A new index based on serum creatinine and cystatin C is useful for assessing sarcopenia in patients with advanced cancer

Fu, Xi; Tian, Zhen; Su, Wen; Sun, Huihui; Thapa, Sudip; Xiong, Huihua; Liu, Huiquan; Li, Lü; Yu, Shiying

doi:10.1016/j.nut.2020.111032

Cited by 41 publications

(46 citation statements)

References 44 publications

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“…Our study demonstrated that, among these serum indices, Cr×eGFRcys exhibited the best correlations with skeletal muscle mass, strength, and gait speed. This observation was in accordance with results from two recent studies in cancer patients, which showed that Cr×eGFRcys outperformed Cr/CysC in predicting sarcopenia and postoperative complications (40,41).…”

Section: Discussionsupporting

confidence: 92%

A Novel Application of Serum Creatinine and Cystatin C to Predict Sarcopenia in Advanced CKD

et al. 2022

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Sarcopenia is highly prevalent in patients with advanced chronic kidney disease (CKD), yet a reliable serum index has not been established. The product of serum creatinine and the estimated glomerular filtration rate based on cystatin C (Cr×eGFRcys) was recently proposed as a sarcopenia index (SI), approximately to 24-h filtered creatinine through the glomerulus. We aimed to evaluate the diagnostic validity of the novel SI in advanced CKD. In 297 patients with non-dialysis stage 3b-5 CKD, aged 68.8 ± 12.9 years, the total skeletal muscle mass (SMM), handgrip strength (HGS), and usual gait speed were assessed. Sarcopenia was defined based on the Asian Working Group for Sarcopenia 2019 consensus update. The prevalence of sarcopenia in this cohort was 20.2%. The SI correlated moderately with SMM (r = 0.503, P < 0.001), HGS (r = 0.508, P < 0.001), and gait speed (r = 0.381, P < 0.001); the independency of the SI with three muscle metrics was confirmed after extensive adjustment. For sarcopenia prediction, the SI had acceptable discriminative powers in males [area under the receiver operating characteristic curve (AUC) 0.646, 95% confidence interval (CI) 0.569–0.718] and females (AUC 0.754, 95% CI 0.670–0.826). In males, the best cut-off was 53.9, which provided 71.1% sensitivity, 58.0% specificity, 32.9% positive predictive value (PPV), and 87.4% negative predictive value (NPV); in females, the best cut-off was 45.8, which provided 81.8% sensitivity, 62.3% specificity, 31.0% PPV, and 94.3% NPV. In conclusion, Cr×eGFRcys could be served as a surrogate marker for sarcopenia and may be helpful for sarcopenia screening in advanced CKD. Further studies are needed to expand our investigation.

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Section: Discussionsupporting

confidence: 92%

A Novel Application of Serum Creatinine and Cystatin C to Predict Sarcopenia in Advanced CKD

et al. 2022

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“… 25 As a new member of this field, SI has low cost, high accessibility and repeatability. 26 Therefore, SI was studied in different populations such as cancer 21 , 27 chronic liver diseases, 28 severe patients, 29 peritoneal dialysis patients, 30 older people with normal kidney function 31 and so on. However, in this follow-up study of 758 hospitalized participants, we firstly demonstrated the association between the SI and mortality, nutritional risk/malnutrition and sarcopenia in the elderly including the patients with RD.…”

Section: Discussionmentioning

confidence: 99%

Sarcopenia Index Based on Serum Creatinine and Cystatin C is Associated with Mortality, Nutritional Risk/Malnutrition and Sarcopenia in Older Patients

Ren¹,

Su²,

Tao³

et al. 2022

CIA

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Purpose To investigate the association of sarcopenia index (SI) [(serum creatinine/serum cystatin C) × 100] with mortality, nutritional risk/malnutrition and sarcopenia among hospitalized older adults. Subjects and Methods A prospective analysis was performed in 758 hospitalized older adults. Anthropometric measures and biochemical parameters were carried out for each patient. Sarcopenia was defined according to the Asian Working Group for Sarcopenia (AWGS) 2019 algorithm. Nutritional risk/malnutrition was defined according to the European Society of Clinical Nutrition and Metabolism (ESPEN) criteria. The logistic regression analysis was employed for the analysis of correlation between the SI and other variables. Cox regression analysis was employed to analyze correlation between the SI and mortality. Results A total of 758 participants agreed to participate in this study (589 men and 169 women; mean age: 85.6±6.1 years). The median of the follow-up period was 212 days. A total of 112 patients died. A high SI (per 1-SD was 22.1) was independently associated with all-cause mortality (HR per 1-SD = 0.61, 95% CI: 0.47–0.79), nutritional risk/malnutrition (OR per 1-SD = 0.38, 95% CI: 0.29–0.49) and sarcopenia (OR per 1-SD = 0.58, 95% CI: 0.45–0.74). High SI was positively correlated with albumin (r = 0.32, P < 0.001), hemoglobin (r = 0.24, P < 0.001), body mass index (BMI) (r = 0.12, P = 0.001), waist circumference (WC) (r = 0.08, P = 0.046), calf circumference (CC) (r = 0.45, P < 0.001), hand grip strength (HGS) (r = 0.52, P < 0.001) and negatively correlated with triglyceride glucose (TyG) (r = −0.11, P = 0.007). Conclusion The SI based on serum cystatin C and creatinine is associated with long-term mortality, nutritional risk/malnutrition and sarcopenia in hospitalized older Chinese patients.

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“…Second, sarcopenia is a well-identified risk factor for diabetes, 28 while there is evidence that increases in creatinine-to-cystatin C ratio were associated with a low likelihood of sarcopenia. 14,29 Third, as shown by our linear regression analyses, increases in creatinine-to-cystatin C ratio were significantly associated with reductions in HbA1c and hs-CRP. This indicates that increases in creatinine-to-cystatin C ratio may improve glycemic control and ameliorate inflammation, leading to reduced risk of diabetes subsequently.…”

Section: Interpretationsmentioning

confidence: 61%

“…10,11 It has been broadly validated against computed tomography in determining muscle mass in a variety of populations including older adults. [12][13][14] Moreover, the finding that creatinine-tocystatin C ratio was better than bioelectrical impedance analysis in discriminating myopenia 13 provides further evidence in support of its great potential as a surrogate biomarker for muscle mass quantification. As a result, assessing the association of changes in creatinine-tocystatin C ratio with risk of diabetes as well as with changes in cardiometabolic factors (eg, blood pressure, hemoglobin A1c [HbA1c], high-sensitivity C-reactive protein [hs-CRP]) may help to enrich our understanding about the clinical utility for creatinine-to-cystatin C ratio and the physiological role of skeletal muscle in maintaining health and well-being.…”

Section: Introductionmentioning

confidence: 83%

“…First, creatinine-tocystatin C ratio is recognized as a surrogate biomarker for muscle mass. [12][13][14] Increases in creatinine-to-cystatin C ratio may therefore indicate an increase in muscle mass, the latter of which might represent an enhanced capacity to consume glucose and maintain glycemic homeostasis. Second, sarcopenia is a well-identified risk factor for diabetes, 28 while there is evidence that increases in creatinine-to-cystatin C ratio were associated with a low likelihood of sarcopenia.…”

Section: Interpretationsmentioning

confidence: 99%

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

Qiu

Cai

Yuan

et al. 2021

Journal of Diabetes

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Background: Creatinine-to-cystatin C ratio has attracted substantial interest as a measure to reflect health well-being, but no studies have assessed whether its longitudinal changes are associated with risk of diabetes. We aimed to examine their association, along with the exploration of the relationship of such changes with cardiometabolic control in middle-aged and older adults. Methods: We included a total of 3278 participants aged ≥45 years who provided measurements of creatinine and cystatin C at baseline and 4 years later from the China Health and Retirement Longitudinal Study. Diabetes was diagnosed based on glucose, hemoglobin A1c (HbA1c), medical history, or use of antidiabetic mediations. Odds ratio (OR) and 95% confidence interval (CI) were obtained using logistic regression analyses.Results: After 4-year follow-up, 272 participants developed diabetes. Larger increases in creatinine-to-cystatin C ratio were associated with lower risk of diabetes. The multivariable-adjusted OR for diabetes per 1 SD increase in creatinine-to-cystatin C ratio was 0.84 (95% CI 0.72-0.98). Compared with participants showing decreases in creatinine-to-cystatin C ratio but increases in body mass index (BMI), those experiencing increases in creatinine-to-cystatin C ratio and decreases in BMI had the largest risk reduction (multivariableadjusted OR 0.52). Changes in creatinine-to-cystatin C ratio showed inverse correlation with blood pressure, HbA1c, lipids, and C-reactive protein at the 4-year follow-up. Moreover, they also correlated inversely with changes in HbA1c and C-reactive protein (all P ≤ 0.004). Conclusions: Increases in creatinine-to-cystatin C ratio led to reduced risk of diabetes and may benefit cardiometabolic control.

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A new index based on serum creatinine and cystatin C is useful for assessing sarcopenia in patients with advanced cancer

Cited by 41 publications

References 44 publications

A Novel Application of Serum Creatinine and Cystatin C to Predict Sarcopenia in Advanced CKD

A Novel Application of Serum Creatinine and Cystatin C to Predict Sarcopenia in Advanced CKD

Sarcopenia Index Based on Serum Creatinine and Cystatin C is Associated with Mortality, Nutritional Risk/Malnutrition and Sarcopenia in Older Patients

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

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