Serum Cystatin C Predicts AKI and the Prognosis of Patients in Coronary Care Unit: a Prospective, Observational Study

被引:17
作者
Hu, Yugang [1 ]
Liu, Huilan [1 ]
Du, Liguo [1 ]
Wan, Jing [2 ]
Li, Xiaoning [1 ]
机构
[1] Wuhan Univ, Zhongnan Hosp, Dept Nephrol, 169 Rd Donghu, Wuhan 430071, Hubei, Peoples R China
[2] Wuhan Univ, Zhongnan Hosp, Dept Cardiol, Wuhan, Hubei, Peoples R China
基金
中国国家自然科学基金;
关键词
Cystatin C; Acute Kidney Injury; Prognosis; Coronary Care Unit; ACUTE KIDNEY INJURY; DECOMPENSATED HEART-FAILURE; GLOMERULAR-FILTRATION-RATE; ACUTE-RENAL-FAILURE; URINARY BIOMARKERS; CARDIAC-SURGERY; RISK PREDICTION; CARDIOVASCULAR-DISEASE; CARDIORENAL SYNDROME; CREATININE;
D O I
10.1159/000485341
中图分类号
Q4 [生理学];
学科分类号
071003 ;
摘要
Background/Aims: Acute Kidney Injury (AKI) is a serious clinical state associated with high morbidity and mortality, particularly in critical ill patients. We investigated the hypothesis that serum Cystatin C (sCysC) is a good predictor for AKI and may affect the short-term prognosis of coronary care unit (CCU) patients. Methods: In this prospective, observational study, we screened 412 adults admitted to the CCU from January 1, 2014 to June 1, 2015 at Zhongnan Hospital of Wuhan University. Serum samples were obtained at the time of admission, and sCysC was quantified through nephelometry. AKI was defined based on KDIGO-AKI criteria. After the patients' hospital discharge, the survivors in this study were followed up for up to 2 years. The primary endpoint was the incidence of AKI stratified by severity stage, while the second endpoints included 2-year mortality, rehospitalization and failure in renal recovery rates, as well as the progression of AKI to CKD. Results: According to the KDIGO-AKI criteria, AKI occurred in 130 (31.6%) patients. After multivariate adjustments, the highest quartile of sCysC was associated with a 9-fold increased risk of incident AKI compared with the lowest quartile. For predicting AKI, sCysC [area under the receiver operating characteristic curve (AUC=0.842)] outperformed beta 2-micro globulin (AUC=0.813) and the clinical model (AUC=0.777), and a cutoff of 1.255 mg/L yielded good sensitivity and specificity. After a median 19.8-month follow-up, 112 (27.2%) patients died within 2 years after admission. The sCysC independently predicted the risk of 2-year mortality [adjusted odds ratio (OR), 4.955; 95% confidence interval (95% CI), 2.853 to 8.603] and rehospitalization (OR, 3.128; 95% CI, 2.011 to 4.867), as well as renal recovery failure (OR, 3.618, 95% CI, 1.753 to 7.463). Conclusions: Serum CysC is a strong predictor of AKI and the short-term prognosis of CCU patients. (c) 2017 The Author(s) Published by S. Karger AG, Basel
引用
收藏
页码:961 / 973
页数:13
相关论文
共 43 条
  • [1] Renal Effects of Coronary Artery Bypass Graft Surgery in Diabetic and Non-Diabetic Patients: A Study with Urinary Neutrophil Gelatinase-Associated Lipocalin and Serum Cystatin C
    Arun, Oguzhan
    Celik, Gulperi
    Oc, Bahar
    Unlu, Ali
    Celik, Jale Bengi
    Oc, Mehmet
    Duman, Ates
    [J]. KIDNEY & BLOOD PRESSURE RESEARCH, 2015, 40 (02) : 141 - 152
  • [2] Novel Markers of Kidney Function as Predictors of ESRD, Cardiovascular Disease, and Mortality in the General Population
    Astor, Brad C.
    Shafi, Tariq
    Hoogeveen, Ron C.
    Matsushita, Kunihiro
    Ballantyne, Christie M.
    Inker, Lesley A.
    Coresh, Josef
    [J]. AMERICAN JOURNAL OF KIDNEY DISEASES, 2012, 59 (05) : 653 - 662
  • [3] Urinary Biomarkers Improve the Diagnosis of Intrinsic Acute Kidney Injury in Coronary Care Units
    Chang, Chih-Hsiang
    Yang, Chia-Hung
    Yang, Huang-Yu
    Chen, Tien-Hsing
    Lin, Chan-Yu
    Chang, Su-Wei
    Chen, Yi-Ting
    Hung, Cheng-Chieh
    Fang, Ji-Tseng
    Yang, Chih-Wei
    Chen, Yung-Chang
    [J]. MEDICINE, 2015, 94 (40)
  • [4] New Combined Serum Creatinine and Cystatin C Quadratic Formula for GFR Assessment in Children
    Chehade, Hassib
    Cachat, Francois
    Jannot, Anne-Sophie
    Meyrat, Blaise-Julien
    Mosig, Dolores
    Bardy, Daniel
    Parvex, Paloma
    Girardin, Eric
    [J]. CLINICAL JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY, 2014, 9 (01): : 54 - 63
  • [5] Urinary Biomarkers at the Time of AKI Diagnosis as Predictors of Progression of AKI among Patients with Acute Cardiorenal Syndrome
    Chen, Chunbo
    Yang, Xiaobing
    Lei, Ying
    Zha, Yan
    Liu, Huafeng
    Ma, Changsheng
    Tian, Jianwei
    Chen, Pingyan
    Yang, Tiecheng
    Hou, Fan Fan
    [J]. CLINICAL JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY, 2016, 11 (09): : 1536 - 1544
  • [6] Acute Kidney Injury Biomarkers for Patients in a Coronary Care Unit: A Prospective Cohort Study
    Chen, Tien-Hsing
    Chang, Chih-Hsiang
    Lin, Chan-Yu
    Jenq, Chang-Chyi
    Chang, Ming-Yang
    Tian, Ya-Chung
    Hung, Cheng-Chieh
    Fang, Ji-Tseng
    Yang, Chih-Wei
    Wen, Ming-Shien
    Lin, Fun-Chung
    Chen, Yung-Chang
    [J]. PLOS ONE, 2012, 7 (02):
  • [7] Chronic kidney disease after acute kidney injury: a systematic review and meta-analysis
    Coca, Steven G.
    Singanamala, Swathi
    Parikh, Chirag R.
    [J]. KIDNEY INTERNATIONAL, 2012, 81 (05) : 442 - 448
  • [8] Prevalence and impact of worsening renal function in patients hospitalized with decompensated heart failure: results of the prospective outcomes study in heart failure (POSH)
    Cowie, MR
    Komajda, M
    Murray-Thomas, T
    Underwood, J
    Ticho, B
    [J]. EUROPEAN HEART JOURNAL, 2006, 27 (10) : 1216 - 1222
  • [9] Chronic kidney disease progression is mainly associated with non-recovery of acute kidney injury
    D'hoore, Eric
    Neirynck, Nathalie
    Schepers, Eva
    Vanholder, Raymond
    Verbeke, Francis
    Van Thielen, Mira
    Van Biesen, Wim
    [J]. JOURNAL OF NEPHROLOGY, 2015, 28 (06) : 709 - 716
  • [10] Plasmatic cystatin C for the estimation of glomerular filtration rate in intensive care units
    Delanaye, P
    Lambermont, B
    Chapelle, JP
    Gielen, J
    Gerard, P
    Rorive, G
    [J]. INTENSIVE CARE MEDICINE, 2004, 30 (05) : 980 - 983