Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
Department of Clinical Chemistry, Karolinska Universitetslaboratoriet, Karolinska Universitetssjukhuset, Stockholm, Sweden.
Scand J Clin Lab Invest. 2023 Jul;83(4):251-257. doi: 10.1080/00365513.2023.2210291. Epub 2023 May 11.
Acute kidney injury (AKI) is common in COVID-19 and is diagnosed using relative serum creatinine increase. Estimated GFR (eGFR) is a more accurate measure of glomerular filtration due to compensation for age and sex. Serum Cystatin-C, less affected by non-renal factors than creatinine, may further improve renal function estimation and add prognostic information. Our aim is to investigate the importance of a calculated eGFR in relation to creatinine as well as the value of Cystatin-C in patients with severe COVID-19. This study is a retrospective cohort study investigating levels and trends of routine laboratory parameters combined with clinical data from 286 consecutive patients with severe COVID-19 from Karolinska University Hospital. AKI developed in 38% of the patients and 15% were treated with hemodialysis. Mortality in the AKI group was 42% compared to 5% in the non-AKI group. At admission, eGFR but not creatinine, was significantly associated with AKI development, need of intubation and mortality. Moreover, discrepant results between eGFR creatinine (eGFR) and eGFR Cystatin-C (eGFR) was common in the ICU patients compared to non-ICU patients and related to outcome. In addition, we found that daily median Cystatin-C levels during the hospital stay were correlated to neutrophil count. eGFR was found to be an overall better prognostic marker than creatinine regarding AKI development and prognosis in severe COVID-19. Fulfillment of Shrunken pore syndrome criteria indicated a higher mortality risk. Cystatin-C may be related to neutrophil count, which could be a clue to the discrepant eGFR results.
急性肾损伤（AKI）在 COVID-19 中很常见，其诊断依据是相对血清肌酐升高。估算肾小球滤过率（eGFR）是一种更准确的肾小球滤过率测量方法，因为它可以补偿年龄和性别因素。血清胱抑素 C 比肌酐受非肾脏因素的影响更小，因此可以进一步改善肾功能估计，并提供预后信息。我们的目的是研究计算 eGFR 与肌酐相比的重要性，以及胱抑素 C 在重症 COVID-19 患者中的价值。这项研究是一项回顾性队列研究，调查了来自卡罗林斯卡大学医院的 286 例连续重症 COVID-19 患者的常规实验室参数水平和趋势，并结合了临床数据。38%的患者发生 AKI，15%的患者接受血液透析治疗。AKI 组的死亡率为 42%，而非 AKI 组为 5%。入院时，eGFR 而非肌酐与 AKI 发生、需要插管和死亡率显著相关。此外，与非 ICU 患者相比，ICU 患者的 eGFR 与胱抑素 C（eGFR）之间的结果差异更为常见，且与结局相关。此外，我们发现住院期间的每日中位胱抑素 C 水平与中性粒细胞计数相关。eGFR 是一种比肌酐更好的预后标志物，可预测重症 COVID-19 中的 AKI 发生和预后。满足小孔综合征标准表明死亡率更高。胱抑素 C 可能与中性粒细胞计数有关，这可能是 eGFR 结果差异的线索。
