Serum and urine cystatin C are poor biomarkers for acute kidney injury and renal replacement therapyReportar como inadecuado

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Intensive Care Medicine

, Volume 37, Issue 3, pp 493–501

First Online: 10 December 2010Received: 23 December 2009Accepted: 01 November 2010


PurposeTo 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.

MethodsMulticenter 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.

ResultsOne 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.

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

KeywordsUrine cystatin C Serum cystatin C Acute kidney injury Renal replacement therapy Predictive biomarkers Intensive care unit Electronic supplementary materialThe online version of this article doi:10.1007-s00134-010-2087-y contains supplementary material, which is available to authorized users.

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Autor: Annick A. N. M. Royakkers - Johanna C. Korevaar - Jeroen D. E. van Suijlen - Lieuwe S. Hofstra - Michael A. Kuiper -


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