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Cystatin C and derived measures of renal function as risk factors for mortality and acute kidney injury in sepsis – A post-hoc analysis of the FINNAKI cohort

Linné, Erik LU orcid ; Elfström, Alma ; Åkesson, Anna LU ; Fisher, Jane LU ; Grubb, Anders LU orcid ; Pettilä, Ville ; Vaara, Suvi T. ; Linder, Adam LU and Bentzer, Peter LU (2022) In Journal of Critical Care 72.
Abstract

Purpose: To assess the association between cystatin C-derived estimates of kidney function and mortality and acute kidney injury (AKI) in sepsis. Materials and methods: Post-hoc analysis of sepsis patients in the FINNAKI-cohort (n = 802). Primary outcome was 90-day mortality. We measured plasma cystatin C and creatinine at intensive care unit (ICU) admission and estimated glomerular filtration rates (eGFRcys, eGFRcrea) and shrunken pore syndrome (SPS; defined as eGFRcys/eGFRcrea ratio < 0.7). Associations were assessed using Cox- or logistic regression. Results: Increased cystatin C and decreased eGFRcys were associated with mortality in unadjusted analyses and in analyses... (More)

Purpose: To assess the association between cystatin C-derived estimates of kidney function and mortality and acute kidney injury (AKI) in sepsis. Materials and methods: Post-hoc analysis of sepsis patients in the FINNAKI-cohort (n = 802). Primary outcome was 90-day mortality. We measured plasma cystatin C and creatinine at intensive care unit (ICU) admission and estimated glomerular filtration rates (eGFRcys, eGFRcrea) and shrunken pore syndrome (SPS; defined as eGFRcys/eGFRcrea ratio < 0.7). Associations were assessed using Cox- or logistic regression. Results: Increased cystatin C and decreased eGFRcys were associated with mortality in unadjusted analyses and in analyses adjusted for illness severity and creatinine. Hazard ratios (HRs) in unadjusted analyses were 3.30 (95% CI; 2.12–5.13, p < 0.001) and 3.26 (95% CI; 2.12–5.02, p < 0.001) respectively. SPS was associated with mortality in an unadjusted- (HR 1.78, 95% CI; 1.33–2.37, p < 0.001) and in an adjusted analysis (HR 1.54, 95% CI; 1.07–2.22, p = 0.021). All cystatin C-derived measures were associated with mortality also after adjustment for AKI development. Cystatin C was associated with AKI in unadjusted analyses but not in analyses adjusted for creatinine. Conclusion: Cystatin C and derived measures of kidney function at ICU admission are associated with an increased 90-day mortality. Increased AKI incidence does not fully explain this association.

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author
; ; ; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Acute kidney injury, Cystatin C, Mortality, sepsis, Shrunken pore syndrome
in
Journal of Critical Care
volume
72
article number
154148
publisher
Elsevier
external identifiers
  • pmid:36108348
  • scopus:85137635334
ISSN
0883-9441
DOI
10.1016/j.jcrc.2022.154148
language
English
LU publication?
yes
id
85d068f6-85b7-4f76-96fd-1f89a22c17f7
date added to LUP
2022-11-30 09:39:39
date last changed
2024-04-16 14:55:45
@article{85d068f6-85b7-4f76-96fd-1f89a22c17f7,
  abstract     = {{<p>Purpose: To assess the association between cystatin C-derived estimates of kidney function and mortality and acute kidney injury (AKI) in sepsis. Materials and methods: Post-hoc analysis of sepsis patients in the FINNAKI-cohort (n = 802). Primary outcome was 90-day mortality. We measured plasma cystatin C and creatinine at intensive care unit (ICU) admission and estimated glomerular filtration rates (eGFR<sub>cys</sub>, eGFR<sub>crea</sub>) and shrunken pore syndrome (SPS; defined as eGFR<sub>cys</sub>/eGFR<sub>crea</sub> ratio &lt; 0.7). Associations were assessed using Cox- or logistic regression. Results: Increased cystatin C and decreased eGFR<sub>cys</sub> were associated with mortality in unadjusted analyses and in analyses adjusted for illness severity and creatinine. Hazard ratios (HRs) in unadjusted analyses were 3.30 (95% CI; 2.12–5.13, p &lt; 0.001) and 3.26 (95% CI; 2.12–5.02, p &lt; 0.001) respectively. SPS was associated with mortality in an unadjusted- (HR 1.78, 95% CI; 1.33–2.37, p &lt; 0.001) and in an adjusted analysis (HR 1.54, 95% CI; 1.07–2.22, p = 0.021). All cystatin C-derived measures were associated with mortality also after adjustment for AKI development. Cystatin C was associated with AKI in unadjusted analyses but not in analyses adjusted for creatinine. Conclusion: Cystatin C and derived measures of kidney function at ICU admission are associated with an increased 90-day mortality. Increased AKI incidence does not fully explain this association.</p>}},
  author       = {{Linné, Erik and Elfström, Alma and Åkesson, Anna and Fisher, Jane and Grubb, Anders and Pettilä, Ville and Vaara, Suvi T. and Linder, Adam and Bentzer, Peter}},
  issn         = {{0883-9441}},
  keywords     = {{Acute kidney injury; Cystatin C; Mortality; sepsis; Shrunken pore syndrome}},
  language     = {{eng}},
  publisher    = {{Elsevier}},
  series       = {{Journal of Critical Care}},
  title        = {{Cystatin C and derived measures of renal function as risk factors for mortality and acute kidney injury in sepsis – A post-hoc analysis of the FINNAKI cohort}},
  url          = {{http://dx.doi.org/10.1016/j.jcrc.2022.154148}},
  doi          = {{10.1016/j.jcrc.2022.154148}},
  volume       = {{72}},
  year         = {{2022}},
}