ABSTRACT
Objective To prospectively evaluate the value of cystatin C (CysC) in diagnosis of contrast-induced acute kidney injury (CIAKI) among patients undergoing Percutaneous Cardiovascular Intervention (PCI).Methods Patients who underwent PCI procedures in our hospital were enrolled.Serum creatinine(SCr) and CysC were measured at baseline before,24 h and 48 h after PCI,respectively.CysC were examined by particle-enhanced turbidimetric immunoassay (PETIA).CIAKI was defined as a relative increase in SCr concentration of at least 25％ or an absolute increase more than 44.8 mmol/L (0.5 mg/dl) within 48 h in the absence of other related causes.Results Among 196 patients,135 were male and 61 female with a mean age of(70.4 ± 11.3)years old.Twenty-nine (14.8％)patients developed CIAKI according to the SCr criteria.The area under the ROC curve (AUC) at 24 h and 48 h post PCI were 0.661 (95％ CI 0.548-0.774,P =0.006) and 0.783 (95％ CI 0.701-0.865,P ＜ 0.001),respectively.The diagnostic sensitivities of CysC at 24 h and 48 h were between 6.9％ and 48.28％,while,the diagnostic specificities and negative predictive values of CysC were between 85.03％-97.60％ and 85.79％-90.45％,respectively.The 15％ elevation of 48 h CysC yielded the diagnostic sensitivity of 41.38％,specificity of 92.86％,negative predictive value of 90.17％,corrective rate of 85.28％ with Youden Index of 0.342 4.Conclusions In this study,CysC presented an excellent diagnostic specificity and negative predictive value in diagnosis of CIAKI.It might be used as a tool for excluding CIAKI in clinical practice.48 h CysC performed better than 24 h CysC in CIAKI diagnosis,among which a 15％ increment achieved relatively the best diagnostic value.
ABSTRACT
ObjectiveTo assess the significance of serum cysteine proteinase inhibitor C (Cys-C) and β2 microglobulin (β2MG) concentrations in the diagnosis and prognosis of sepsis-induced acute kidney injury.Methods Two hundred and fifty patients presenting to the Emergency Department of Beijing Chaoyang Hospital from October 2008 to October 2009 with sepsis were assessed.Serum creatinine (SCr),β2MG and Cys-C concentrations and Acute Physiology and Chronic Health Evaluation Ⅱ ( APACHE Ⅱ ) scores were determined when the septic patients presented to the hospital. The 28-day mortality was recorded.The study patients were retrospectively divided into acute kidney injury ( n =63 ) and no acute kidney injury groups (n =187 ).The predictive accuracies of Cys-C and β2MG for acute kidney injury were analyzed by plotting a relative operating characteristic (ROC) curve.The Spearman interclass correlation method was used to analyze the correlation between Cys-C concentration and APACHE Ⅱ score in sepsisinduced acute kidney injury.ResultsCys-C and β2 MG concentrations were significantly greater in the acute than in the no acute kidney injury group [ ( 1189 ± 214) μg/L vs.(678 ± 118) μg/L,P =0.007 ; (3705 ±599)μg/L vs.(2365 ±446) μg/L,P =0.004,respectively].SCr concentrations and APACHE Ⅱ scores were significantly greater in the acute than in the no acute kidney injury group [ (145 ±49) vs.(73 ±25),P=0.013,(19 ±4) vs.(13 ±4),P=0.016].There was a significant correlation between Cys-C concentration and APACHEII score in the acute kidney injury group (P ＜0.01).The 28-day mortality was significantly greater in the acute than in the no acute kidney injury group.The areas under the ROC curve for Cys-C and β2MG concentrations were 0.909 ( OR =1.006,95％ CI =1.002 - 1.009) and 0.82 ( OR =1.001,95％ CI =1.000 -1.001),respectively.ConclusionsMonitoring of Cys-C and β2MG concentrations can effectively predict the occurrence of acute kidney injury in septic patients.Cys-C concentration is a more accurate predictor of this diagnosis than β2MG concentration.An increasing Cys-C concentration is an indicator of poor prognosis.
