Cystatin C as a Predictor of In-Hospital Mortality After Exacerbation of COPD

Hu, Guoping; Wu, Yankui; Zhou, Yumin; Yu, Yan; Liang, Wenjie; Ran, Pixin

doi:10.4187/respcare.04034

Cited by 7 publications

(7 citation statements)

References 33 publications

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“…Consistent with previous studies, we found that the elevated levels of Cys C were significantly correlated with disease status and lung function. Hu et al [24] found that the elevated Cys C levels was an important and independent risk factor of increased mortality in a hospital setting during COPD exacerbation, Formiga et al [51] indicated that inspiratory muscle function was reduced with greater degrees of inflammation in COPD as expressed higher levels of Cys C. Combining with the results of previous studies and this meta-analysis, we thought that the elevated levels of serum Cys C might indicate the exacerbation and progression of COPD.…”

Section: Discussionsupporting

confidence: 60%

“…Recent studies indicate a possible link between Cys C and COPD [24][25][26][27][28]; however, the conclusion is not clear. Most studies have shown that serum Cys C levels are higher in the exacerbation group than stable COPD or healthy control [29,30], but Selder et al [31] find that serum Cys C levels are lower in exacerbation group than stable COPD.…”

Section: Introductionmentioning

confidence: 96%

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The association between cystatin C and COPD: a meta-analysis and systematic review

et al. 2020

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Background: In recent years, many studies have discovered that cystatin C (Cys C) may play an important role in respiratory diseases, especially in chronic obstructive pulmonary disease (COPD). However, the findings of these studies were inconsistent. This systematic review and meta-analysis aimed to assess the relationship between serum Cys C and COPD. Methods: We conducted a systematic literature search in PubMed, Embase, Web of Science, Wanfang databases, and the China National Knowledge Infrastructure. The standardized mean difference (SMD), Fisher's Z-value and 95% confidence interval (CI) were calculated to investigate the effect sizes. Subgroup analyses were performed on disease status, ethnicity, assay method, and study design. Sensitivity was performed, and publication bias was assessed. Results: A total of 15 studies, including 4079 COPD patients and 5949 controls, were included in this meta-analysis. The results showed that serum Cys C levels in patients with COPD were significantly higher than those in controls (SMD = 0.99, 95% CI =0.62-1.37, P < 0.001), especially in AECOPD (SMD = 1.59, 95% CI =1.05-2.13, P < 0.001), and there were statistically different among AECOPD and SCOPD (SMD = 0.35, 95% CI =0.10-0.59, P = 0.005). The serum Cys C levels were negatively correlated with FEV1%pre (Z = − 0.45, 95%CI =-0.58-0.32, P = 0.011) and FEV1/FVC (Z = − 0.32, 95%CI =-0.50-0.14, P = 0.006). The serum Cys C levels were independent of ethnicity, assay method, and study design. Conclusion: Serum Cys C levels were associated with COPD and COPD exacerbation, and they were inversely correlated with FEV1%pre and FEV1/FVC.

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Section: Discussionsupporting

confidence: 60%

Section: Introductionmentioning

confidence: 96%

The association between cystatin C and COPD: a meta-analysis and systematic review

et al. 2020

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“…Of course, there are also studies that showed that elevated HsCRP was not associated with mortality of AECOPD 26. In a previous study from our group, we showed that plasma cystatin C was a risk factor for in-hospital mortality 27. Additionally, in another study from our group, the PSI index was associated with in-hospital death 28.…”

Section: Discussionmentioning

confidence: 57%

Prognostic role of D-dimer for in-hospital and 1-year mortality in exacerbations of COPD

Zhou

et al. 2016

COPD

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Background and objectiveSerum D-dimer is elevated in respiratory disease. The objective of our study was to investigate the effect of D-dimer on in-hospital and 1-year mortality after acute exacerbations of chronic obstructive pulmonary disease (AECOPD).MethodsUpon admission, we measured 343 AECOPD patients’ serum D-dimer levels and arterial blood gas analysis, and recorded their clinical characteristics. The level of D-dimer that discriminated survivors and non-survivors was determined using a receiver operator curve (ROC). The risk factors for in-hospital mortality were identified through univariate analysis and multiple logistic regression analyses. To evaluate the predictive role of D-dimer for 1-year mortality, univariate and multivariate Cox regression analyses were performed.ResultsIn all, 28 patients died, and 315 patients survived in the in-hospital period. The group of dead patients had lower pH levels (7.35±0.11 vs 7.39±0.05, P<0.0001), higher D-dimer, arterial carbon dioxide tension (PaCO2), C-reactive protein (CRP), and blood urea nitrogen (BUN) levels (D-dimer 2,244.9±2,310.7 vs 768.2±1,078.4 µg/L, P<0.0001; PaCO2: 58.8±29.7 vs 46.1±27.0 mmHg, P=0.018; CRP: 81.5±66, P=0.001; BUN: 10.20±6.87 vs 6.15±3.15 mmol/L, P<0.0001), and lower hemoglobin levels (118.6±29.4 vs 128.3±18.2 g/L, P=0.001). The areas under the ROC curves of D-dimer for in-hospital death were 0.748 (95% confidence interval (CI): 0.641–0.854). D-dimer ≥985 ng/L was a risk factor for in-hospital mortality (relative risk =6.51; 95% CI 3.06–13.83). Multivariate logistic regression analysis also showed that D-dimer ≥985 ng/L and heart failure were independent risk factors for in-hospital mortality. Both univariate and multivariate Cox regression analyses showed that D-dimer ≥985 ng/L was an independent risk factor for 1-year death (hazard ratio (HR) 3.48, 95% CI 2.07–5.85 for the univariate analysis; and HR 1.96, 95% CI 1.05–3.65 for the multivariate analysis).ConclusionD-dimer was a strong and independent risk factor for in-hospital and 1-year death for AECOPD patients.

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“…Cystatin C is easily detectable in the biological fluids and acts as a reliable marker, independently of age, sex, and muscle mass [ 27 – 29 ]. Previous studies not only confirmed the role of cystatin C in indicating organ dysfunction but also clarified that serum cystatin C levels might associate with inflammatory phase and adverse outcomes in various diseases [ 30 – 33 ]. These findings accorded with our observations of cystatin C levels and COVID-19.…”

Section: Discussionmentioning

confidence: 93%

Serum Cystatin C and Coronavirus Disease 2019: A Potential Inflammatory Biomarker in Predicting Critical Illness and Mortality for Adult Patients

Chen

Sun

et al. 2020

Mediators of Inflammation

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This study aimed at determining the relationship between baseline cystatin C levels and coronavirus disease 2019 (COVID-19) and investigating the potential prognostic value of serum cystatin C in adult patients with COVID-19. 481 patients with COVID-19 were consecutively included in this study from January 2, 2020, and followed up to April 15, 2020. All clinical and laboratory data of COVID-19 patients with definite outcomes were reviewed. For every measure, COVID-19 patients were grouped into quartiles according to the baseline levels of serum cystatin C. The highest cystatin C level was significantly related to more severe inflammatory conditions, worse organ dysfunction, and worse outcomes among patients with COVID-19 (P values < 0.05). In the adjusted logistic regression analyses, the highest cystatin C level and ln-transformed cystatin C levels were independently associated with the risks of developing critically ill COVID-19 and all-cause death either in overall patients or in patients without chronic kidney disease (P values < 0.05). As a potential inflammatory marker, increasing baseline levels of serum cystatin C might independently predict adverse outcomes for COVID-19 patients. Serum cystatin C could be routinely monitored during hospitalization, which showed clinical importance in prognosticating for adult patients with COVID-19.

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Cystatin C as a Predictor of In-Hospital Mortality After Exacerbation of COPD

Cited by 7 publications

References 33 publications

The association between cystatin C and COPD: a meta-analysis and systematic review

The association between cystatin C and COPD: a meta-analysis and systematic review

Prognostic role of D-dimer for in-hospital and 1-year mortality in exacerbations of COPD

Serum Cystatin C and Coronavirus Disease 2019: A Potential Inflammatory Biomarker in Predicting Critical Illness and Mortality for Adult Patients

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