Cystatin C and beta2-microglobulin: markers of glomerular filtration in critically ill children

Abstract

Introduction: Parameters allowing regular evaluation of renal function in a paediatric intensive care unit (PICU) are not optimal. The aim of the present study was to analyse the utility of serum cystatin C and beta2-microglobulin (B2M) in detecting decreased glomerular filtration rate in critically ill children.

Methods: This was a prospective, observational study set in an eight-bed PICU. Twenty-five children were included. The inverses of serum creatinine, cystatin C, and B2M were correlated with creatinine clearance (CrC) using a 24-hour urine sample and CrC estimation by Schwartz formula (Schwartz). The diagnostic value of serum creatinine, cystatin C, and B2M to identify a glomerular filtration rate under 80 ml/minute per 1.73 m(2) was evaluated using receiver operating characteristic (ROC) curve analysis.

Results: Mean age was 2.9 years (range, 0.1 to 13.9 years). CrC was less than 80 ml/minute per 1.73 m(2) in 14 children, and Schwartz was less than 80 ml/minute per 1.73 m(2) in 9 children. Correlations between inverse of B2M and CrC (r = 0.477) and between inverse of B2M and Schwartz (r = 0.697) were better than correlations between inverse of cystatin C and CrC (r = 0.390) or Schwartz (r = 0.586) and better than correlations between inverse of creatinine and CrC (r = 0.104) or Schwartz (r = 0.442). The ability of serum cystatin C and B2M to identify a CrC rate and a Schwartz CrC rate under 80 ml/minute per 1.73 m(2) was better than that of creatinine (areas under the ROC curve: 0.851 and 0.792 for cystatin C, 0.802 and 0.799 for B2M, and 0.633 and 0.625 for creatinine).

Conclusion: Serum cystatin C and B2M were confirmed as easy and useful markers, better than serum creatinine, to detect acute kidney injury in critically ill children.

Figure 1

Receiver operating characteristic curves to diagnose creatinine clearance of less than 80 ml/minute per 1.73 m². Areas under the curve (95% confidence intervals) are 0.633 (0.403 to 0.863) for creatinine, 0.851 (0.698 to 1.003) for cystatin C, and 0.802 (0.628 to 0.976) for beta2-microglobulin (B2M).

Figure 2

Receiver operating characteristic curves to diagnose creatinine clearance estimation by Schwartz formula of less than 80 ml/minute per 1.73 m². Areas under the curve (95% confidence intervals) are 0.625 (0.403 to 0.847) for creatinine, 0.792 (0.598 to 0.986) for cystatin C, and 0.799 (0.622 to 0.976) for beta2-microglobulin (B2M).