Creatinine-to-cystatin C ratio as a marker of skeletal muscle mass for predicting postoperative complications in patients undergoing gastric cancer surgery

Gao, Jiaqi; Liang, Hailun; Qian, Yun; Pan, Junhai; Liu, Wei; Qi, Wei; Zhou, Wei; Ge, Xiaolong; Wang, Xianfa

doi:10.21037/apm-20-2366

Cited by 7 publications

(4 citation statements)

References 32 publications

(33 reference statements)

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“…In 2020, Ulmann G. et al [ 34 ] validated the efficacy of SI in 44 cancer patients and found it to be better than that of BIA. Gao et al [ 35 ] found that SI could predict postoperative complications after gastric cancer surgery. To our knowledge, the value of SI among EC patients was assessed for the first time.…”

Section: Discussionmentioning

confidence: 99%

Serum creatinine/cystatin C ratio as a screening tool for sarcopenia and prognostic indicator for patients with esophageal cancer

Zheng

Wang

et al. 2022

BMC Geriatr

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Background & aims Sarcopenia is associated with poor clinical outcomes of patients who underwent esophagectomy. The current diagnostic criteria for sarcopenia are complex and laborious. We aimed to employ the simple and economic indicator sarcopenia index (SI = creatinine/cystatin C ×100) to screen for sarcopenia and to evaluate its prognostic value in patients with esophageal cancer (EC). Methods Older participants in the National health and nutrition examination survey (NHANES) database (1999–2002) were divided into three groups according to tertiles of the SI value to explore the feasibility of SI in the diagnosis of sarcopenia. Restricted cubic spline (RCS) was utilized to show the non-linear relationship between all-cause mortality and SI. Patients with EC admitted to Jinling Hospital were enrolled to validate the efficacy and prognostic value of SI. Cut-off values of SI were determined using receiver operating characteristic curves. Multivariable logistic analyses and Cox analyses were used to identify the independent factors of postoperative complications and long-term survival, respectively. Results A total of 989 participants were identified from the NHANES database. SI showed the diagnostic value of sarcopenia (tertile 1 vs. tertile 3: odds ratio [OR]=3.67, 95% confidence interval [CI]: 1.52–8.87, p=0.004; tertile 2 vs. tertile 3: OR=1.79, 95% CI: 0.75–4.28, p=0.191) adjusted for race, gender, and body mass index (BMI). Individuals with SI ≤ 68 had a poorer overall survival (OS) (hazard ratio [HR]=2.14, 95% CI: 1.71–2.68, p<0.001), and the RCS plot showed that the all-cause mortality risk gradually decreased with the increase in SI. Then, 203 patients with EC were enrolled, of which 76 patients were diagnosed with sarcopenia. There was a linear correlation between SI and skeletal muscle index and prealbumin, indicating that SI was reliable for diagnosing sarcopenia. Patients in the high sarcopenia risk group (Male: SI < 62; Female: SI < 55) showed a higher incidence of complications (OR=3.50, 95% CI: 1.85–6.61, p<0.001) and poorer long-term survival (HR=2.62, 95% CI: 1.02–6.77, p=0.046). Conclusion SI could be used to identify sarcopenia in patients with EC, and it is a useful prognostic factor of postoperative complications and long-term survival.

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Section: Discussionmentioning

confidence: 99%

Serum creatinine/cystatin C ratio as a screening tool for sarcopenia and prognostic indicator for patients with esophageal cancer

Zheng

Wang

et al. 2022

BMC Geriatr

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“…Kashani et al 22 reported that Cr/CysC ratio was independently predictive of both hospital and 90‐day mortality among patients in the intensive care unit. Gao et al 29 revealed that the Cr/CysC ratio could effectively predict postoperative complications in patients with gastric cancer postoperatively. Zheng et al 11 reported a higher incidence of postoperative complications and poorer long‐term survival in patients with esophageal cancer with low Cr/CysC ratios.…”

Section: Discussionmentioning

confidence: 99%

“…reported that Cr/CysC ratio was independently predictive of both hospital and 90-day mortality among patients in the intensive care unit. Gao et al29 revealed that the Cr/…”

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confidence: 99%

Usefulness of serum creatinine and cystatin C ratio as a screening tool for predicting prognosis in patients with pancreatic cancer

Tsukagoshi

Watanabe

Araki

et al. 2023

Annals of Gastroent Surgery

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AimThis study aimed to evaluate the usefulness of the serum creatinine/cystatin C (Cr/CysC) ratio as a prognostic factor after pancreatic surgery in patients with pancreatic cancer.MethodsWe retrospectively analyzed the data of 88 patients with pancreatic ductal carcinoma who underwent pancreatic surgery from January 2017 to December 2020. CysC measured from frozen serum samples and circulating Cr levels were used to calculate the Cr/CysC ratio. The cutoff value of the Cr/CysC ratio was determined using receiver operating characteristic curves. Cox proportional hazards model analysis and survival curves were applied to identify the prognostic factors.ResultsThe optimal cutoff value of the Cr/CysC ratio for predicting mortality after surgery was 1.05. This study included 20 (22.7%) and 68 (77.3%) patients with high and low Cr/CysC ratios, respectively. The low Cr/CysC ratio was significantly associated with female sex (p = 0.020) and higher levels of C‐reactive protein (p = 0.020). The postoperative length of stay was significantly longer in patients with low Cr/CysC rates (p = 0.044). Patients with low Cr/CysC ratio showed poorer prognosis in relapse‐free survival (hazard ratio [HR] = 3.33; 95% confidence interval [CI]: 1.54–4.20; p = 0.002) and overall survival (HR = 2.52, 95% CI: 1.04–6.10, p = 0.041), respectively, which were significantly worse than in those with high Cr/CysC ratios (p = 0.003 and 0.049, respectively).ConclusionThe Cr/CysC ratio could be a useful screening tool for predicting the prognosis of patients with pancreatic ductal carcinoma undergoing pancreatic surgery.

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“…In this context, several researchers have evaluated the difference between creatinine and cystatin C and tried to find the clinical implication of the discrepancy between the two biomarkers. Previous studies have shown that elevated serum creatinine/cystatin C ratio (CCR) is associated with various diseases, including chronic obstructive pulmonary disease (COPD) ( 8 ), DM ( 9 ), non-alcoholic fatty liver disease ( 10 ), obstructive coronary artery disease ( 11 ) and cancer ( 12 , 13 ) as well as all-cause mortality. Surprisingly, although both cystatin C and creatinine are cleared by renal excretion and are widely used as biomarkers of renal function, there is no study concerning renal impairment as a confounding variable in the relationship between CCR and hard outcomes.…”

Section: Introductionmentioning

confidence: 99%

Changes in Mortality According to Creatinine/Cystatin C Ratio in Chronic Kidney Disease and Non-chronic Kidney Disease Patients

et al. 2022

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BackgroundSerum creatinine and cystatin C are not only good indicators of renal function but have also been confirmed to be related to disease prognosis and mortality in various diseases via creatinine/cystatin C ratio (CCR). However, although they are biomarkers of renal function, there is no study regarding renal impairment as a confounding variable in the relationship between CCR and all-cause mortality.MethodsPatients who had simultaneous measurements of serum creatinine and cystatin C between 2003 and 2020 were enrolled. The patients with chronic kidney disease (CKD) were defined as having an estimated glomerular filtration rate (eGFR) CKD-EPI Cr-Cystatin C < 60 ml/min/1.73 m2. CCR was calculated by dividing the serum creatinine level by the cystatin C level measured on the same day. The main outcome assessed was all-cause mortality according to CCR in CKD or non-CKD groups.ResultsAmong the 8,680 patients in whom creatinine and cystatin C levels were measured simultaneously, 4,301 were included in the CKD group, and 4,379 were included in the non-CKD group, respectively. CCR was 1.4 ± 0.6 in total participants. The non-CKD group showed higher mean CCR, (1.5 ± 0.7 vs. 1.3 ± 0.5) as well as a wider distribution of CCR (p < 0.001) when compared to the CKD group. In non-CKD group, 1st, 4th and 5th quintiles of CCR significantly increased the all-cause mortality risk compared to 2nd quintile of CCR, suggesting U-shaped mortality risk according to CCR in non-CKD. On the other hand, in CKD group, the risk of all-cause mortality linearly increased and 5th quintile of CCR showed 1.82 times risk of mortality compared to 2nd quintile of CCR. In the subgroup analysis of mortality by age and sex, the mortality difference according to CCR were diminished in old age and female sex subgroups.ConclusionWe discovered a U-shaped relationship between mortality and CCR levels in normal renal function, and an increased risk of mortality in CKD with elevated CCR.

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Creatinine-to-cystatin C ratio as a marker of skeletal muscle mass for predicting postoperative complications in patients undergoing gastric cancer surgery

Cited by 7 publications

References 32 publications

Serum creatinine/cystatin C ratio as a screening tool for sarcopenia and prognostic indicator for patients with esophageal cancer

Serum creatinine/cystatin C ratio as a screening tool for sarcopenia and prognostic indicator for patients with esophageal cancer

Usefulness of serum creatinine and cystatin C ratio as a screening tool for predicting prognosis in patients with pancreatic cancer

Changes in Mortality According to Creatinine/Cystatin C Ratio in Chronic Kidney Disease and Non-chronic Kidney Disease Patients

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