Indian journal of Medical Biochemistry

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VOLUME 24 , ISSUE 3 ( September-December, 2020 ) > List of Articles

RESEARCH ARTICLE

A Comparative Study of Serum Cystatin C with Serum Creatinine as an Early Marker of Acute Renal Dysfunction in Intensive Care Patients

Arun Sinha, C Vibha, HL Vishwanath, B Prabhakar

Keywords : MDRD, Renal function, Renal function test, ROC curve

Citation Information : Sinha A, Vibha C, Vishwanath H, Prabhakar B. A Comparative Study of Serum Cystatin C with Serum Creatinine as an Early Marker of Acute Renal Dysfunction in Intensive Care Patients. Indian J Med Biochem 2020; 24 (3):115-118.

DOI: 10.5005/jp-journals-10054-0140

License: CC BY-NC 4.0

Published Online: 00-12-2020

Copyright Statement:  Copyright © 2020; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Introduction: Acute kidney injury (AKI) is a very common complication occurring in medical intensive care, causing significant morbidity and mortality. Several biomarkers have been studied for their utility in diagnosing acute renal failure but without much success. Still, serum creatinine is the marker of choice despite having several shortcomings. In this study, we have tried to see the usefulness of serum cystatin C in comparison to serum creatinine as an early marker of AK. Materials and methods: A cross-sectional study was conducted involving 50 cases admitted in the ICU of our hospitals and their Cystatin C and creatinine was estimated. The results were compared with cystatin c and creatinine values of healthy controls. Results: In cases, the mean cystatin C was found to be 744.58 ± 321.00 ng/mL. Data showed that 50% of cases had abnormal values for serum cystatin C. Estimation of serum creatinine in cases showed a value of 1.07 ± 0.45 mg/dL with a p = 0.008. Among cases, 20% of patients had abnormal creatinine. Receiver operator curve (ROC) analysis with AUC showed that cystatin C with a cutoff >40 had sensitivity and specificity of 100% and AUC 1.000 (p =1.0) the sensitivity and specificity were 50 and 70%, respectively, and AUC 0.637 (p = 0.013). The creatinine clearance as estimated by both MDRD and CKD EPI formulae were found to be normal in both cases and controls. Conclusion: The results clearly showed that estimation of serum cystatin c in ICU patient could go long way in reducing mortality due to acute renal dysfunction.


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  1. Liu DK, Chertow GM. Acute renal failure Fauci AS, Kasper DL, Longo DL, et al., ed. Harrison's Principles of Internal Medicine. 17th ed., New York: McGraw Hill, Health Professional Division; 2008. 1752–1761.
  2. Brady HR. Acute renal failure. Brenner and Rector's The Kidney. 7th ed., Philadelphia: Saunders; 2004.
  3. Lameiere N. The path physiology of acute renal failure. Crit Care Clin 2005;21(2):197. DOI: 10.1016/j.ccc.2005.01.001.
  4. Herget-Rosenthal S, Marggraf G, Hüsing J, et al. Early detection of acute renal failure by serum cystatin C. Kidney Int 2004;66(3):1115–1122. DOI: 10.1111/j.1523-1755.2004.00861.x.
  5. Burtis CA, Ashwood ER, Bruns DE. Tietz Textbook of Clinical Chemistry and Molecular Diagnostics. 4th ed., St. Louis, Missouri: Elsevier Saunders; 2006. 546, 602, 607, 612, 755, 774, 797, 801, 837 & 1193. 15 Proc Nadl Acad Sci 1986 Nov; 83:8749-53.
  6. Vasudevan DM, Sreekumari S, Vaidyanathan K, Cystatin C as a filtration marker, Textbook of Biochemistry for Medical Students. 6th ed., Kochi, St. Louis, Panama City, London, New Delhi, Ahmadabad, Bengaluru, Chennai, Hyderabad.
  7. Kolkata, Lucknow, Mumbai, Nagpur, Jaypee Brothers Medical Publishers (P) Ltd.2011; p. 322.
  8. Bhagavan NV, Ha C-E. Creatine and related compounds; Essentials of Medical Biochemistry with Clinical Cases. 1st ed, Amsterdam, Boston, Heidelberg, London, Oxford, Paris, San Diego, San Francisco, Singapore, Sydney Tokyo: Elseveir Academic Press; 2011. 181–182.
  9. Ekiel I, Abrahamson M, Fulton DB, et al. NMR structural studies of human cystatin C dimmers and monomer. J Mol Biol 1997;271(2):266–277. DOI: 10.1006/jmbi.1997.1150.
  10. Marin T, DeRossett B, Bhatia J. Urinary biomarkers to predict neonatal acute kidney injury. J Perinat Neonatal Nurs 2018;32(3):266–274. DOI: 10.1097/JPN.0000000000000295.
  11. Shores DR, Everett AD. Children as biomarker orphans: progress in the field of pediatric biomarkers. J Pediatr 2017;193:14–20.e31. DOI: 10.1016/j.jpeds.2017.08.077.
  12. Deirdre U. Sweetman, neonatal acute kidney injury – severity and recovery prediction and the role of serum and urinary biomarkers. Early Hum Dev 2017;105:57–61. DOI: 10.1016/j.earlhumdev.2016.12.006.
  13. Villa P, Jiménez M, Soriano MC, et al. Serum cystatin C concentration as a marker of acute kidney dysfunction in critically ill patients. Crit Care 2005(2):139–143. DOI: 10.1186/cc3044.
  14. Mussap M, Plebani M. Biochemistry and clinical role of human cystatin C. Crit Rev Clin Lab Sci 2004;41(5-6):467–550. DOI: 10.1080/10408360490504934.
  15. Hameed HM, Sharbini SAE, Barakat NA, et al. Serum cystatin C is a poor biomarker for diagnosing acute kidney injury in critically-ill children. Indian J Criti Care Med 2013;17(2):92–98. DOI: 10.4103/0972-5229.114829.
  16. Shlipak MG, Matsushita K, Ärnlöv J, et al. Relationship of kidney function estimates to risks improvements by measuring serum cystatin C in blood. N Eng J Med 2013;369(10):932–943. DOI: 10.1056/NEJMoa1214234.
  17. Coll E, Botey A, Alvarez L, et al. Serum cystatin C as a new marker for non-invasive estimation of glomerular filtration rate and as a marker for early renal impairment. Am J Kidney Dis 2000;36(1):29–34. DOI: 10.1053/ajkd.2000.8237.
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