Hyonam Kidney Laboratory, Department of Internal Medicine, Soon Chun Hyang University Hospital, Seoul, South Korea.
J Crit Care. 2011 Dec;26(6):566-71. doi: 10.1016/j.jcrc.2011.01.004. Epub 2011 Mar 21.
Recent epidemiologic studies suggest a significant association between small increases in serum creatinine (sCr) and adverse outcomes. The Acute Kidney Injury Network (AKIN) sought to increase the sensitivity of the AKIN criteria for acute kidney injury (AKI) by recommending the use of small changes in sCr for the diagnosis of AKI. Several recent studies have reported that serum cystatin C (cysC) is more accurate than sCr as a surrogate for the glomerular filtration rate. This study was performed to determine whether small increases in cysC (≥0.3 mg/L within 48 hours) are associated with clinical outcomes in critically ill patients.
This was a prospective study of 274 consecutive patients admitted to the intensive care unit. Clinical data, including urine output, sCr, cysC, and outcomes, were collected for up to 3 months. Kaplan-Meier curves were used to determine the 90-day survival rate. Mortality was adjusted according to the Cox proportional hazards model.
Acute kidney injury developed in 84 (30.7%) patients based on the AKIN criteria. Among these patients, 42 (50%) had stage 1; 8 (9.5%), stage 2; and 34 (40.4%), stage 3 disease. Fourteen patients with increased cysC did not have AKI by AKIN criteria. The overall 90-day mortality was 20.8%. When mortality was stratified by group, it was 5.7% for the no-AKI-without-cysC-increment group, 28.6% for the no-AKI-with-increased-cysC group, 33.3% for the AKIN stage 1 group, 62.5% for the AKIN stage 2 group, and 70.6% for the AKIN stage 3 group (P < .001). Kaplan-Meier curves were constructed for each group based on stage and 90-day survival. The Cox analysis showed that patients who met AKIN criteria and patients with increases of cysC without AKI had associated mortality. In addition, patients with increases in cysC without AKI had outcomes similar to the patients with stage 1 AKI.
Small increases of cysC were associated with increased mortality in intensive care unit patients independent of diagnosis of AKI by AKIN criteria.
最近的流行病学研究表明，血清肌酐（sCr）的小幅度升高与不良结局显著相关。急性肾损伤网络（AKIN）试图通过建议使用 sCr 的小变化来诊断急性肾损伤（AKI），从而提高 AKIN 标准对急性肾损伤（AKI）的敏感性。最近的几项研究报告称，血清胱抑素 C（cysC）作为肾小球滤过率的替代物比 sCr 更准确。本研究旨在确定 sCr （48 小时内增加≥0.3mg/L）的微小增加是否与危重病患者的临床结局相关。
这是一项对 274 例连续入住重症监护病房的患者进行的前瞻性研究。收集了包括尿量、sCr、cysC 和结局在内的临床数据，最长随访 3 个月。使用 Kaplan-Meier 曲线确定 90 天生存率。根据 Cox 比例风险模型调整死亡率。
根据 AKIN 标准，84 例（30.7%）患者发生急性肾损伤。在这些患者中，42 例（50%）为 1 期；8 例（9.5%）为 2 期；34 例（40.4%）为 3 期。14 例 cysC 升高的患者未根据 AKIN 标准发生 AKI。总的 90 天死亡率为 20.8%。当按组分层死亡率时，无 AKI 且无 cysC 增加组为 5.7%，无 AKI 且 cysC 增加组为 28.6%，AKIN 1 期组为 33.3%，AKIN 2 期组为 62.5%，AKIN 3 期组为 70.6%（P<0.001）。根据分期和 90 天生存率为每个组构建 Kaplan-Meier 曲线。Cox 分析显示，符合 AKIN 标准的患者和无 AKI 的 cysC 升高的患者均有相关死亡率。此外，无 AKI 的 cysC 升高患者的结局与 AKIN 1 期患者相似。
cysC 的小幅度增加与重症监护病房患者的死亡率增加相关，而与 AKIN 标准诊断的 AKI 无关。
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