in both studies, and specificity 50 and 53%. For 2.0, sensitivity was 42 and 44%, and specificity 95 and 90%.ConclusionsUrinary [TIMP-2]•[IGFBP7] values of 0.3 or greater identify patients at high risk and those >2 at highest risk for AKI and provide new information to support clinical decision-making.Clinical Trials RegistrationClintrials.gov # NCT01209169 (Sapphire) and NCT01846884 (Opal).© The Author 2014. Published by Oxford University Press on behalf of ERA-EDTA.

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