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Differential Bias for Creatinine- and Cystatin C- Derived Estimated Glomerular Filtration Rate in Critical COVID-19.
Larsson, Anders O; Hultström, Michael; Frithiof, Robert; Nyman, Ulf; Lipcsey, Miklos; Eriksson, Mats B.
  • Larsson AO; Department of Medical Sciences, Section of Clinical Chemistry, Uppsala University, 751 85 Uppsala, Sweden.
  • Hultström M; Department of Surgical Sciences, Anaesthesiology and Intensive Care Medicine, Uppsala University, 751 85 Uppsala, Sweden.
  • Frithiof R; Department of Medical Cell Biology, Integrative Physiology, Uppsala University, 751 23 Uppsala, Sweden.
  • Nyman U; Department of Epidemiology, McGill University, Montréal, QC H3A 0G4, Canada.
  • Lipcsey M; Lady Davis Institute of Medical Research, Jewish General Hospital, Montréal, QC H3T 1E2, Canada.
  • Eriksson MB; Department of Surgical Sciences, Anaesthesiology and Intensive Care Medicine, Uppsala University, 751 85 Uppsala, Sweden.
Biomedicines ; 10(11)2022 Oct 26.
Article in English | MEDLINE | ID: covidwho-2089994
ABSTRACT
COVID-19 is a systemic disease, frequently affecting kidney function. Dexamethasone is standard treatment in severe COVID-19 cases, and is considered to increase plasma levels of cystatin C. However, this has not been studied in COVID-19. Glomerular filtration rate (GFR) is a clinically important indicator of renal function, but often estimated using equations (eGFR) based on filtered metabolites. This study focuses on sources of bias for eGFRs (mL/min) using a creatinine-based equation (eGFRLMR) and a cystatin C-based equation (eGFRCAPA) in intensive-care-treated patients with COVID-19. This study was performed on 351 patients aged 18 years old or above with severe COVID-19 infections, admitted to the intensive care unit (ICU) in Uppsala University Hospital, a tertiary care hospital in Uppsala, Sweden, between 14 March 2020 and 10 March 2021. Dexamethasone treatment (6 mg for up to 10 days) was introduced 22 June 2020 (n = 232). Values are presented as medians (IQR). eGFRCAPA in dexamethasone-treated patients was 69 (37), and 74 (46) in patients not given dexamethasone (p = 0.01). eGFRLMR was not affected by dexamethasone. eGFRLMR in females was 94 (20), and 75 (38) in males (p = 0.00001). Age and maximal CRP correlated negatively to eGFRCAPA and eGFRLMR, whereas both eGFR equations correlated positively to BMI. In ICU patients with COVID-19, dexamethasone treatment was associated with reduced eGFRCAPA. This finding may be explained by corticosteroid-induced increases in plasma cystatin C. This observation is important from a clinical perspective since adequate interpretation of laboratory results is crucial.
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Full text: Available Collection: International databases Database: MEDLINE Type of study: Observational study / Prognostic study Language: English Year: 2022 Document Type: Article Affiliation country: Biomedicines10112708

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Full text: Available Collection: International databases Database: MEDLINE Type of study: Observational study / Prognostic study Language: English Year: 2022 Document Type: Article Affiliation country: Biomedicines10112708