Cystatin C predicts long term mortality better than creatinine in a nationwide study of intensive care patients

Forskningsoutput: TidskriftsbidragArtikel i vetenskaplig tidskrift

Standard

Cystatin C predicts long term mortality better than creatinine in a nationwide study of intensive care patients. / Helmersson-Karlqvist, Johanna; Lipcsey, Miklos; Ärnlöv, Johan; Bell, Max; Ravn, Bo; Dardashti, Alain; Larsson, Anders.

I: Scientific Reports, Vol. 11, Nr. 1, 5882, 2021.

Forskningsoutput: TidskriftsbidragArtikel i vetenskaplig tidskrift

Harvard

APA

CBE

MLA

Vancouver

Author

Helmersson-Karlqvist, Johanna ; Lipcsey, Miklos ; Ärnlöv, Johan ; Bell, Max ; Ravn, Bo ; Dardashti, Alain ; Larsson, Anders. / Cystatin C predicts long term mortality better than creatinine in a nationwide study of intensive care patients. I: Scientific Reports. 2021 ; Vol. 11, Nr. 1.

RIS

TY - JOUR

T1 - Cystatin C predicts long term mortality better than creatinine in a nationwide study of intensive care patients

AU - Helmersson-Karlqvist, Johanna

AU - Lipcsey, Miklos

AU - Ärnlöv, Johan

AU - Bell, Max

AU - Ravn, Bo

AU - Dardashti, Alain

AU - Larsson, Anders

PY - 2021

Y1 - 2021

N2 - Decreased glomerular filtration rate (GFR) is linked to poor survival. The predictive value of creatinine estimated GFR (eGFR) and cystatin C eGFR in critically ill patients may differ substantially, but has been less studied. This study compares long-term mortality risk prediction by eGFR using a creatinine equation (CKD-EPI), a cystatin C equation (CAPA) and a combined creatinine/cystatin C equation (CKD-EPI), in 22,488 patients treated in intensive care at three University Hospitals in Sweden, between 2004 and 2015. Patients were analysed for both creatinine and cystatin C on the same blood sample tube at admission, using accredited laboratory methods. During follow-up (median 5.1 years) 8401 (37%) patients died. Reduced eGFR was significantly associated with death by all eGFR-equations in Cox regression models. However, patients reclassified to a lower GFR-category by using the cystatin C-based equation, as compared to the creatinine-based equation, had significantly higher mortality risk compared to the referent patients not reclassified. The cystatin C equation increased C-statistics for death prediction (p < 0.001 vs. creatinine, p = 0.013 vs. combined equation). In conclusion, this data favours the sole cystatin C equation rather than the creatinine or combined equations when estimating GFR for risk prediction purposes in critically ill patients.

AB - Decreased glomerular filtration rate (GFR) is linked to poor survival. The predictive value of creatinine estimated GFR (eGFR) and cystatin C eGFR in critically ill patients may differ substantially, but has been less studied. This study compares long-term mortality risk prediction by eGFR using a creatinine equation (CKD-EPI), a cystatin C equation (CAPA) and a combined creatinine/cystatin C equation (CKD-EPI), in 22,488 patients treated in intensive care at three University Hospitals in Sweden, between 2004 and 2015. Patients were analysed for both creatinine and cystatin C on the same blood sample tube at admission, using accredited laboratory methods. During follow-up (median 5.1 years) 8401 (37%) patients died. Reduced eGFR was significantly associated with death by all eGFR-equations in Cox regression models. However, patients reclassified to a lower GFR-category by using the cystatin C-based equation, as compared to the creatinine-based equation, had significantly higher mortality risk compared to the referent patients not reclassified. The cystatin C equation increased C-statistics for death prediction (p < 0.001 vs. creatinine, p = 0.013 vs. combined equation). In conclusion, this data favours the sole cystatin C equation rather than the creatinine or combined equations when estimating GFR for risk prediction purposes in critically ill patients.

U2 - 10.1038/s41598-021-85370-8

DO - 10.1038/s41598-021-85370-8

M3 - Article

C2 - 33723337

AN - SCOPUS:85102498287

VL - 11

JO - Scientific Reports

JF - Scientific Reports

SN - 2045-2322

IS - 1

M1 - 5882

ER -