Urine TIMP2.IGFBP7 Reflects Kidney Injury After Moderate Volume Paracentesis in Patients With Ascites: A Randomized Control Study

IF 1.5 Q3 GASTROENTEROLOGY & HEPATOLOGY JGH Open Pub Date : 2025-04-22 DOI:10.1002/jgh3.70168

Anuchit Suksamai, Sanpolpai Khaoprasert, Amnart Chaiprasert, Sakkarin Chirapongsathorn

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Abstract

Background

Urinary biomarkers may predict acute kidney injury (AKI) in cirrhosis with ascites in a moderate volume paracentesis setting.

Objective

The study aimed to assess the risk and consequence of AKI and its progression in patients with decompensated cirrhosis undergoing paracentesis using a urine test measuring tissue inhibitor of metalloproteinases-2 (TIMP2) and insulin-like growth factor-binding protein 7 (IGFBP7).

Methods

A randomized, controlled trial was performed. All outpatients with decompensated cirrhosis with ascites and diuretic complications were enrolled and randomized into 3 and 5 L paracentesis groups. Serial urine samples were analyzed for TIMP2. IGFBP7 concentration before and after paracentesis.

Results

A total of 90 patients with decompensated cirrhosis were consecutively enrolled during the study period. After screening, 29 patients were enrolled in the 3-L paracentesis group, and 25 patients were enrolled in the 5-L paracentesis group. The mean of the MELD score was 8 ± 1.2. Urine TIMP2.IGFBP7 > 2, rising urine TIMP2, and rising urine TIMP2/urine Cr were shown in patients within the 5-L group for 48% (p = 0.015), 32% (p = 0.049), and 76% (p = 0.010) respectively, indicating a higher incidence of renal tubular injury markers in this group. Urine TIMP2.IGFBP7/1000 > 2 was statistically significant to predict a hemodynamic event (p = 0.002).

Conclusion

In cirrhotic patients with ascites undergoing paracentesis, a 5-L paracentesis volume was associated with a higher incidence of renal tubular injury markers.

Trail Registration: The national clinical registration number was TCTR20191116003.

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尿液中的 TIMP2.IGFBP7 可反映腹水患者适量腹腔穿刺术后的肾损伤：随机对照研究

背景尿液生物标志物可预测中等容量腹腔穿刺术中肝硬化腹水患者的急性肾损伤（AKI）。目的该研究旨在通过尿液检测组织金属蛋白酶抑制剂-2（TIMP2）和胰岛素样生长因子结合蛋白 7（IGFBP7），评估接受腹腔穿刺术的失代偿期肝硬化患者发生 AKI 及其进展的风险和后果。方法进行了一项随机对照试验。所有患有失代偿期肝硬化并伴有腹水和利尿并发症的门诊患者均被纳入试验，并随机分为 3 升腹腔穿刺组和 5 升腹腔穿刺组。对连续尿液样本进行 TIMP2 分析。腹腔穿刺前后的 IGFBP7 浓度。结果在研究期间，共有 90 名失代偿期肝硬化患者连续入组。经过筛选，29 名患者被纳入 3 升腹腔穿刺术组，25 名患者被纳入 5 升腹腔穿刺术组。MELD 评分的平均值为 8 ± 1.2。尿TIMP2.IGFBP7 >2、尿TIMP2升高、尿TIMP2/尿Cr升高在5L组患者中分别占48%（P = 0.015）、32%（P = 0.049）和76%（P = 0.010），表明该组肾小管损伤标志物的发生率更高。尿液中的 TIMP2.IGFBP7/1000 > 2 在预测血流动力学事件方面具有统计学意义（p = 0.002）。结论在接受腹腔穿刺术的肝硬化腹水患者中，5 升腹腔穿刺量与较高的肾小管损伤指标发生率相关。追踪登记：国家临床注册号为 TCTR20191116003。

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