Department of Medicine, University of Otago Christchurch, Riccarton Avenue, Christchurch 8140, New Zealand.
Crit Care. 2010;14(3):R85. doi: 10.1186/cc9014. Epub 2010 May 12.
To evaluate the utility of urinary cystatin C (uCysC) as a diagnostic marker of acute kidney injury (AKI) and sepsis, and predictor of mortality in critically ill patients.
This was a two-center, prospective AKI observational study and post hoc sepsis subgroup analysis of 444 general intensive care unit (ICU) patients. uCysC and plasma creatinine were measured at entry to the ICU. AKI was defined as a 50% or 0.3-mg/dL increase in plasma creatinine above baseline. Sepsis was defined clinically. Mortality data were collected up to 30 days. The diagnostic and predictive performances of uCysC were assessed from the area under the receiver operator characteristic curve (AUC) and the odds ratio (OR). Multivariate logistic regression was used to adjust for covariates.
Eighty-one (18%) patients had sepsis, 198 (45%) had AKI, and 64 (14%) died within 30 days. AUCs for diagnosis by using uCysC were as follows: sepsis, 0.80, (95% confidence interval (CI), 0.74 to 0.87); AKI, 0.70 (CI, 0.64 to 0.75); and death within 30 days, 0.64 (CI, 0.56 to 0.72). After adjustment for covariates, uCysC remained independently associated with sepsis, AKI, and mortality with odds ratios (CI) of 3.43 (2.46 to 4.78), 1.49 (1.14 to 1.95), and 1.60 (1.16 to 2.21), respectively. Concentrations of uCysC were significantly higher in the presence of sepsis (P < 0.0001) or AKI (P < 0.0001). No interaction was found between sepsis and AKI on the uCysC concentrations (P = 0.53).
Urinary cystatin C was independently associated with AKI, sepsis, and death within 30 days.
Australian New Zealand Clinical Trials Registry ACTRN012606000032550.
评估尿胱抑素 C(uCysC) 作为急性肾损伤(AKI)和脓毒症的诊断标志物以及危重症患者死亡率的预测因子的效用。
这是一项针对 444 名普通重症监护病房(ICU)患者的双中心前瞻性 AKI 观察性研究和脓毒症亚组事后分析。在进入 ICU 时测量 uCysC 和血浆肌酐。AKI 的定义为血浆肌酐比基线升高 50%或 0.3mg/dL。脓毒症根据临床定义。收集 30 天内的死亡率数据。使用受试者工作特征曲线(ROC)下面积(AUC)和比值比(OR)评估 uCysC 的诊断和预测性能。多变量逻辑回归用于调整协变量。
81(18%)名患者患有脓毒症，198(45%)名患者发生 AKI，64(14%)名患者在 30 天内死亡。使用 uCysC 进行诊断的 AUC 如下：脓毒症，0.80(95%置信区间(CI)，0.74 至 0.87)；AKI，0.70(CI，0.64 至 0.75)；30 天内死亡，0.64(CI，0.56 至 0.72)。调整协变量后，uCysC 与脓毒症、AKI 和死亡率仍然独立相关，比值比(CI)分别为 3.43(2.46 至 4.78)、1.49(1.14 至 1.95)和 1.60(1.16 至 2.21)。在存在脓毒症(P < 0.0001)或 AKI(P < 0.0001)时，uCysC 的浓度显著升高。在 uCysC 浓度上未发现脓毒症和 AKI 之间存在交互作用(P = 0.53)。
尿胱抑素 C 与 AKI、脓毒症和 30 天内死亡独立相关。
澳大利亚和新西兰临床试验注册 ACTRN012606000032550。
