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Cystatin C-derived measures of renal function as risk factors for mortality and renal replacement therapy in the critically ill – An analysis of the SWECRIT cohort

Linné, Erik LU orcid ; Åkesson, Anna ; Lengquist, Maria LU orcid ; Friberg, Hans LU ; Frigyesi, Attila LU ; Larsson, Anders O. ; Grubb, Anders LU orcid and Bentzer, Peter LU (2025) In Journal of Critical Care 89.
Abstract

Purpose: Assess if cystatin C-derived measures of kidney function are associated with mortality in septic- and non-septic intensive care unit (ICU) patients. Methods: Data from adult patients staying >24 h in four ICUs in Sweden from November 2015–December 2018 included. Outcomes were mortality and need for renal replacement therapy (RRT) due to acute kidney injury. Associations between cystatin C-estimated glomerular filtration rate (eGFRcys) and shrunken pore syndrome (SPS) and outcomes were assessed with Cox-regression in unadjusted and analyses adjusted for sex, age, illness severity, chronic kidney disease and creatinine. SPS was defined as a ratio between eGFRcys and eGFRcreatinine <0.6. Results: In total, 4455 patients were... (More)

Purpose: Assess if cystatin C-derived measures of kidney function are associated with mortality in septic- and non-septic intensive care unit (ICU) patients. Methods: Data from adult patients staying >24 h in four ICUs in Sweden from November 2015–December 2018 included. Outcomes were mortality and need for renal replacement therapy (RRT) due to acute kidney injury. Associations between cystatin C-estimated glomerular filtration rate (eGFRcys) and shrunken pore syndrome (SPS) and outcomes were assessed with Cox-regression in unadjusted and analyses adjusted for sex, age, illness severity, chronic kidney disease and creatinine. SPS was defined as a ratio between eGFRcys and eGFRcreatinine <0.6. Results: In total, 4455 patients were included in the analysis, of which 32 % had sepsis. SPS was present in 7.4 % of the cohort, and 90-day mortality was 30.8 %. In sepsis- and non-sepsis patients, SPS and eGFRcys were associated with 90-day-, 1-year mortality and RRT in unadjusted analyses. In an adjusted analysis, SPS was associated with 1-year mortality in sepsis patients (hazard ratio [HR] 1.4, 95 % CI 1.1–1.9, p = 0.021), and eGFRcys was associated with RRT in both sepsis and non-sepsis patients (HR 3.1, 95 % CI 1.6–6.0, p < 0.001, eGFRcys <20 vs ≥60 ml/min/1.73m2). No other associations between eGFRcys, SPS and mortality were detected in adjusted analyses. Conclusion: Our finding that SPS is more robustly associated with mortality in sepsis patients than in non-sepsis patients suggests that the association between SPS and mortality may depend on underlying pathophysiology. A cystatin C-based estimate of GFR is independently associated with RRT in sepsis and non-sepsis.

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author
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organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Critical care, Cystatin C, Renal function, Selective glomerular hypofiltration, Sepsis, Shrunken pore syndrome
in
Journal of Critical Care
volume
89
article number
155116
publisher
Elsevier
external identifiers
  • scopus:105004899853
  • pmid:40373615
ISSN
0883-9441
DOI
10.1016/j.jcrc.2025.155116
language
English
LU publication?
yes
id
34e20fb9-40e1-44aa-93cd-80d03311d981
date added to LUP
2025-07-18 09:14:18
date last changed
2025-07-19 03:27:51
@article{34e20fb9-40e1-44aa-93cd-80d03311d981,
  abstract     = {{<p>Purpose: Assess if cystatin C-derived measures of kidney function are associated with mortality in septic- and non-septic intensive care unit (ICU) patients. Methods: Data from adult patients staying &gt;24 h in four ICUs in Sweden from November 2015–December 2018 included. Outcomes were mortality and need for renal replacement therapy (RRT) due to acute kidney injury. Associations between cystatin C-estimated glomerular filtration rate (eGFRcys) and shrunken pore syndrome (SPS) and outcomes were assessed with Cox-regression in unadjusted and analyses adjusted for sex, age, illness severity, chronic kidney disease and creatinine. SPS was defined as a ratio between eGFRcys and eGFRcreatinine &lt;0.6. Results: In total, 4455 patients were included in the analysis, of which 32 % had sepsis. SPS was present in 7.4 % of the cohort, and 90-day mortality was 30.8 %. In sepsis- and non-sepsis patients, SPS and eGFRcys were associated with 90-day-, 1-year mortality and RRT in unadjusted analyses. In an adjusted analysis, SPS was associated with 1-year mortality in sepsis patients (hazard ratio [HR] 1.4, 95 % CI 1.1–1.9, p = 0.021), and eGFRcys was associated with RRT in both sepsis and non-sepsis patients (HR 3.1, 95 % CI 1.6–6.0, p &lt; 0.001, eGFRcys &lt;20 vs ≥60 ml/min/1.73m<sup>2</sup>). No other associations between eGFRcys, SPS and mortality were detected in adjusted analyses. Conclusion: Our finding that SPS is more robustly associated with mortality in sepsis patients than in non-sepsis patients suggests that the association between SPS and mortality may depend on underlying pathophysiology. A cystatin C-based estimate of GFR is independently associated with RRT in sepsis and non-sepsis.</p>}},
  author       = {{Linné, Erik and Åkesson, Anna and Lengquist, Maria and Friberg, Hans and Frigyesi, Attila and Larsson, Anders O. and Grubb, Anders and Bentzer, Peter}},
  issn         = {{0883-9441}},
  keywords     = {{Critical care; Cystatin C; Renal function; Selective glomerular hypofiltration; Sepsis; Shrunken pore syndrome}},
  language     = {{eng}},
  publisher    = {{Elsevier}},
  series       = {{Journal of Critical Care}},
  title        = {{Cystatin C-derived measures of renal function as risk factors for mortality and renal replacement therapy in the critically ill – An analysis of the SWECRIT cohort}},
  url          = {{http://dx.doi.org/10.1016/j.jcrc.2025.155116}},
  doi          = {{10.1016/j.jcrc.2025.155116}},
  volume       = {{89}},
  year         = {{2025}},
}