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

Abstract

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.

Age- and sex-specific reference intervals for the serum cystatin C/creatinine ratio in healthy children (0–18 years old)

“…[1][2][3] CysC is less affected by non-renal factors compared with Cr. 4 In patients with postrenal acute kidney injury, serum Cr levels are significantly increased, while there is only a slight increase in CysC levels. 5,6 Determining whether the CysC/Cr ratio is a potential diagnostic marker for postrenal acute kidney injury is would be helpful, especially for patients without definite hydronephrosis.…”

Early Predictors of Acute Kidney Injury: A Narrative Review

“…The areas under the curve of CysC and Scr were 0.728 and 0.901, respectively, in patients with traumatic hemorrhagic shock. Although CysC levels were significantly increased in the early stage and can serve as a predictor of AKI, its value in early diagnosis of traumatic hemorrhagic shock was still lower than Scr [19].…”

Roles Played by Biomarkers of Kidney Injury in Patients with Upper Urinary Tract Obstruction

“…Use of the urine cystatin C level for early detection of AKI after cardiac surgery allows for the diagnosis of tubular damage and dysfunction [ 30 ]. Serum cystatin C is a useful biomarker for AKI in patients in the intensive care unit (ICU) [ 31 , 32 ] with contrast-induced AKI [ 29 , 33 ]. In one study, preoperative serum cystatin C levels were significantly higher in children with UPJO compared to controls and decreased after surgery ( Table 1 ) [ 26 ], and the AUC-ROC value of serum cystatin C indicating UPJO was 0.72 ( Table 1 ) [ 26 , 34 ].…”