Serum creatinine/cystatin C ratio as a case-finding tool for low handgrip strength in Chinese middle-aged and older adults

Abstract

Measuring handgrip strength is the initial step to diagnose sarcopenia. To investigate whether the serum creatinine (Cr)/cystatin C (CysC) ratio could serve as a case-finding tool for low handgrip strength, we conducted a diagnostic accuracy study. Adults (aged ≥ 40 years) with normal renal function were recruited. Trained nurses collected blood samples and conducted the anthropometric measurements and handgrip strength test. The serum concentrations of Cr, CysC, and other biomarkers were measured. We recruited 1098 men and 1241 women. The Cr/CysC ratio was significantly associated with AWGS-defined low handgrip strength among men and women. The areas under the receiver operating characteristic curves were 0.79 among men and 0.78 among women for using the Cr/CysC ratio to identify AWGS-defined low handgrip strength. We set the Cr/CysC ratio cutoff values at < 8.9 among men and < 8.0 among women. The corresponding sensitivity values were 64.9% among men and 63.1% among women, while the specificity values were 83.7% among men and 77.5% among women. In conclusion, the Cr/CysC ratio is positively and linearly associated with handgrip strength and may be helpful for screening low handgrip strength in Chinese middle-aged and older adults dwelling in communities.

Normalized Creatinine-to-Cystatin C Ratio and Risk of Diabetes in Middle-Aged and Older Adults: The China Health and Retirement Longitudinal Study

“…Our study showed that high normalized creatinine-to-cystatin C ratio reduced risk of diabetes in middle-aged and older adults. One might assume that this relationship is attributable to variations in muscle mass and/or muscle strength [5,6,18,28], both of which are identified determinants for risk of diabetes [20,29,30]. However, in the present study, the association between high normalized creatinine-to-cystatin C ratio and low risk of diabetes was independent of muscle strength.…”

“…(2) were diagnosed with diabetes at baseline based on the American Diabetes Association 2010 criteria [21]; (3) had missing information on gender, body weight, body mass index (BMI), systolic blood pressure (SBP), or diastolic blood pressure (DBP); (4) were with outlier data (<1 or >99 percentile) on BMI, SBP, or DBP; (5) were with kidney disease or an estimated glomerular filtration rate (eGFR; calculated using the Chinesebased equation [22]) of less than 30 mL/(min×1.73 m 2 ); and (6) aged <45 years. Finally, a total of 5,055 middle-aged and older adults were included in this study (Supplementary Fig.…”

“…Being extensively presented in nucleated cells, cystatin C is recognized as a novel biomarker that outperforms creatinine in reflecting glomerular filtration [1]. In recent years its ratio from creatinine, namely creatinine-to-cystatin C ratio, has been indicated to reflect health wellbeing in a wide range of clinical contexts [2][3][4][5]. For example, creatinine-to-cystatin C ratio has been advocated to be a surrogate marker for sarcopenia [2][3][4][5][6].…”

“…In recent years its ratio from creatinine, namely creatinine-to-cystatin C ratio, has been indicated to reflect health wellbeing in a wide range of clinical contexts [2][3][4][5]. For example, creatinine-to-cystatin C ratio has been advocated to be a surrogate marker for sarcopenia [2][3][4][5][6]. Moreover, several prospective cohort studies have found that creatinine-to-cystatin C ratio is associated with prognostic outcomes, which include all-cause and cardiovascular mortality [1,7,8], as well as bone fracture [9].…”

Nutritional and Non-Nutritional Predictors of Low Spot Urinary Creatinine Concentration in Patients with Heart Failure

“…The use of the creatinine to cystatin C ratio as a sign of low muscle mass was first proposed by Tetsuka [35], later called the sarcopenia index and validated among critically ill patients in intensive care units [36,37]. It was also clearly established that sarcopenia index is well correlated not only with muscle mass, but also with strength and markers of malnutrition and can serve as an objective tool for screening of malnutrition [23,38]. Taking into account the current diagnostic criteria for sarcopenia, these findings further support the utility of the creatinine/cystatin C ratio as a marker of sarcopenia.…”