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. 2016 Sep 13;17(1):130.
doi: 10.1186/s12882-016-0346-z.

Serum cystatin is a useful marker for the diagnosis of acute kidney injury in critically ill children: prospective cohort study

Osama Y Safdar  1   2 , Mohammed Shalaby  3 , Norah Khathlan  4 , Bassem Elattal  5 , Mohammed Bin Joubah  5 , Esraa Bukahri  5 , Mafaza Saber  5 , Arwa Alahadal  5 , Hala Aljariry  5 , Safaa Gasim  5 , Afnan Hadadi  6   7 , Abdullah Alqahtani  8 , Roaa Awleyakhan  5 , Jameela A Kari  3
Affiliations

Serum cystatin is a useful marker for the diagnosis of acute kidney injury in critically ill children: prospective cohort study

Osama Y Safdar et al. BMC Nephrol. .

Abstract

Background: Acute kidney injury (AKI) has been associated with high morbidity and mortality rates among critically ill children. Cystatin C is a protease inhibitor, and studies have shown that it is a promising marker for the early diagnosis of AKI. Our goal in this study was to assess whether serum cystatin C could serve as an accurate marker for the diagnosis of AKI.

Methods: This prospective study was undertaken in the pediatric intensive care unit at King Abdulaziz University Hospital. Serum creatinine and serum cystatin C levels were both measured in patients on admission (0 h) and at 6, 12, and 24 h after admission. AKI was diagnosed according to the modified pRIFLE criteria. Receiver operating characteristic (ROC) curve analysis was performed to assess the utility of serum cystatin C for diagnosing AKI.

Results: A total of 62 patients were enrolled in this study, and 32 were diagnosed with AKI according to the modified pRIFLE criteria (51.4 %). The area under the ROC curve for serum cystatin indicated that it was a good marker for the diagnosis of AKI at 0, 6, 12 and 24 h, with sensitivities of 78, 94, 94 and 83 %, respectively. However, the specificities of serum cystatin C at 0, 6, 12, and 24 h were 57, 57, 60 and 50 %, respectively. The optimal cutoff value was 0.645 mg/L. The area under the ROC for serum creatinine showed sensitivities of 50, 65.4, 69.2 and 57.7 % and specificities of 67.7, 70, 60 and 70 % at 0, 6, 12 and 24 h, respectively. The optimal cutoff value for serum creatinine was 30 μmol/l. Comparisons of ROC curves revealed that serum cystatin C was superior to serum creatinine for the diagnosis of AKI at 12 h (p = 0.03), but no differences were detected at 0, 6 or 24 h.

Conclusion: Serum cystatin is a sensitive, but not a specific, marker for the diagnosis of AKI in critically ill children.

Keywords: Acute kidney injury; Creatinine; Cystatin C; Pediatric.

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Figures

Fig. 1
Fig. 1
ROC analysis of cysatatin C at 0 h for the diagnosis of AKI had a sensitivity of 78 % and a specificity of 57 % with a cutoff 0.645, while serum creatinine had a sensitivity of 50 % and a specificity of 67.7 % with a cutoff value of 30 umol/l
Fig. 2
Fig. 2
At 6 h, ROC analysis of serum cystatin C revealed a sensitivity of 94 % and a specificity of 57 % with cut-off value of 0.645 mg/l, while ROC analysis of serum creatinine showed a sensitivity of 65.4 % and a specificity of 70 % with cut-off value of 30 umol/l. This difference was not significant (p = 0.15)
Fig. 3
Fig. 3
At 12 h, ROC analysis of serum cystatin C revealed a sensitivity of 94 % and a specificity of 60 % with cut-off value of 0.645 mg/l, while ROC analysis of serum creatinine showed a sensitivity of 69.2 % and a specificity of 60 % with cut-off value of 30 umol/l. This difference was significant (p = 0.03)
Fig. 4
Fig. 4
At 24 h, ROC analysis of serum cystatin C revealed a sensitivity of 83 % and a specificity of 50 % with cut-off value of 0.645 mg/l, while ROC analysis of serum creatinine showed a sensitivity of 57.7 % and a specificity of 70 % with cut-off value of 30 umol/l. This difference was not significant (p = 0.18)
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