Baseline Serum Cystatin C Is a Potential Predictor for Acute Kidney Injury in Patients with Acute Pancreatitis

Abstract

Aims The study is aimed at studying the incidence of acute kidney injury (AKI) and exploring the potential predictor for AKI in patients with acute pancreatitis. Methods A retrospective study adopting a stratified cohort sampling design was performed in a cohort of patients (n = 237) diagnosed with acute pancreatitis without any renal injury. The following information including age, gender, serum creatinine, serum urea nitrogen, serum uric acid, serum cystatin C, fasting serum glucose, serum amylase, serum lipase, serum choline esterase, total protein, albumin, globulin, total bilirubin, direct bilirubin, total bile acids, glutamic-pyruvic transaminase, glutamic-oxaloacetic transaminase, gamma glutamyl transpeptidase, and alkaline phosphatase were collected from each patient when they were diagnosed with acute pancreatitis. Student t-test was conducted to figure out the difference between patients with and without AKI. Univariate and multivariate logistic regression analyses were used for investigating the predictors for AKI in patients with acute pancreatitis. Results 18 (7.6%) patients in total had developed AKI among the study group. Compared with patients without AKI (1.01 ± 0.26 mg/L), the level of baseline serum cystatin C (CYS-C) was significantly higher in patients with AKI (3.64 ± 2.17 mg/L, P < 0.001). Baseline serum CYS-C (OR = 203.594, P < 0.001) was the independent and significant predictor for AKI in patients with acute pancreatitis. AKI in patients with acute pancreatitis could be identified with a sensitivity of 88.9% at specificity of 100% (AUC = 0.948, 95% CI 0.879–1.000) by baseline serum CYS-C (cut-off value = 1.865 mg/L). Conclusions Baseline serum CYS-C shall be adopted to predict the potential risk of AKI in patients with acute pancreatitis.

Does Beta-Trace Protein (BTP) Outperform Cystatin C as a Diagnostic Marker of Acute Kidney Injury Complicating the Early Phase of Acute Pancreatitis?

“…Most laboratory markers proposed for the fast prognosis or diagnosis of AKI have not been studied in AP [19]. Previously, serum cystatin C has been shown to predict AKI in AP with high diagnostic accuracy [33]. Our study shows for the first time that serum BTP, a marker of glomerular filtration, is increased early in patients with AP who develop AKI, in parallel to serum cystatin C. BTP concentrations were highly correlated with serum creatinine and cystatin C. The diagnostic accuracy of BTP for early diagnosis of AKI in the early phase of AP was comparable to that of serum cystatin C. However, it seemed lower than the diagnostic accuracy of serum and urine NGAL.…”

“…Serum cystatin C has been evaluated as a marker of AKI in various settings, including sepsis [40,41] and AP [33]. Recent study in over 200 patients with AP reported excellent diagnostic accuracy for AKI (area under ROC curve of 0.948) [33].…”

“…However, both SAP and AKI were more prevalent in our study group (9.6% and 18% versus 5% and 7.6%, respectively). Our study included patients admitted within 24 h from the onset of AP symptoms; this time-period was not defined in the study of Chai et al [33] and might be longer. Moreover, Chai et al [33] excluded patients with prediagnosed renal disease, whereas in our group four patients had kidney disease diagnosed before the onset of AP.…”

Development and validation of a predictive model for predicting acute kidney injury in patients with acute pancreatitis

“…Acute kidney injury (AKI) is a common complication of acute pancreatitis, occurs in almost 70% of cases of severe acute pancreatitis [3]. The development of acute kidney injury in patients with acute pancreatitis significantly increases the risk of death [4].…”

Serum Cystatin C in Early Identification of Acute Kidney Injury in Acute Pancreatitis: Is It an Old Wine in a New Bottle?

“…However, the cut-off value as observed by them seems different as compared to other studies. 10 , 11 …”