Serum and urine cystatin C are poor biomarkers for acute kidney injury and renal replacement therapy

• Published in: Intensive care medicine Vol. 37; no. 3; pp. 493 - 501
• Main Authors: Royakkers, Annick A. N. M., Korevaar, Johanna C., van Suijlen, Jeroen D. E., Hofstra, Lieuwe S., Kuiper, Michael A., Spronk, Peter E., Schultz, Marcus J., Bouman, Catherine S. C.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer-Verlag 01.03.2011; Springer; Springer Nature B.V
• Subjects: Acute Kidney Injury - blood; Acute Kidney Injury - therapy; Acute Kidney Injury - urine; Adult; Aged; Aged, 80 and over; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Anesthesiology; Biological and medical sciences; Biological markers; Biomarkers; Biomarkers - blood; Biomarkers - urine; Cohort analysis; Cohort Studies; Creatinine; Critical care; Critical Care Medicine; Cystatin C - blood; Cystatin C - urine; Diseases of the respiratory system; Emergency Medicine; Female; Hospitals; Humans; Intensive; Intensive care; Intensive care medicine; Kidneys; Male; Medical research; Medical sciences; Medicine; Medicine & Public Health; Medicine, Experimental; Middle Aged; Needs Assessment; Original; Pain Medicine; Pediatrics; Physiology; Pneumology/Respiratory System; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Renal Replacement Therapy; Urine; Netherlands; Renal replacement therapy; Serum cystatin C; Acute kidney injury; Predictive biomarkers; Intensive care unit; Urine cystatin C; Kidney disease; Cystatin; Intensive care; Replacement therapy; Urinary system disease; Serum cystatin C; Urine cystatin C; Resuscitation
• ISSN: 0342-4642; 1432-1238
• DOI: 10.1007/s00134-010-2087-y

Purpose To evaluate whether cystatin C in serum (sCyC) and urine (uCyC) can predict early acute kidney injury (AKI) in a mixed heterogeneous intensive care unit (ICU), and also whether these biomarkers can predict the need for renal replacement therapy (RRT). Methods Multicenter prospective observational cohort study in patients ≥18 years old and with expected ICU stay ≥72 h. The RIFLE class for AKI was calculated daily, while sCyC and uCyC were determined on days 0, 1, and alternate days until ICU discharge. Test characteristics were calculated to assess the diagnostic performance of CyC. Results One hundred fifty-one patients were studied, and three groups were defined: group 0 ( N  = 60), non-AKI; group 1 ( N  = 35), AKI after admission; and group 2 ( N  = 56), AKI at admission. We compared the two days prior to developing AKI from group 1 with the first two study days from group 0. On Day –2, median sCyC was significantly higher (0.93 versus 0.80 mg/L, P  = 0.01), but not on Day –1 (0.98 versus 0.86 mg/L, P  = 0.08). The diagnostic performance for sCyC was fair on Day –2 [area under the curve (AUC) 0.72] and poor on Day –1 (AUC 0.62). Urinary CyC had no diagnostic value on either of the two days prior to AKI (AUC <0.50). RRT was started in 14 patients with AKI; sCyC and uCyC determined on Day 0 were poor predictors for the need for RRT (AUC ≤0.66). Conclusions In this study, sCyC and uCyC were poor biomarkers for prediction of AKI and the need for RRT.