Volpon Leila C, Sugo Edward K, Carlotti Ana P C P
Division of Pediatric Critical Care, Department of Pediatrics, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil.
Pediatr Crit Care Med. 2015 Jun;16(5):e125-31. doi: 10.1097/PCC.0000000000000403.
We aimed to evaluate the value of serum cystatin C for detection of acute kidney injury and pediatric Risk, Injury, Failure, Loss, End-Stage Renal Disease categories in critically ill children and to investigate whether serum cystatin C was associated with outcome.
Prospective cohort study.
PICU of a tertiary-care university hospital.
A heterogeneous population of critically ill children.
None.
Blood and 24-hour urine samples were collected daily over the first 2 days after PICU admission for measurement of serum cystatin C, serum creatinine, and creatinine clearance. Acute kidney injury was classified by pediatric Risk, Injury, Failure, Loss, End-Stage Renal Disease criteria. One hundred twenty-two children were prospectively enrolled; 40 (32.8%) developed acute kidney injury. Serum cystatin C was higher in patients with acute kidney injury compared with those who did not develop acute kidney injury at PICU admission (median, 0.90 mg/L vs 0.51 mg/L) and on the first (1.12 mg/L vs 0.57 mg/L) and second PICU days (1.15 mg/L vs 0.58 mg/L). Serum creatinine was higher in acute kidney injury group only on the first (0.50 mg/dL vs 0.40 mg/dL) and second PICU days (0.60 mg/dL vs 0.40 mg/dL). Serum cystatin C was increasingly higher according to acute kidney injury severity (Failure > Injury > Risk). Area under the receiver operating characteristic curve of cystatin C for acute kidney injury detection was 0.89. Serum cystatin C greater than 0.70 mg/L was associated with longer length of PICU stay (adjusted hazard ratio, 1.64) and prolonged duration of mechanical ventilation (adjusted hazard ratio, 1.82).
Cystatin C is an early and accurate biomarker for acute kidney injury and pediatric Risk, Injury, Failure, Loss, End-Stage Renal Disease categories, and it is associated with adverse clinical outcomes in a heterogeneous population of critically ill children.
我们旨在评估血清胱抑素C在检测危重症儿童急性肾损伤及儿科风险、损伤、衰竭、失功、终末期肾病分类中的价值，并研究血清胱抑素C是否与预后相关。
前瞻性队列研究。
一所三级大学医院的儿科重症监护病房。
危重症儿童的异质性群体。
无。
在儿科重症监护病房入院后的头2天，每天采集血液和24小时尿液样本，以测定血清胱抑素C、血清肌酐和肌酐清除率。急性肾损伤根据儿科风险、损伤、衰竭、失功、终末期肾病标准进行分类。前瞻性纳入122名儿童；40名（32.8%）发生急性肾损伤。与在儿科重症监护病房入院时未发生急性肾损伤的患者相比，发生急性肾损伤的患者血清胱抑素C水平更高（中位数，0.90mg/L对0.51mg/L），在儿科重症监护病房的第1天（1.12mg/L对0.57mg/L）和第2天（1.15mg/L对0.58mg/L）也是如此。仅在儿科重症监护病房的第1天（0.50mg/dL对0.40mg/dL）和第2天（0.60mg/dL对0.40mg/dL），急性肾损伤组的血清肌酐水平更高。血清胱抑素C根据急性肾损伤的严重程度（衰竭>损伤>风险）越来越高。胱抑素C用于检测急性肾损伤的受试者工作特征曲线下面积为0.89。血清胱抑素C大于0.70mg/L与儿科重症监护病房住院时间延长（校正风险比，1.64）和机械通气时间延长（校正风险比，1.82）相关。
胱抑素C是急性肾损伤及儿科风险、损伤、衰竭、失功、终末期肾病分类的一种早期且准确的生物标志物，并且在危重症儿童的异质性群体中与不良临床结局相关。
