DOI 10.5414/CNP62344

Clinical Nephrology, Volume 62 (2004) - November (344 - 350)

Evolution and predictive power of serum cystatin C in acute renal failure

A. Åhlström1, M. Tallgren1, S. Peltonen2, V. Pettilä1
1 Department of Surgery, Division of Anesthesiology, Intensive Care Medicine, Intensive Care Unit, Helsinki University Hospital, 2 Department of Internal Medicine, Division of Nephrology, Helsinki University Hospital, Helsinki, Finland

Abstract

Aims: The serum concentration of cystatin C has recently been proposed as a better indicator of glomerular filtration rate (GFR) than plasma creatinine. Little is known about cystatin C in critical illness. We assessed serum cystatin C as a marker of renal function in acute renal failure (ARF) and its power in predicting survival of ARF patients. Material: 202 consecutive adult patients admitted into the intensive care unit (ICU) during a period of 9 months. Method: Serum cystatin C, plasma creatinine and plasma urea were measured on admission, daily during the first 3 days, and 5 – 7 times a week during the rest of the ICU stay. The patients with and without ARF were compared by the Mann-Whitney U-test. The correlation between different variables was calculated by Spearman’s correlation. Forward stepwise multiple regression analysis was performed to test independent predictors of mortality. The positive predictive value of serum cystatin C and plasma creatinine for ARF and mortality was calculated by ROC analysis. Results: ARF occurred in 54 patients (27%). Serum cystatin C showed excellent positive predictive value for ARF in critical illness by ROC analysis. In acute renal dysfunction, abnormal values of serum cystatin C and plasma creatinine appeared equally quickly (median 3 days). The diagnosis of ARF, the day 1 Apache II score and admission plasma creatinine appeared as independent predictors of hospital mortality. ROC analysis showed only weak predictive power for serum cystatin C and plasma creatinine regarding hospital mortality. Conclusions: Serum cystatin C was as good as plasma creatinine in detecting ARF in intensive care patients. Neither marker was clinically useful in predicting mortality.

Author Details

Authors

  • A. Åhlström1
  • M. Tallgren1
  • S. Peltonen2
  • V. Pettilä1

Departments

  • 1 Department of Surgery, Division of Anesthesiology, Intensive Care Medicine, Intensive Care Unit, Helsinki University Hospital,
  • 2 Department of Internal Medicine, Division of Nephrology, Helsinki University Hospital, Helsinki, Finland

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