Cystatin C predicts long term mortality better than creatinine in a nationwide study of intensive care patients
Abstract Decreased glomerular filtration rate (GFR) is linked to poor survival. The predictive value of creatinine estimated GFR (eGFR) and cystatin C eGFR in critically ill patients may differ substantially, but has been less studied. This study compares long-term mortality risk prediction by eGFR...
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| Format: | Article |
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Nature Portfolio
2021-03-01
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| Series: | Scientific Reports |
| Online Access: | https://doi.org/10.1038/s41598-021-85370-8 |
| _version_ | 1818430911182536704 |
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| author | Johanna Helmersson-Karlqvist Miklos Lipcsey Johan Ärnlöv Max Bell Bo Ravn Alain Dardashti Anders Larsson |
| author_facet | Johanna Helmersson-Karlqvist Miklos Lipcsey Johan Ärnlöv Max Bell Bo Ravn Alain Dardashti Anders Larsson |
| author_sort | Johanna Helmersson-Karlqvist |
| collection | DOAJ |
| description | Abstract Decreased glomerular filtration rate (GFR) is linked to poor survival. The predictive value of creatinine estimated GFR (eGFR) and cystatin C eGFR in critically ill patients may differ substantially, but has been less studied. This study compares long-term mortality risk prediction by eGFR using a creatinine equation (CKD-EPI), a cystatin C equation (CAPA) and a combined creatinine/cystatin C equation (CKD-EPI), in 22,488 patients treated in intensive care at three University Hospitals in Sweden, between 2004 and 2015. Patients were analysed for both creatinine and cystatin C on the same blood sample tube at admission, using accredited laboratory methods. During follow-up (median 5.1 years) 8401 (37%) patients died. Reduced eGFR was significantly associated with death by all eGFR-equations in Cox regression models. However, patients reclassified to a lower GFR-category by using the cystatin C-based equation, as compared to the creatinine-based equation, had significantly higher mortality risk compared to the referent patients not reclassified. The cystatin C equation increased C-statistics for death prediction (p < 0.001 vs. creatinine, p = 0.013 vs. combined equation). In conclusion, this data favours the sole cystatin C equation rather than the creatinine or combined equations when estimating GFR for risk prediction purposes in critically ill patients. |
| first_indexed | 2024-12-14T15:40:56Z |
| format | Article |
| id | doaj.art-fbf5f43988d446b68f90ff12015283f2 |
| institution | Directory Open Access Journal |
| issn | 2045-2322 |
| language | English |
| last_indexed | 2024-12-14T15:40:56Z |
| publishDate | 2021-03-01 |
| publisher | Nature Portfolio |
| record_format | Article |
| series | Scientific Reports |
| spelling | doaj.art-fbf5f43988d446b68f90ff12015283f22022-12-21T22:55:38ZengNature PortfolioScientific Reports2045-23222021-03-011111910.1038/s41598-021-85370-8Cystatin C predicts long term mortality better than creatinine in a nationwide study of intensive care patientsJohanna Helmersson-Karlqvist0Miklos Lipcsey1Johan Ärnlöv2Max Bell3Bo Ravn4Alain Dardashti5Anders Larsson6Department of Medical Sciences/Clinical Chemistry, Uppsala UniversityHedenstierna Laboratory, CIRRUS, Department of Surgical Sciences, Anesthesiology and Intensive Care, Uppsala UniversityDivision of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska InstitutetDepartment of Anesthesiology, Surgical Services and Intensive Care, Karolinska University HospitalDepartment of Anesthesiology, Surgical Services and Intensive Care, Karolinska University HospitalDepartment of Cardiothoracic Surgery, Anesthesia and Intensive Care, Skane University HospitalDepartment of Medical Sciences/Clinical Chemistry, Uppsala UniversityAbstract Decreased glomerular filtration rate (GFR) is linked to poor survival. The predictive value of creatinine estimated GFR (eGFR) and cystatin C eGFR in critically ill patients may differ substantially, but has been less studied. This study compares long-term mortality risk prediction by eGFR using a creatinine equation (CKD-EPI), a cystatin C equation (CAPA) and a combined creatinine/cystatin C equation (CKD-EPI), in 22,488 patients treated in intensive care at three University Hospitals in Sweden, between 2004 and 2015. Patients were analysed for both creatinine and cystatin C on the same blood sample tube at admission, using accredited laboratory methods. During follow-up (median 5.1 years) 8401 (37%) patients died. Reduced eGFR was significantly associated with death by all eGFR-equations in Cox regression models. However, patients reclassified to a lower GFR-category by using the cystatin C-based equation, as compared to the creatinine-based equation, had significantly higher mortality risk compared to the referent patients not reclassified. The cystatin C equation increased C-statistics for death prediction (p < 0.001 vs. creatinine, p = 0.013 vs. combined equation). In conclusion, this data favours the sole cystatin C equation rather than the creatinine or combined equations when estimating GFR for risk prediction purposes in critically ill patients.https://doi.org/10.1038/s41598-021-85370-8 |
| spellingShingle | Johanna Helmersson-Karlqvist Miklos Lipcsey Johan Ärnlöv Max Bell Bo Ravn Alain Dardashti Anders Larsson Cystatin C predicts long term mortality better than creatinine in a nationwide study of intensive care patients Scientific Reports |
| title | Cystatin C predicts long term mortality better than creatinine in a nationwide study of intensive care patients |
| title_full | Cystatin C predicts long term mortality better than creatinine in a nationwide study of intensive care patients |
| title_fullStr | Cystatin C predicts long term mortality better than creatinine in a nationwide study of intensive care patients |
| title_full_unstemmed | Cystatin C predicts long term mortality better than creatinine in a nationwide study of intensive care patients |
| title_short | Cystatin C predicts long term mortality better than creatinine in a nationwide study of intensive care patients |
| title_sort | cystatin c predicts long term mortality better than creatinine in a nationwide study of intensive care patients |
| url | https://doi.org/10.1038/s41598-021-85370-8 |
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