Clinical Utility of Liver-type Fatty Acid-binding Protein (L-fabp), and Tissue Inhibitor of Metalloproteinase-2 and Insulin-like Growth Factor-binding Protein-7 (Timp-2*igfbp-7) as Early Detector for Acute Kidney Injury in Surgical Patients After Cardiopulmonary Bypass

ARJAY VERANO ABICHUELA; CHRISTOPHER CUA CHENG; ARLENE MALOLOS DE LUNA

doi:10.36948/ijfmr.2025.v07i06.60086

Clinical Utility of Liver-type Fatty Acid-binding Protein (L-fabp), and Tissue Inhibitor of Metalloproteinase-2 and Insulin-like Growth Factor-binding Protein-7 (Timp-2*igfbp-7) as Early Detector for Acute Kidney Injury in Surgical Patients After Cardiopulmonary Bypass

Author(s)	Mr. ARJAY VERANO ABICHUELA, Dr. CHRISTOPHER CUA CHENG, Dr. ARLENE MALOLOS DE LUNA
Country	Philippines
Abstract	ABSTRACT BACKGROUND Acute kidney injury (AKI) is a sudden episode of kidney failure or kidney damage that develops within 48 hours after the onset of renal injury. Coronary Artery Bypass Graft (CABG) using cardiopulmonary bypass (CPB) is one of the most frequent surgical procedures in which AKI is a frequent surgical complication. L-FABP, and TIMP-2 and IGFBP-7 are two novel urinary biomarkers which can indicate the onset of AKI within a few hours after a renal insult and 24-28 hours before serum creatinine rises. The aim of this study is to determine the correlation among urine L-FABP, TIMP-2IGFBP-7, and serum creatinine levels in detecting acute kidney injury in patients who underwent a surgical procedure utilizing cardiopulmonary bypass. METHODOLOGY This cross-sectional time series study involved 43 eligible participants scheduled to undergo cardiopulmonary bypass procedure who were recruited within a 6-month period. Participants were interviewed using data collection form prior to enrollment in the study. Conclusions were drawn based on the values retrieved from the patients’ laboratory results 24 hours prior to the surgery (baseline) and on the 3rd hour, 6th hour, 12th hour, 24th, and 48th hour after the cardiopulmonary bypass procedure. One of the highlights in conducting the study is to determine at which time point there is a clinical and statistical increase of L-FABP, and TIMP-2IGFBP-7 that is predictive of AKI. RESULTS Thirty-six patients were able to complete the study. The cardiopulmonary by-pass time ranged from 1.06 to 7.3 hours; averaging 3.18 hrs for patients without AKI (34 patients) and 3.8 hrs for patients with AKI (2 patients). The patients who developed AKI was 5.6% of the study population. There were 2 mortalities (4.6 %) of the total study population, one from each group. Among patients who developed AKI, elevated L-FABP values were observed on the 3rd hour and monitoring values past the sixth hour following by-pass had identified the continuous rise from the cut-off level. The amount of urine TIMP-2IGFBP-7 started to increase after the sixth hour but did not remain elevated. The increased level was regained after the 24th hour. The significant difference between the mean L-FABP values of AKI and non-AKI patients was reached at the 6th hour. Using TIMP-2IGFBP-7, all patients were within the universal urine reference range of 0.04 to 2.22 (ng/ml2)/1000 at baseline. The significant change predictive of AKI was seen on the 12th hr. with 100% sensitivity and after the 24th hour with 50% sensitivity. CONCLUSION The two novel biomarkers L-FABP and TIMP-2IGFBP-7 can be utilized to track the development of early-onset acute kidney injury in patients having cardiopulmonary by-pass surgery. Monitoring for AKI together with serum creatinine can be started after the 3rd hour post by-pass. The use of at least one novel urine biomarker to detect early onset AKI to start monitoring 6 hours post-bypass and continue on the 12th, and 24th hour is recommended. Keywords: L-FABP, TIMP-2IGFBP-7, acute kidney injury, cardiopulmonary by-pass
Keywords	Keywords: L-FABP, TIMP-2*IGFBP-7, acute kidney injury, cardiopulmonary by-pass
Field	Biology > Medical / Physiology
Published In	Volume 7, Issue 6, November-December 2025
Published On	2025-11-19
DOI	https://doi.org/10.36948/ijfmr.2025.v07i06.60086

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Clinical Utility of Liver-type Fatty Acid-binding Protein (L-fabp), and Tissue Inhibitor of Metalloproteinase-2 and Insulin-like Growth Factor-binding Protein-7 (Timp-2*igfbp-7) as Early Detector for Acute Kidney Injury in Surgical Patients After Cardiopulmonary Bypass

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