The effect of glucocorticoids on serum cystatin C in identifying acute kidney injury: a propensity-matched cohort study

Abstract

Background Glucocorticoids may impact the accuracy of serum cystatin C (sCysC) in reflecting renal function. We aimed to assess the effect of glucocorticoids on the performance of sCysC in detecting acute kidney injury (AKI) in critically ill patients. Methods A prospective observational cohort study was performed in a general intensive care unit (ICU). Using propensity score matching, we successfully matched 240 glucocorticoid users with 960 non-users among 2716 patients. Serum creatinine (SCr) and sCysC were measured for all patients at ICU admission. Patients were divided into four groups based on cumulative doses of glucocorticoids within 5 days before ICU admission (Group I: non-users; Group II: 0 mg < prednisone ≤50 mg; Group III: 50 mg < prednisone ≤150 mg; Group IV: prednisone > 150 mg). We compared the performance of sCysC for diagnosing and predicting AKI in different groups using the area under the receiver operator characteristic curve (AUC). Results A total of 240 patients received glucocorticoid medication within 5 days before ICU admission. Before and after matching, the differences of sCysC levels between glucocorticoid users and non-users were both significant (P < 0.001). The multiple linear regression analysis revealed that glucocorticoids were independently associated with sCysC (P < 0.001). After matching, the group I had significantly lower sCysC levels than the group III and group IV (P < 0.05), but there were no significant differences in sCysC levels within different glucocorticoids recipient groups (P > 0.05). Simultaneously, we did not find significant differences in the AUC between any two groups in the matched cohort (P > 0.05). Conclusions Glucocorticoids did not impact the performance of sCysC in identifying AKI in critically ill patients.

Assessment of kidney function: clinical indications for measured GFR

“…Also, cystatin C has been questioned for the determination of GFR and the detection of nephrotoxicity in oncology patients due to possible GFR-independent effects of the underlying malignancy and chemotherapy on cystatin C levels [ 24 ]. Liang et al [ 34 ] analysed the effect of high-dose prednisone on the prediction of AKI on admission to the intensive care unit. As expected from the physiology of cystatin C, the authors found a dose-dependent increase in the serum cystatin C concentration.…”

Serum N-terminal pro-B-type natriuretic peptide and cystatin C for acute kidney injury detection in critically ill adults in China: a prospective, observational study

“…CysC is a glomerular filtration biomarker that can be utilised to anticipate the development of AKI and undesirable outcomes 8 9. The application and performance of CysC for AKI prediction have been demonstrated in various clinical settings 5 11 51–53. In individuals with ST-segment elevation myocardial infarction, a combination of B-type natriuretic peptide and CysC may contribute to risk stratification for AKI 25.…”

Use of ultra high performance liquid chromatography with high resolution mass spectrometry to analyze urinary metabolome alterations following acute kidney injury in post-cardiac surgery patients

“…As a sensitive indicator of renal tubular and glomerular injury, quantitative proteinuria spectrum has consistently been the focus of predicting nephrotic syndrome, which can also reflect systemic vascular inflammation and endothelial dysfunction [7] , [8] , [9] . Recent studies have associated serum/urine levels of cystatin C with other factors to reflect the glomerular filtration rate [10] , [11] , [12] , [13] . Neutrophil gelatinase-associated lipocalin (NGAL), kidney injury molecule-1 (KIM-1), and liver type fatty acid binding protein (L-FABP) were measured to investigate the relationship between inflammatory factors and renal tubular epithelial cell damage [14] , [15] , [16] , [17] .…”