Cystatin C in acute kidney injury diagnosis: early biomarker or alternative to serum creatinine?

Lagos-Arevalo, Paola; Palijan, Ana; Vertullo, Laura; Devarajan, Prasad; Bennett, Michael; Sabbisetti, Venkata; Bonventre, Joseph V.; Ma, Qing; Gottesman, Ronald; Zappitelli, Michael

doi:10.1007/s00467-014-2987-0

Cited by 61 publications

(46 citation statements)

References 53 publications

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“…In this observational study, we found that sCysC levels measured on the first day of admission were a powerful predictor for AKI and the short-term prognosis of CCU patients. These findings are consistent with previous results that have been reported in two other clinical studies [36, 37]. More importantly, despite evidence that β2-micro globulin is useful for predicting prognosis in kidney disease, cardiovascular outcomes and death [38-40], the performance of sCysC in predicting AKI and short-term prognosis was superior to β2-micro globulin in our study.…”

Section: Discussionsupporting

confidence: 83%

Serum Cystatin C Predicts AKI and the Prognosis of Patients in Coronary Care Unit: a Prospective, Observational Study

Hu¹,

Liu²,

Du³

et al. 2017

Kidney Blood Press Res

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Background/Aims: Acute Kidney Injury (AKI) is a serious clinical state associated with high morbidity and mortality, particularly in critical ill patients. We investigated the hypothesis that serum Cystatin C (sCysC) is a good predictor for AKI and may affect the short-term prognosis of coronary care unit (CCU) patients. Methods: In this prospective, observational study, we screened 412 adults admitted to the CCU from January 1, 2014 to June 1, 2015 at Zhongnan Hospital of Wuhan University. Serum samples were obtained at the time of admission, and sCysC was quantified through nephelometry. AKI was defined based on KDIGO-AKI criteria. After the patients’ hospital discharge, the survivors in this study were followed up for up to 2 years. The primary endpoint was the incidence of AKI stratified by severity stage, while the second endpoints included 2-year mortality, rehospitalization and failure in renal recovery rates, as well as the progression of AKI to CKD. Results: According to the KDIGO-AKI criteria, AKI occurred in 130 (31.6%) patients. After multivariate adjustments, the highest quartile of sCysC was associated with a 9-fold increased risk of incident AKI compared with the lowest quartile. For predicting AKI, sCysC [area under the receiver operating characteristic curve (AUC=0.842)] outperformed β2-micro globulin (AUC=0.813) and the clinical model (AUC=0.777), and a cutoff of 1.255 mg/L yielded good sensitivity and specificity. After a median 19.8-month follow-up, 112 (27.2%) patients died within 2 years after admission. The sCysC independently predicted the risk of 2-year mortality [adjusted odds ratio (OR), 4.955; 95% confidence interval (95% CI), 2.853 to 8.603] and rehospitalization (OR, 3.128; 95% CI, 2.011 to 4.867), as well as renal recovery failure (OR, 3.618, 95% CI, 1.753 to 7.463). Conclusions: Serum CysC is a strong predictor of AKI and the short-term prognosis of CCU patients.

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Section: Discussionsupporting

confidence: 83%

Serum Cystatin C Predicts AKI and the Prognosis of Patients in Coronary Care Unit: a Prospective, Observational Study

Hu¹,

Liu²,

Du³

et al. 2017

Kidney Blood Press Res

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show abstract

“…This result was similar to findings in other studies (22)(23)(24). None of the serum indicators, however, showed a significant correlation with mortality.…”

Section: Discussionsupporting

confidence: 82%

Cystatin C is a moderate predictor of acute kidney injury in the early stage of traumatic hemorrhagic shock

Chen

Shi

Yibulayin

et al. 2015

Experimental and Therapeutic Medicine

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Abstract. Patients with traumatic hemorrhagic shock are highly susceptible to the development of acute kidney injury (AKI), but little data are available regarding the changes in cystatin C (CysC) in patients with traumatic hemorrhagic shock. The aim of the present study, therefore, was to investigate whether CysC has a higher value than serum creatinine (SCr) and urea for use in monitoring glomerular function in traumatic hemorrhagic shock. Data from a cohort of patients with traumatic hemorrhagic shock, who had been admitted to a trauma center, were collected. Receiver operating characteristic (ROC) curve analysis was used to determine the diagnostic value of serum CysC, SCr and urea for the identification of renal dysfunction, and the data were expressed as the area under the curve (AUC). CysC was not significantly affected by gender, age, mechanism of injury or time between injury and arrival at the center in the patients with traumatic hemorrhagic shock. The CysC level of the patients was significantly higher than that of the normal subjects (1.10±0.36 vs. 0.91±0.34 mg/l); the SCr and urea levels of the patients were also significantly increased compared with those of the normal subjects. Nonparametric ROC plots of the sensitivity and specificity of SCr, CysC and urea for the detection of AKI revealed AUC values of 0.901 [95% confidence interval (CI), 0.791-1.000], 0.728 (95% CI, 0.570-0.886) and 0.709 (95% CI, 0.552-0.865) for SCr, CysC and urea, respectively. No significant correlation between mortality and CysC, SCr or urea was found. These data indicate that the level of CysC is significantly increased in the early stage of traumatic hemorrhagic shock and that CysC can be used as a marker to predict AKI; however, the diagnostic utility of CysC remains lower than that of SCr in the early stage of the condition.

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“…Another study has reported that the sensitivity and specificity of serum cystatin C for diagnosing AKI are 73.9 % and 78.9, respectively, using 0.6 mg/l as the cutoff value (6) . Similarly, a study conducted by Lagos-Arevaldo et al [18] on pediatric patients admitted to a PICU has reported that serum cystatin C has more diagnostic accuracy than serum creatinine and a greater predictive value for clinical outcomes.…”

Section: Discussionmentioning

confidence: 93%

Serum Cystatin C as an Early Indicator for Acute Kidney Injury in Critically Ill Children in Pediatric Intensive Care Units

Elkeiy¹

2017

jmscr

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Cystatin C in acute kidney injury diagnosis: early biomarker or alternative to serum creatinine?

Cited by 61 publications

References 53 publications

Serum Cystatin C Predicts AKI and the Prognosis of Patients in Coronary Care Unit: a Prospective, Observational Study

Serum Cystatin C Predicts AKI and the Prognosis of Patients in Coronary Care Unit: a Prospective, Observational Study

Cystatin C is a moderate predictor of acute kidney injury in the early stage of traumatic hemorrhagic shock

Serum Cystatin C as an Early Indicator for Acute Kidney Injury in Critically Ill Children in Pediatric Intensive Care Units

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