Divergence between serum creatine and cystatin C in estimating glomerular filtration rate of critically ill COVID-19 patients

Abstract

Background: The clinical use of serum creatine (sCr) and cystatin C (CysC) in kidney function evaluation of critically ill patients has been in continuous discussion. The difference between estimated glomerular filtration rate calculated by sCr (eGFRcr) and CysC (eGFRcysc) of critically ill COVID-19 patients were investigated in this study. Methods: This is a retrospective, single-center study of critically ill patients with COVID-19 admitted in intensive care unit (ICU) at Wuhan, China. Control cases were moderate COVID-19 patients matched in age and sex at a ratio of 1:1. The eGFRcr and eGFRcysc were compared. The association between eGFR and death were analyzed in critically ill cases. The potential factors influencing the divergence between eGFRcr and eGFRcysc were explored. Results: A total of 76 critically ill COVID-19 patients were concluded. The mean age was 64.5 ± 9.3 years. The eGFRcr (85.45 (IQR 60.58-99.23) ml/min/1.73m 2 ) were much higher than eGFRcysc (60.6 (IQR 34.75-79.06) ml/min/1.73m 2 ) at ICU admission. About 50 % of them showed eGFRcysc < 60 ml/min/1.73 m 2 while 25% showed eGFRcr < 60 ml/min/1.73 m 2 (v 2 ¼ 10.133, p ¼ 0.001). This divergence was not observed in moderate group. The potential factors influencing the divergence included serum interleukin-6 (IL-6), tumor necrosis factor (TNF-a) level as well as APACHEII, SOFA scores. Reduced eGFRcr (<60 mL/min/1.73 m 2 ) was associated with death (HR ¼ 1.939, 95%CI 1.078-3.489, p ¼ 0.027). Conclusions: The eGFRcr was generally higher than eGFRcysc in critically ill COVID-19 cases with severe inflammatory state. The divergence might be affected by inflammatory condition and illness severity. Reduced eGFRcr predicted in-hospital death. In these patients, we advocate for caution when using eGFRcysc.

Laboratory Biomarkers for Diagnosis and Prognosis in COVID-19

“…This is also sustained by the fact that anti-inflammatory drugs, such as steroids, play a key role in limiting renal disease progression ( 98 ). Classic diagnostic biomarkers of kidney damage include creatinine, neutrophil gelatinase-associated lipocalin (NGAL), cystatin C, kidney injury molecule-1 (KIM-1), blood and urinary urea nitrogen, and urinary proteins ( 99 , 100 ).…”

Neurological complications and infection mechanism of SARS-CoV-2

“… 222 – 224 Although infections by SARS-CoV-2 mainly cause lung injury, other organs like the liver, kidney, cardiovascular system, and nervous system are also affected. 225 – 227 Currently, human lung, liver, kidney, intestine, and blood vessels organoids have been deployed to study SARS-CoV-2 infection. 138 , 180 , 228 – 230 Human brain organoids have been applied to study SARS-CoV-2 CNS infections.…”

m6A Regulator-Mediated Methylation Modification Patterns and Characteristics of Immunity in Blood Leukocytes of COVID-19 Patients

“…More importantly, patients without COVID-19 displayed higher protective scores compared to patients with COVID-19. In addition, previous studies have reported that patients with severe COVID-19 had relatively high crp and higher SOFA and APACHE-II scores ( 48 – 50 ). Consistent with the above findings, the results of the correlation analysis suggested that protective score was negatively correlated with the crp, SOFA score, and APACHE-II score.…”