Cystatin C at Admission in the Intensive Care Unit Predicts Mortality among Elderly Patients

Abstract

Introduction. Cystatin C has been used in the critical care setting to evaluate renal function. Nevertheless, it has also been found to correlate with mortality, but it is not clear whether this association is due to acute kidney injury (AKI) or to other mechanism. Objective. To evaluate whether serum cystatin C at intensive care unit (ICU) entry predicts AKI and mortality in elderly patients. Materials and Methods. It was a prospective study of ICU elderly patients without AKI at admission. We evaluated 400 patients based on normality for serum cystatin C at ICU entry, of whom 234 (58%) were selected and 45 (19%) developed AKI. Results. We observed that higher serum levels of cystatin C did not predict AKI (1.05 ± 0.48 versus 0.94 ± 0.36 mg/L; P = 0.1). However, it was an independent predictor of mortality, H.R. = 6.16 (95% CI 1.46–26.00; P = 0.01), in contrast with AKI, which was not associated with death. In the ROC curves, cystatin C also provided a moderate and significant area (0.67; P = 0.03) compared to AKI (0.47; P = 0.6) to detect death. Conclusion. We demonstrated that higher cystatin C levels are an independent predictor of mortality in ICU elderly patients and may be used as a marker of poor prognosis.

The value of cystatin C in evaluating the severity and prognosis of patients with severe fever with thrombocytopenia syndrome

“…The risk of death in high CysC group (≥ 1.23 mg/L) was significantly higher than that in low CysC group (< 1.23 mg/L) (HR = 5.487), and other renal function indexes were not independent risk factors for disease severity and risk of death. At the same time, previous studies have found the association between septicemia and high serum CysC levels, and the association trend between Acute Physiology and Chronic Health Evaluation II(APACHE II) and cystatin C [ 28 ], which may represent direct and indirect inflammation, as some authors have suggested, CysC may reflect the pathogenic state other than GFR [ 29 ]. Therefore, CysC, as an index that is easy to detect and relatively unaffected, can provide a certain value in judging the severity and prognosis of patients with SFTS, which undoubtedly provides a more convenient basis for clinical work to judge the severity of the disease and prognosis.…”

Advances in the study of subclinical AKI biomarkers

“…Additional randomized and controlled clinical tests are required to determine if treating subclinical AKI improves clinical results in this populace ( Fang et al, 2018 ). In a study of patients over 60 years old, Dalboni et al found a contrary conclusion that Cys-C did not predict AKI, but greater Cys-C levels were an independent risk factor for death ( Dalboni et al, 2013 ). Several investigations have found that Cys-C levels can alter as a result of conditions other than renal filtration (e.g., use of glucocorticoids, thyroid hormones, and systemic inflammation), however, acute inflammation, especially that induced by sepsis, has no effect on it ( Manetti et al, 2005 ; Stevens et al, 2009 ).…”