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Multicenter Study
. 2011 Mar;37(3):493-501.
doi: 10.1007/s00134-010-2087-y. Epub 2010 Dec 10.

Serum and urine cystatin C are poor biomarkers for acute kidney injury and renal replacement therapy

Annick A N M Royakkers  1 , Johanna C Korevaar, Jeroen D E van Suijlen, Lieuwe S Hofstra, Michael A Kuiper, Peter E Spronk, Marcus J Schultz, Catherine S C Bouman
Affiliations
Multicenter Study

Serum and urine cystatin C are poor biomarkers for acute kidney injury and renal replacement therapy

Annick A N M Royakkers et al. Intensive Care Med. 2011 Mar.

Abstract

Purpose: To evaluate whether cystatin C in serum (sCyC) and urine (uCyC) can predict early acute kidney injury (AKI) in a mixed heterogeneous intensive care unit (ICU), and also whether these biomarkers can predict the need for renal replacement therapy (RRT).

Methods: Multicenter prospective observational cohort study in patients ≥18 years old and with expected ICU stay ≥72 h. The RIFLE class for AKI was calculated daily, while sCyC and uCyC were determined on days 0, 1, and alternate days until ICU discharge. Test characteristics were calculated to assess the diagnostic performance of CyC.

Results: One hundred fifty-one patients were studied, and three groups were defined: group 0 (N = 60), non-AKI; group 1 (N = 35), AKI after admission; and group 2 (N = 56), AKI at admission. We compared the two days prior to developing AKI from group 1 with the first two study days from group 0. On Day -2, median sCyC was significantly higher (0.93 versus 0.80 mg/L, P = 0.01), but not on Day -1 (0.98 versus 0.86 mg/L, P = 0.08). The diagnostic performance for sCyC was fair on Day -2 [area under the curve (AUC) 0.72] and poor on Day -1 (AUC 0.62). Urinary CyC had no diagnostic value on either of the two days prior to AKI (AUC <0.50). RRT was started in 14 patients with AKI; sCyC and uCyC determined on Day 0 were poor predictors for the need for RRT (AUC ≤0.66).

Conclusions: In this study, sCyC and uCyC were poor biomarkers for prediction of AKI and the need for RRT.

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Figures

Fig. 1
Fig. 1
Time course of serum creatinine, serum cystatin C, and urine cystatin C. Time courses are from 2 days prior to acute kidney injury (AKI) for patients developing AKI after entry (open circles), and from entry for the non-AKI group (closed circles). Values are mean and standard error of the means. The number of patients investigated is shown in italics at each time point. * P < 0.05 compared with the non-AKI group
Fig. 2
Fig. 2
Receiver-operating curves demonstrating the performance of cystatin C (CyC) for prediction of acute kidney injury (AKI). Upper panels 2 days prior to AKI (N = 71, disease prevalence 0.20); lower panels 1 day prior to AKI. (N = 81, disease prevalence 0.35). Area under the curve (AUC) is depicted in each panel. uCyC corr urine cystatin C normalized for urinary creatinine
Fig. 3
Fig. 3
Receiver-operating curves demonstrating the performance of cystatin C (CyC) for prediction of the need of renal replacement therapy. (N = 80, disease prevalence 0.16). Area under the curve (AUC) is depicted in each panel
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