Cystatin C is correlated with mortality in patients with and without acute kidney injury

被引:62
作者
Bell, Max [1 ]
Granath, Fredrik [2 ]
Martensson, Johan [1 ]
Lofberg, Erland [3 ]
Ekbom, Anders [2 ]
Martling, Claes-Roland [1 ]
机构
[1] Karolinska Univ Hosp, Dept Anaesthesiol & Intens Care, Solna, Sweden
[2] Karolinska Univ Hosp, Dept Med, Clin Epidemiol Unit, Solna, Sweden
[3] Karolinska Univ Hosp, Dept Med, Div Nephrol, Solna, Sweden
关键词
AKI; critical care; cystatin C; epidemiology; RIFLE; ACUTE-RENAL-FAILURE; GLOMERULAR-FILTRATION-RATE; CRITICALLY-ILL PATIENTS; CARDIOVASCULAR EVENTS; REPLACEMENT THERAPY; PREDICTS MORTALITY; RIFLE CRITERIA; INTENSIVE-CARE; HEART-FAILURE; RISK-FACTOR;
D O I
10.1093/ndt/gfp196
中图分类号
R3 [基础医学]; R4 [临床医学];
学科分类号
1001 ; 1002 ; 100602 ;
摘要
Background. Recent research has shown cystatin C to predict mortality and cardiovascular morbidity independent of renal function. The aim of this study was to evaluate the prognostic value of cystatin C on mortality in adult general ICU patients with acute kidney injury (AKI). We later expanded the study and included patients without signs of AKI. Methods. A total of 845 ICU patients were analysed for cystatin C and classified according to the RIFLE criteria. Of these, 271 patients with either creatinine > 150 mu mol/l, urea > 25 or anuria/oliguria entered the AKI cohort. The remaining 562 patients entered the non-AKI cohort. Both cohorts were divided into quartiles according to cystatin C at entry. In the non-AKI cohort, we split the highest cystatin C quartile into two. The relationship between the different cystatin C quartiles and mortality in patients with and without AKI was estimated by hazard ratios (HR) derived from the Cox proportional hazards regression model. Results. A relationship between cystatin C and mortality was found in patients with and without AKI, being stronger in patients without AKI. In AKI patients, the HR comparing cystatin C above and below the median more than doubled from the second year on compared to the first year follow-up. After exclusion of patients in the non-AKI cohort with 'potential AKI' (creatinine > 100 mu mol/l or urea > 20 mmol/l), the correlation between cystatin C levels and risk of death was strengthened. Conclusions. Cystatin C is correlated with mortality independently of renal function measured by creatinine in patients entering the general ICU.
引用
收藏
页码:3096 / 3102
页数:8
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