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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 LU ; Lipcsey, Miklos and Eriksson, Mats B. (2022) In Biomedicines 10(11).
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... (More)

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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author
; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
biomarkers, corticosteroids, COVID-19, creatinine, cystatin C, eGFR, intensive care, kidney, SARS-CoV-2
in
Biomedicines
volume
10
issue
11
article number
2708
publisher
MDPI AG
external identifiers
  • pmid:36359231
  • scopus:85141832913
ISSN
2227-9059
DOI
10.3390/biomedicines10112708
language
English
LU publication?
yes
id
4546d4fc-3e0a-4f98-b38a-bba2529f452c
date added to LUP
2023-01-04 12:21:56
date last changed
2024-06-13 22:44:25
@article{4546d4fc-3e0a-4f98-b38a-bba2529f452c,
  abstract     = {{<p>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 (eGFR<sub>LMR</sub>) and a cystatin C-based equation (eGFR<sub>CAPA</sub>) 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). eGFR<sub>CAPA</sub> in dexamethasone-treated patients was 69 (37), and 74 (46) in patients not given dexamethasone (p = 0.01). eGFR<sub>LMR</sub> was not affected by dexamethasone. eGFR<sub>LMR</sub> in females was 94 (20), and 75 (38) in males (p = 0.00001). Age and maximal CRP correlated negatively to eGFR<sub>CAPA</sub> and eGFR<sub>LMR</sub>, whereas both eGFR equations correlated positively to BMI. In ICU patients with COVID-19, dexamethasone treatment was associated with reduced eGFR<sub>CAPA</sub>. 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.</p>}},
  author       = {{Larsson, Anders O. and Hultström, Michael and Frithiof, Robert and Nyman, Ulf and Lipcsey, Miklos and Eriksson, Mats B.}},
  issn         = {{2227-9059}},
  keywords     = {{biomarkers; corticosteroids; COVID-19; creatinine; cystatin C; eGFR; intensive care; kidney; SARS-CoV-2}},
  language     = {{eng}},
  number       = {{11}},
  publisher    = {{MDPI AG}},
  series       = {{Biomedicines}},
  title        = {{Differential Bias for Creatinine- and Cystatin C- Derived Estimated Glomerular Filtration Rate in Critical COVID-19}},
  url          = {{http://dx.doi.org/10.3390/biomedicines10112708}},
  doi          = {{10.3390/biomedicines10112708}},
  volume       = {{10}},
  year         = {{2022}},
}