血清胱抑素C是急性主动脉夹层患者短期死亡率和急性肾损伤的潜在预测指标：一项回顾性队列研究。
Serum cystatin C is a potential predictor of short-term mortality and acute kidney injury in acute aortic dissection patients: a retrospective cohort study.
作者信息
Wang Jun, Yang Biwen, Liu Meili, You Tao, Shen Han, Chen Yihuan, Huang Haoyue, Li Shifeng, Wang Zhiyang, Li Xinyue, Huang Fang, Teng Xiaomei
机构信息
Department of Cardiovascular Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China.
Department of Intensive Care Medicine, The First Affiliated Hospital of Soochow University, Suzhou, China.
出版信息
J Thorac Dis. 2022 Aug;14(8):2977-2986. doi: 10.21037/jtd-22-937.
BACKGROUND
Serum cystatin C concentration is associated with cardiovascular disease. However, the relationship between cystatin C and acute aortic dissection (AAD) remains unclear. In the current study, we aim to evaluate the predictive value of cystatin C in the occurrence of acute kidney injury (AKI) and the prognosis of AAD patients.
METHODS
The patients with AAD admitted to our hospital from November 2019 through January 2022 were consecutively included in the retrospective cohort study. A complete blood cell count, serum biochemistry tests, including cystatin C and creatinine, in-hospital mortality and the incidence of AKI were recorded. All the patients were categorized into four groups according to the quartile of their serum cystatin C levels. Multivariate logistic and Cox regression analyses were conducted to determine the independent risk factors for the incidence of AKI and the prognosis of AAD patients, respectively. Kaplan-Meier analyses and log-rank tests were used to evaluate differences in survival. Receiver operating characteristic (ROC) curves were used to assess the predictive value of cystatin C for short-term mortality and the incidence of AKI in AAD patients.
RESULTS
A total of 357 patients were included in this study. The results showed that the higher the concentration of cystatin C, the higher the level of serum creatinine and the higher the incidence of AKI. Mortality was significantly higher in the group with serum cystatin C levels >1.18 mg/L. Type A AAD, white blood cell count >10×10/L, platelet count <100×10/L, and serum cystatin C concentration >1.18 mg/L [adjusted hazards ratio (HR) =2.405, 95% confidence interval (CI), 1.029-4.063, P=0.041] were independent risk factors for in-hospital mortality. Cystatin C levels >1.18 mg/L remained an independent predictor of AKI in AAD after adjusting for the confounding [odds ratio (OR) 76.489, 95% CI, 25.586-228.660]. The areas under the ROC curves of cystatin C in predicting the mortality and incidence of AKI in AAD patients were 0.655 (95% CI, 0.551-0.760) and 0.807 (95% CI, 0.758-0.856), respectively.
CONCLUSIONS
In sum, serum cystatin C concentration is a potential predictor of short-term mortality and the incidence of AKI in AAD patients.
背景
血清胱抑素C浓度与心血管疾病相关。然而，胱抑素C与急性主动脉夹层（AAD）之间的关系仍不清楚。在本研究中，我们旨在评估胱抑素C对急性肾损伤（AKI）发生的预测价值以及AAD患者的预后。
方法
连续纳入2019年11月至2022年1月在我院收治的AAD患者进行回顾性队列研究。记录全血细胞计数、血清生化检查，包括胱抑素C和肌酐、住院死亡率及AKI发生率。所有患者根据血清胱抑素C水平的四分位数分为四组。分别进行多因素logistic回归和Cox回归分析，以确定AKI发生率和AAD患者预后的独立危险因素。采用Kaplan-Meier分析和对数秩检验评估生存差异。采用受试者工作特征（ROC）曲线评估胱抑素C对AAD患者短期死亡率和AKI发生率的预测价值。
结果
本研究共纳入357例患者。结果显示，胱抑素C浓度越高，血清肌酐水平越高，AKI发生率越高。血清胱抑素C水平>1.18 mg/L组的死亡率显著更高。A型AAD、白细胞计数>10×10⁹/L、血小板计数<100×10⁹/L以及血清胱抑素C浓度>1.18 mg/L[调整后风险比（HR）=2.405，95%置信区间（CI），1.029 - 4.063，P = 0.041]是住院死亡率的独立危险因素。在校正混杂因素后，胱抑素C水平>1.18 mg/L仍是AAD患者发生AKI的独立预测因素[比值比（OR）76.489，95% CI，25.586 - 228.660]。胱抑素C预测AAD患者死亡率和AKI发生率的ROC曲线下面积分别为0.655（95% CI，0.551 - 0.760）和0.807（95% CI，0.758 - 0.856）。
结论
总之，血清胱抑素C浓度是AAD患者短期死亡率和AKI发生率的潜在预测指标。
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