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The mortality increase in cardiac surgery patients associated with shrunken pore syndrome correlates with the eGFR cystatin C /eGFR creatinine -ratio

Herou, Erik LU ; Dardashti, Alain LU ; Nozohoor, Shahab LU ; Zindovic, Igor LU ; Ederoth, Per LU ; Grubb, Anders LU and Bjursten, Henrik LU (2019) In Scandinavian Journal of Clinical and Laboratory Investigation
Abstract


Shrunken pore syndrome (SPS) is a condition in which estimated glomerular filtration rate (eGFR) based upon cystatin C is lower than eGFR based upon creatinine. It has been associated with increased mortality even in the presence of normal GFR in both a cardiac surgical population and a general population. No systematic studies of the variation in eGFR
cystatin C
/eGFR
creatinine
-ratio used for SPS diagnosis have... (More)


Shrunken pore syndrome (SPS) is a condition in which estimated glomerular filtration rate (eGFR) based upon cystatin C is lower than eGFR based upon creatinine. It has been associated with increased mortality even in the presence of normal GFR in both a cardiac surgical population and a general population. No systematic studies of the variation in eGFR
cystatin C
/eGFR
creatinine
-ratio used for SPS diagnosis have been published. This study aims to evaluate whether early and midterm mortality following elective cardiac surgery varies with the ratio used to identify SPS. Preoperative levels of cystatin C and creatinine were analysed in 4007 patients undergoing elective coronary artery bypass grafting (CABG) and/or surgical aortic valve replacement (sAVR). The eGFR
cystatin C
/eGFR
creatinine
-ratio was calculated based on the equation pairs CKD-EPI
cystatin C
/CKD-EPI
creatinine
and CAPA/LMrev. The overall 1- and 3-year all-cause mortality was 2.9 and 6.8%, respectively. Mean follow-up time was 3.6 years. Mortality markedly and progressively increased with a decrease in the eGFR
cystatin C
/eGFR
creatinine
-ratio for both equation pairs. An increase in mortality was noted already when the ratio decreased from 1.0 to 0.90. To facilitate the clinical decisions based upon the SPS-defining eGFR
cystatin C
/eGFR
creatinine
-ratio, we calculated both the ratios defining the highest combined sensitivity and specificity and the ratios producing a high specificity of 95%, finding different cut-off for these scenarios.

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author
publishing date
type
Contribution to journal
publication status
epub
subject
keywords
aortic valve replacement, Cardiac surgery, coronary artery bypass, creatinine, cystatin C, glomerular filtration rate, shrunken pore syndrome
in
Scandinavian Journal of Clinical and Laboratory Investigation
publisher
Informa Healthcare
external identifiers
  • scopus:85061778385
ISSN
0036-5513
DOI
10.1080/00365513.2019.1576101
language
English
LU publication?
no
id
df767ba1-b5b6-4c54-8957-f0f981efb91b
date added to LUP
2019-03-04 10:43:42
date last changed
2019-09-17 04:49:36
@article{df767ba1-b5b6-4c54-8957-f0f981efb91b,
  abstract     = {<p><br>
                                                         Shrunken pore syndrome (SPS) is a condition in which estimated glomerular filtration rate (eGFR) based upon cystatin C is lower than eGFR based upon creatinine. It has been associated with increased mortality even in the presence of normal GFR in both a cardiac surgical population and a general population. No systematic studies of the variation in eGFR                             <br>
                            <sub>cystatin C</sub><br>
                                                         /eGFR                             <br>
                            <sub>creatinine</sub><br>
                                                         -ratio used for SPS diagnosis have been published. This study aims to evaluate whether early and midterm mortality following elective cardiac surgery varies with the ratio used to identify SPS. Preoperative levels of cystatin C and creatinine were analysed in 4007 patients undergoing elective coronary artery bypass grafting (CABG) and/or surgical aortic valve replacement (sAVR). The eGFR                             <br>
                            <sub>cystatin C</sub><br>
                                                         /eGFR                             <br>
                            <sub>creatinine</sub><br>
                                                         -ratio was calculated based on the equation pairs CKD-EPI                             <br>
                            <sub>cystatin C</sub><br>
                                                         /CKD-EPI                             <br>
                            <sub>creatinine</sub><br>
                                                          and CAPA/LMrev. The overall 1- and 3-year all-cause mortality was 2.9 and 6.8%, respectively. Mean follow-up time was 3.6 years. Mortality markedly and progressively increased with a decrease in the eGFR                             <br>
                            <sub>cystatin C</sub><br>
                                                         /eGFR                             <br>
                            <sub>creatinine</sub><br>
                                                         -ratio for both equation pairs. An increase in mortality was noted already when the ratio decreased from 1.0 to 0.90. To facilitate the clinical decisions based upon the SPS-defining eGFR                             <br>
                            <sub>cystatin C</sub><br>
                                                         /eGFR                             <br>
                            <sub>creatinine</sub><br>
                                                         -ratio, we calculated both the ratios defining the highest combined sensitivity and specificity and the ratios producing a high specificity of 95%, finding different cut-off for these scenarios.                         <br>
                        </p>},
  author       = {Herou, Erik and Dardashti, Alain and Nozohoor, Shahab and Zindovic, Igor and Ederoth, Per and Grubb, Anders and Bjursten, Henrik},
  issn         = {0036-5513},
  keyword      = {aortic valve replacement,Cardiac surgery,coronary artery bypass,creatinine,cystatin C,glomerular filtration rate,shrunken pore syndrome},
  language     = {eng},
  month        = {02},
  publisher    = {Informa Healthcare},
  series       = {Scandinavian Journal of Clinical and Laboratory Investigation},
  title        = {The mortality increase in cardiac surgery patients associated with shrunken pore syndrome correlates with the eGFR                         
                        <sub>cystatin C</sub>
                                                 /eGFR                         
                        <sub>creatinine</sub>
                                                 -ratio},
  url          = {http://dx.doi.org/10.1080/00365513.2019.1576101},
  year         = {2019},
}