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NDT Advance Access published online on April 25, 2009
Nephrology Dialysis Transplantation, doi:10.1093/ndt/gfp196
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© The Author [2009]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org


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

Max Bell1, Fredrik Granath2, Johan Mårtensson1, Erland Löfberg3, Anders Ekbom2, Claes-Roland Martling1 of KING (Karolinska Intensive care Nephrology Group)

1 Department of Anaesthesiology and Intensive Care 2 Department of Medicine, Clinical Epidemiology Unit 3 Division of Nephrology, Department of Medicine, Karolinska University Hospital, Solna, Sweden

Correspondence and offprint requests to: Max Bell; E-mail: max.bell{at}karolinska.se



  Abstract

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 µmol/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 µmol/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.

Keywords: AKI; critical care; cystatin C; epidemiology; RIFLE

Received for publication: 15.12.08
Accepted in revised form: 3. 4.09


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