Cystatin C and serum creatinine in estimating acute kidney injury of shock patients

Abstract

Abstract:

BACKGROUND: Serum creatinine (SCr) is the most commonly used parameter to estimate renal function impairement, but there are some shortcomings. Many factors including age, gender, drug, diet, muscle mass and metabolic rate can influence SCr, leading to an inaccurate estimation of kidney impairment. Studies have shown that cystatin C (CysC) is not affected by factors such as muscle mass, age, gender, diet, inflammation or tumor. The present study was undertaken to compare the sensitivity of CysC and SCr in evaluating renal function impairment at early stage of shock.

METHODS: Seventy-one patients aged 38.3±21.4 years, who had been treated at the Emergency Medicine Department of the First Affiliated Hospital, Sun Yat-sen University between February 2006 and June 2007, were studied. They were divided into groups A, B, C, and D according to the shock time. Serum sample was drawn from each patient at 1, 2, 3, 4 hours after shock to determine SCr and CysC. CysC and SCr were determined again at 72 hours and 7 days after shock.

RESULTS: CysC increased earlier than SCr in the 71 patients, and CysC decreased slower than SCr when shock was corrected. CysC increased at 1 hour after shock. There was a negative correlationship between CysC, SCr and glomerular filtration rate (GFR), especially at early stage of shock.

CONCLUSIONS: There is renal injury at early stage of shock. CysC is more sensitive than SCr in assessing renal function at the early stage of shock.

Key words: Cystatin C, Serum creatinine, Shock, Acute kidney injury

Qiang Li, Jie-yu Fang, Wei-ping Wang, Jiang-hui Liu, Ke-ke Wang. Cystatin C and serum creatinine in estimating acute kidney injury of shock patients[J]. World Journal of Emergency Medicine, 2010, 1(3): 185-189.

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Stages	Creatinine	Urine volume
Stage 1 at risk	SCr increased ≥ 26.5 μmol/L or SCr increase >50% or GFR decreased > 25%	Or <0.5 ml/kg per hour for more than 6 hours
Stage 2 injury	SCr increased >200%-300% or GFR decreased > 50%	Or <0.5 ml/kg per hour for more than 12 hours
Stage 3 failure	SCr increased >300% or GFR decreased >75% or SCr ≥353.6 μmol/L or increased ≥ 44.2 μmol/L	Or <0.3 ml/kg per hour for more than 24 hours or oliguria 12 hours

Group	1h		2h		3h		4h		72h		7d
Group	CysC	Xc	CysC	Xc	CysC	Xc	CysC	Xc	CysC	Xc	CysC	Xc
A (n=35)	1.14±0.11	100	1.10±0.10	97.1	1.10±0.10	97.1	1.08±0.07	94.3	0.80±0.13	0	——
B (n=21)	1.21±0.10	100	1.47±0.32	100	1.49±0.31	100	1.50±0.32	100	1.36±0.46	76.2	0.94±0.25	33
C (n=9)	1.28±0.18	100	1.50±0.33	100	2.15±0.35	100	1.98±0.31	100	1.50±0.32	100	1.34±0.13	100
D (n=6)	1.28±0.19	100	1.54±0.38	100	2.24±0.67	100	3.42±0.73	100	1.87±0.39	100	1.41±0.25	100

Group	1h		2h		3h		4h		72h		7d
Group	SCr	Xc	SCr	Xc	SCr	Xc	SCr	Xc	SCr	Xc	SCr	Xc
A (n=35)	110.3±18.4	51.4	110.1±18.1	51.4	110.2±17.1	51.4	110.0±15.6	51.4	98.6± 8.1	0	——
B (n=21)	114.2±19.3	57.1	139.1±24.2	76.2	140.9±13.4	76.2	137.2±19.3	76.2	121.0±29.1	42.8	91.0±14.2	0
C (n=9)	118.2±19.3	55.6	159.6±12.4	100	239.4±89.1	100	247.0±36.9	100	157.1±43.3	88.9	130.0±18.1	55.6
D (n=6)	119.3±17.5	66.6	168.2±16.4	100	287.8±87.6	100	348.1±83.6	100	276.4±49.1	100	176.1±87.3	83.3

Group	1h		2h		3h		4h
Group	SCr	AKI stage	SCr	AKI stage	SCr	AKI stage	SCr	AKI stage
A (n=35)	91.9-128.7	0-1	92-128.2	0-1	93.1-127.3	0-1	94.4-125.6	0-1
B (n=21)	94.9-133.5	0-1	114.9-163.3	1-2	127.5-154.3	1-2	117.9-156.5	1-2
C (n=9)	98.9-137.5	0-1	147.2-172	1-3	150.3-328.5	2-3	170.1-283.9	3
D (n=6)	101.8-136.8	0-1	135.8-200.6	1-3	200.2-375.4	3	264.5-431.7	3

Group	1h		2h		3h		4h
Group	decreased GFR%	AKI stage	decreased GFR%	AKI stage	decreased GFR%	AKI stage	decreased GFR%	AKI stage
A (n=35)	32.3-55.6	1-2	28.8-58.5	1-2	28.8-56.9	1-2	24.6-48.7	1
B (n=21)	32.1-58.6	1-2	50.1-67.2	1-2	46.2-67.3	1-2	37.2-68.0	1-2
C (n=9)	37.1-60.5	1-2	51.2-68.0	2	64.0-77.0	2-3	65.6-75.4	2-3
D (n=6)	42.4-61.5	1-2	53.6-68.8	2	69.1-80.5	2-3	77.3-88.7	3