Differential Bias for Creatinine- and Cystatin C- Derived Estimated Glomerular Filtration Rate in Critical COVID-19
(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.
(Less)
- author
- Larsson, Anders O. ; Hultström, Michael ; Frithiof, Robert ; Nyman, Ulf LU ; Lipcsey, Miklos and Eriksson, Mats B.
- organization
- publishing date
- 2022-11
- 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
-
- scopus:85141832913
- pmid:36359231
- 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
- 2024-09-20 07:56:44
@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}}, }