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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Autores principales:	Johanna Helmersson-Karlqvist, Miklos Lipcsey, Johan Ärnlöv, Max Bell, Bo Ravn, Alain Dardashti, Anders Larsson
Formato:	article
Lenguaje:	EN
Publicado:	Nature Portfolio 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/fbf5f43988d446b68f90ff12015283f2
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spelling	oai:doaj.org-article:fbf5f43988d446b68f90ff12015283f22021-12-02T16:31:17ZCystatin C predicts long term mortality better than creatinine in a nationwide study of intensive care patients10.1038/s41598-021-85370-82045-2322https://doaj.org/article/fbf5f43988d446b68f90ff12015283f22021-03-01T00:00:00Zhttps://doi.org/10.1038/s41598-021-85370-8https://doaj.org/toc/2045-2322Abstract 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.Johanna Helmersson-KarlqvistMiklos LipcseyJohan ÄrnlövMax BellBo RavnAlain DardashtiAnders LarssonNature PortfolioarticleMedicineRScienceQENScientific Reports, Vol 11, Iss 1, Pp 1-9 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q 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
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.
format	article
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
title	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_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_sort	cystatin c predicts long term mortality better than creatinine in a nationwide study of intensive care patients
publisher	Nature Portfolio
publishDate	2021
url	https://doaj.org/article/fbf5f43988d446b68f90ff12015283f2
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Cystatin C predicts long term mortality better than creatinine in a nationwide study of intensive care patients

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