Serum cystatin C: A potential predictor for hospital-acquired acute kidney injury in patients with acute exacerbation of COPD

Abstract

Hospital-acquired acute kidney injury (HA-AKI) is associated with poor prognosis. In this study, we evaluated whether serum cystatin C on admission could predict AKI in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). The retrospective study was conducted using data on adult inpatients with AECOPD from January 2014 to January 2017. A total of 1035 patients were included, among which 79 (7.6%) with HA-AKI were identified. Univariate and multivariate logistic regression analyses were used to investigate predictors of HA-AKI in patients with AECOPD. HA-AKI was associated with poor prognosis, and patients with HA-AKI had higher inpatient mortality (34.2% vs. 2.6%, p < 0.001). Furthermore, after adjusting for confounders, HA-AKI was an independent risk factor for inpatient mortality for patients with AECOPD (odds ratio (OR) 11.02; 95% confidence interval (CI) 4.77–25.45; p < 0.001). Four independent risk factors for HA-AKI (age, levels of urea and cystatin C, and platelet count on admission) were identified in patients with AECOPD. Cystatin C (OR 5.22; 95% CI 2.49–10.95; p < 0.001) was a significant independent predictor of AKI in patients with AECOPD. HA-AKI in patients with AECOPD could be identified with a sensitivity of 73.5% and a specificity of 75.9% (area under the curve (AUC) = 0.803, 95% CI 0.747–0.859) by cystatin C level (cutoff value = 1.3 mg/L) and with a sensitivity of 75.9% and a specificity of 82.0% (AUC = 0.853, 95% CI 0.810–0.896) using a model comprising all significant predictors. Serum cystatin C has the potential for use to predict the risk of HA-AKI in patients with AECOPD.

Prognostic Value of Leukocyte-Based Risk Model for Acute Kidney Injury Prediction in Critically Ill Acute Exacerbation of Chronic Obstructive Pulmonary Disease Patients

“…17 Chen et al indicated that hospital-acquired AKI was 7.9% in AECOPD patient. 18 Another study reported a higher AKI occurrence in AECOPD patients, Wan et al illustrated that 1768 patients admitted to Nanjing First Hospital with a principal diagnosis of AECOPD. Of these, 377 (21%) patients had AKI.…”

“…Previous studies reported that AECOPD patients complicated with AKI were more likely to require non-invasive mechanical ventilation, had a longer duration of mechanical ventilation and duration of hospital stay, higher in-hospital mortality and higher allcause readmission than those without AKI. [16][17][18][19] Hence, it is important to seek biomarkers or risk model for early detection, early diagnosis, and early intervention of the disease can significantly improve prognosis and reduce patient mortality. Chen et al evaluated whether serum cystatin C on admission could predict AKI in patients with AECOPD and the results demonstrated that serum cystatin C has the potential for use to predict the risk of HA-AKI in patients with AECOPD.…”

“…Chen et al evaluated whether serum cystatin C on admission could predict AKI in patients with AECOPD and the results demonstrated that serum cystatin C has the potential for use to predict the risk of HA-AKI in patients with AECOPD. 18 Another study also explored the potential biomarkers predict the AKI in AECOPD patients and concluded that hypoxia and inflammation might be risk factors for renal injury in patients with AECOPD, serum cystatin C and beta-2 (β2) microglobulin (β2-MG) could be sensitive indicators for the early detection of renal injury. 20 Wei et al found that interleukin-10 (IL-10) and neutrophil gelatinase-associated lipocalin (NGAL) have a better diagnostic effect in…”