Cystatin C as a novel predictor of preterm labor in severe preeclampsia

Abstract

BackgroundThe most common cause of acute kidney injury (AKI) in pregnancy is preeclampsia. Serum cystatin C (CysC) is a potential biomarker of early kidney damage as its levels are not disturbed by volume status changes in pregnancy, and serum CysC levels could serve as a replacement for conventionally used creatinine. In this study, we investigated the serum levels of CysC in severe preeclampsia cases and the associations between CysC levels and poor obstetric outcomes.MethodsOur cohort included severe preeclampsia patients with a normal serum creatinine level. Creatinine was measured to calculate estimated glomerular filtration rate (eGFR) based on the Cockcroft and Gault, Modification of Diet in Renal Disease Study (MDRD), and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations, while CysC was measured to calculated eGFR based on a CysC-based equation. We then evaluated the correlations between serum CysC level, eGFR, and obstetric outcomes.ResultsTwenty-six patients were evaluated of which 38.5% delivered preterm and 30.8% had low-birth weight babies. Unlike creatinine-based eGFR and CysC-based eGFR, serum CysC demonstrate significant negative correlation with gestational age. Receiver operating characteristic curve analysis indicated that serum CysC is a potential biomarker of preterm delivery with a cut-off serum level of 1.48 mg/L with 80% sensitivity and 75% specificity.ConclusionGFR estimation using CysC is likely to be inaccurate in pregnancy. However, we found a significant correlation between preterm delivery and serum CysC level. Our results suggest that serum CysC level has the potential to predict preterm delivery in severe preeclampsia patients.

Cystatin C in pregnant women is not a simple kidney filtration marker

“…In the present study, interestingly, Wattanavaekin et al [6] suggested an additional relevant role for cystatin C in women with preeclampsia independent of renal function. Even among women with preeclampsia, elevated cystatin C levels may predict adverse pregnancy outcomes, such as preterm birth.…”

“…In this issue of Kidney Research and Clinical Practice , Wattanavaekin et al [6] explored the role of cystatin C in a prospective cohort of 26 women with preeclampsia, all with a normal kidney function with serum creatinine 0.4 to 0.8 mg/dL. The authors found a marked difference between cystatin C-based and creatinine-based eGFR values.…”

Epigenetic age and pregnancy outcomes: GrimAge acceleration is associated with shorter gestational length and lower birthweight

“…Hemodynamic adaptations are essential during pregnancy to ensure adequate circulation to the placenta and to meet the increased metabolic demands of the developing fetus, and include remodeling of cardiac tissue, increases in blood volume, increased cardiac output, and vasodilation of the vasculature and kidneys [40,41]. Higher levels of cystatin C are associated with risk for preeclampsia diagnosis [42][43][44][45], a cardio-metabolic disease of pregnancy driven by distress signals released by an ischemic placenta. Preeclampsia is also associated with risk for shorter gestational length and low birthweight [46].…”

Predictive values of multiple serum biomarkers in women with suspected preeclampsia: a prospective study

“…Cysc, the alternative test of Cre used in glomerular ltration rate estimation, was found elevated in PE patients (31) and was able to predict PE in combination of neutrophil gelatinase-associated lipocalin (AUC = 0.88) (32). Moreover, Cysc was reported as a predictor of preterm labor in severe PE, although the physiological increase of Cysc during pregnancy may pose an additional confounding factor in its clinical evaluation (33). In a prospective study with relatively large cohort (n = 9522) by Rezk et al, the serum UA was found to be a useful PE predictor for women at moderate or low risk (34).…”