Department of Infectious Diseases, Tokyo Metropolitan Komagome Hospital, Japan.
Department of Infectious Diseases, Tokyo Metropolitan Komagome Hospital, Japan; Toshima Hospital, Tokyo Metropolitan Health and Medical Treatment Corporation, Japan.
J Infect Chemother. 2015 Feb;21(2):84-9. doi: 10.1016/j.jiac.2014.10.006. Epub 2014 Nov 20.
Cystatin C is an overall biomarker of pathophysiologic abnormalities that accompany chronic kidney disease (CKD). The utility of cystatin C is not fully understood in an HIV-infected population.
This prospective study investigated 661 HIV-infected individuals for 4 years to determine the incidence of adverse outcomes, including all-cause mortality, cardiovascular disease, and renal dysfunction. The risk of developing the outcomes was discriminated with a 4 color-coded classification in a 3 × 6 contingency table, that combined 3 grades of dipstick proteinuria with 6 grades of estimated glomerular filtration rate (eGFR) calculated using either serum creatinine (eGFRcr) or cystatin C (eGFRcy): green, low risk; yellow, moderately increased risk; orange, high risk; and red, very high risk. The cumulative incidence of the outcomes was assessed by the Kaplan-Meier method, and the association between color-coded risk and the time to outcome was evaluated using multivariate proportional hazards analysis.
Compared with eGFRcr, the use of eGFRcy reduced the prevalence of risk ≥ orange by 0.8%. The adverse outcomes were significantly more likely to occur to the patients with baseline risk category ≥orange than those with ≤ yellow, independent of risk categories based on eGFRcr or eGFRcy. However, in multivariate analysis, risk category ≥orange with eGFRcy-based classification was significantly associated with adverse outcomes, but not the one with eGFRcr.
Replacing creatinine by cystatin C in the CKD color-coded risk classification may be appropriate to discriminate HIV-infected patients at increased risk of a poor prognosis.
胱抑素 C 是一种反映慢性肾脏病（CKD）病理生理异常的整体生物标志物。胱抑素 C 在 HIV 感染人群中的应用尚未完全明确。
本前瞻性研究纳入 661 例 HIV 感染者，随访 4 年，以确定不良结局（包括全因死亡率、心血管疾病和肾功能障碍）的发生率。通过 3×6 列联表中的 4 种颜色编码分类来判断发生结局的风险，该表将 3 级尿蛋白试纸检测结果与 6 级基于血清肌酐（eGFRcr）或胱抑素 C（eGFRcy）计算的估计肾小球滤过率（eGFR）相结合：绿色，低风险；黄色，中度增加风险；橙色，高风险；红色，极高风险。采用 Kaplan-Meier 法评估结局的累积发生率，采用多变量比例风险分析评估颜色编码风险与结局时间的关系。
与 eGFRcr 相比，使用 eGFRcy 将风险≥橙色的患病率降低了 0.8%。与风险类别≤黄色的患者相比，基线风险类别≥橙色的患者发生不良结局的可能性显著更高，与基于 eGFRcr 或 eGFRcy 的风险类别无关。然而，在多变量分析中，基于 eGFRcy 的分类的风险类别≥橙色与不良结局显著相关，而基于 eGFRcr 的分类则不然。
在 CKD 颜色编码风险分类中用胱抑素 C 替代肌酐可能有助于区分预后不良风险增加的 HIV 感染者。
