Predictive value of serum creatinine/cystatin C in neurocritically ill patients

Abstract

ObjectiveTo explore the predictive value of serum creatinine (Cr) to cystatin C (CysC) ratio in neurocritically ill patients.MethodsWe conducted a retrospectively observational study of adult patients admitted to a neurocritical care unit (NCU) between Jan 2013 and Jan 2017. Patients were excluded if <18 years old, required neurocritical care <72 hr, did operation during hospitalization, had premorbid disability or acute kidney injury (AKI) at admission. The Cr/CysC ratio was obtained at NCU admission. Primary end points were short‐term (30‐day) mortality and long‐term (6‐month) poor outcome, with the latter defined as modified Rankin Scale (mRS) of 4–6.ResultsOf 538 eligible patients, the etiology included acute ischemic stroke (N = 193, 35.9%), intracranial hemorrhage (N = 116, 21.6%), encephalitis and/or meningitis (N = 85, 15.8%), and others (N = 144, 26.7%). Serum Cr/CysC ratio was significantly correlated with body mass index (BMI) (r = .161, p < .001), the length of NCU stay (r = −.161, p < .001), duration of mechanical ventilation (r = −.138, p = .001), and risk of tracheotomy (r = −.095, p = .028). During follow‐up, 88 (16.4%), patients died within 30 days and 307 (57.1%) patients achieved good outcome at 6 months. In multivariate logistic regression analysis, we identified serum Cr/CysC ratio as an independent predictor of long‐term functional outcome (OR: 0.989, 95% CI: 0.980–0.998, p = .015) but not 30‐day mortality (p = .513).ConclusionsSerum Cr/CysC ratio at admission could be used as a predictor of long‐term poor prognosis in neurocritically ill patients.

Association of serum creatinine-to-cystatin C ratio with skeletal muscle mass and strength in nonalcoholic fatty liver disease in the Iwaki Health Promotion Project

“…( 13 – 15 ) Furthermore, Cre/Cys ratio correlated with muscle strength ( 28 ) and predicted prognostic outcomes in various diseases, including hepatocellular carcinoma. ( 29 – 33 ) However, to the best of our knowledge, the association between Cre/CysC ratio and sarcopenia in NAFLD has never been reported. Thus, our study is the first to show a positive relationship between Cre/CysC ratio and both muscle mass and muscle strength in NAFLD.…”

Sarcopenia index as a predictor of clinical outcomes in older patients undergoing transcatheter aortic valve replacement

“…7 By contrast, an indicator that can be easily calculated that reflects SMM simply is the serum creatinine/serum cystatin-C ratio, the so-called sarcopenia index (SI). Studies have also been published suggesting that low SI can predict poor long-term prognosis in noncardiac conditions such as neuro critically ill patients, 8 acute kidney injury (AKI) requiring renal replacement therapy (RRT) 9 and cardiovascular procedures including postpercutaneous coronary intervention (PCI). 10 However, the clinical relevance of SI in older patients undergoing TAVR has not been addressed.…”

Changes in creatinine‐to‐cystatin C ratio over 4 years, risk of diabetes, and cardiometabolic control: The China Health and Retirement Longitudinal Study

“…Previous studies have suggested that higher creatinine-tocystatin C ratio at baseline was associated with better prognostic outcomes including low risk of cardiovascular events 23,24 and short-and long-term mortality. [25][26][27] However, none of them has assessed whether changes in creatinine-to-cystatin C ratio were predictive for future health outcome. As an attempt to fill in this blank, our study showed that both absolute and relative increases in creatinine-to-cystatin C ratio during follow-up were related to reduced risk of diabetes.…”