Predictive value of serum cystatin C for acute kidney injury in adults: a meta-analysis of prospective cohort trials

Abstract

The role of serum cystatin C (Scys) for the detection of acute kidney injury (AKI) has not been fully discussed. This meta-analysis was aimed to investigate the overall diagnostic accuracy of Scys for AKI in adults, and further identify factors affecting its performance. Studies before Sept. 2016 were retrieved from PubMed, Embase, Web of Science and the Cochrane Library. A total of 30 prospective cohort studies (involving 4247 adults from 15 countries, 982 patients occurring AKI) were included. The revised Quality Assessment for Studies of Diagnostic Accuracy (QUADAS-2) tools demonstrated no significant bias had influenced the methodological quality of the included studies. Scys showed a high predictive power for all-cause AKI, that the area under the receiver operating characteristic curve was 0.89. The detailed assessment parameters, such as sensitivity, specificity, positive likelihood ratio, negative likelihood ratio and diagnostic odds ratio for Scys were 0.82, 0.82, 4.6, 0.22 and 21, respectively. Although Scys could be slightly influenced by the following factors: settings, AKI diagnostic criteria, ethnicity, determination method, age and gender, these factors above did not reach statistically significance. In conclusion, Scys could be a vital promising marker to screen out AKI.

A Prospective Observational Study on the Predictive Value of Serum Cystatin C for Successful Weaning from Continuous Renal Replacement Therapy

“…Moreover, the serum CysC level is less dependent on age, sex, race, and muscle mass compared to serum creatinine. Therefore, serum CysC could be an optimal marker, not only for the diagnosis of chronic kidney disease, but also for predicting AKI [12]. Zhang et al [20] performed a retrospective study, and showed that higher serum CysC is associated with poor renal recovery and a longer dependence on CRRT in critically ill patients.…”

“…It may also be a better biomarker to prediction all-cause AKI based on its half-life, which is shorter than that of serum creatinine [12,13]. Moreover, neutrophil gelatinase-associated lipocalin (NGAL) has been shown to be an early biomarker for predicting AKI before serum creatinine increases [14].…”

Use of Both Serum Cystatin C and Creatinine as Diagnostic Criteria for Cardiac Surgery-Associated Acute Kidney Injury and Its Correlation with Long-Term Major Adverse Events

“…It is anticipated that these biomarkers will enable earlier diagnosis of AKI and facilitate prognostication [10-13, 17, 18]. Among these novel biomarkers, sCyC is considered the most promising functional marker for glomerular filtration [10, 17, 18].…”

“…It is anticipated that these biomarkers will enable earlier diagnosis of AKI and facilitate prognostication [10-13, 17, 18]. Among these novel biomarkers, sCyC is considered the most promising functional marker for glomerular filtration [10, 17, 18]. Wan et al [23] reported that the predictive value (the area under the ROC curve, AUC) of sCyC was 0.974, with high sensitivity and specificity, which were similar in Liu’s [24], Yim’s [25], and other studies.…”

“…Namely, once renal function is fluctuating, sCyC changes much earlier than sCr [15, 16]. Recently, sCyC has been proposed as a superior marker to sCr for detection of early changes in GFR and as a marker of acute injury to the kidney [17, 18]. Besides, sCyC can be assayed easily, and routine laboratory measurement increasingly is becoming available to clinicians.…”