Serum cystatin C in elderly cardiac surgery patients.

Elderly cardiac surgery patients are more prone to develop postoperative acute kidney injury (AKI). The common clinical glomerular filtration marker, plasma creatinine, is considered to be inadequate to discover AKI in its early stage. The aim of this study was to determine if serum cystatin C can detect mild renal failure earlier than plasma creatinine. From 110 cardiac surgery patients aged 70 or greater years, serum cystatin C and plasma creatinine samples were collected preoperatively and on postoperative days 1 to 5. Their urine output, creatinine, and estimated glomerular filtration rate were calculated and AKI was determined by the risk-injury-failure-loss-end-stage kidney disease criteria (RIFLE). The correlation of plasma creatinine and serum cystatin C to AKI was calculated. After cardiac surgery, 62 of the 110 patients (56.4%) developed AKI according to the RIFLE classification. In this group, both serum cystatin C and plasma creatinine peaked on postoperative day 3. Cystatin C and creatinine correlated equally with AKI at different time points calculated with receiver operating characteristic curves. On postoperative day 1 the area under the curve (AUC) for creatinine was 0.66 (0.55 to 0.76) and for cystatin C 0.71 (0.61 to 0.81); Delta AUC 0.05 (0.01 to 0.12), p = 0.11. On postoperative day 2 the AUC for creatinine was 0.74 (0.64 to 0.83) and for cystatin was C 0.77 (0.68 to 0.86); Delta AUC -0.03 (-0.09 to 0.03), p = 0.32. Elderly cardiac surgery patients have a high incidence of AKI, as defined by the RIFLE criteria. After cardiac surgery serum cystatin C and plasma creatinine detected AKI similarly.

Ristikankare A ，Pöyhiä R ，Kuitunen A ，Skrifvars M ，Hämmäinen P ，Salmenperä M ，Suojaranta-Ylinen R ... -  《-》

[Prospective study of cystatin C for diagnosis of acute kidney injury after cardiac surgery].

Liang XL ，Shi W ，Liu SX ，Yan LJ ，Xuan HJ ，Xiong WP ，Peng YQ ，Huang JS ，Liang YZ ... -  《-》

Novel biomarkers early predict the severity of acute kidney injury after cardiac surgery in adults.

Haase M ，Bellomo R ，Devarajan P ，Ma Q ，Bennett MR ，Möckel M ，Matalanis G ，Dragun D ，Haase-Fielitz A ... -  《-》

Predictive power of serum cystatin C to detect acute kidney injury and pediatric-modified RIFLE class in children undergoing cardiac surgery.

Hassinger AB ，Backer CL ，Lane JC ，Haymond S ，Wang D ，Wald EL ... -  《Pediatric Critical Care Medicine》

Utility of cystatin C for assessment of renal function after cardiac surgery.

Though acute renal failure among cardiac surgery patients is associated with increased mortality, diagnosis of renal failure is often delayed due to the late detectability of laboratory markers for kidney failure. Recently, a number of clinical studies have shown that glomerular filtration rate (GFR) can be estimated by measuring the serum concentration of cystatin C (CysC). However, comparisons between the diagnostic effectiveness of CysC and serum creatinine have been inconsistent. The present study compares the diagnostic effectiveness of both serum markers in cardiac surgery patients. In 50 cardiac surgery patients, GFR was quantified by measuring creatinine clearance and estimated from serum concentrations of both creatinine and CysC. The sensitivity and specificity of serum creatinine and CysC for detection of reduced GFR values were compared as well as correlation between estimated GFR values and creatinine clearance. GFR values <60 ml/min/1.73 m(2) were detected with equal effectiveness using creatinine or CysC, whereas for the detection of GFR <90 ml/min/1.73 m(2) the area under the curve of serum creatinine was significantly higher. Correlation between estimated GFR values and creatinine clearance was higher when creatinine-based formulae were used. In patients after cardiac surgery, CysC is not superior to serum creatinine for assessment of GFR.

Heise D ，Waeschle RM ，Schlobohm J ，Wessels J ，Quintel M ... -  《-》