Cystatin C based measures of kidney function are associated with mortality in sepsis

The association remains after adjustment for both illness severity and creatinine

The association remains also after adjustment for development of acute kidney injury

To assess the association between cystatin C-derived estimates of kidney function and mortality and acute kidney injury (AKI) in sepsis.

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.

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.

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.

Cystatin C

Shrunken pore syndrome

Mortality

sepsis

Acute kidney injury

Angiotensin Converting Enzyme

Angiotensin Receptor Blocker

Caucasian Asian and Pediatric Adult

Central Nervous System

Chronic Obstructive Pulmonary Disease

Estimated Glomerular Filtration Rate

Estimated Glomerular Filtration Rate based on creatinine

Estimated Glomerular Filtration Rate based on cystatin C

Glomerular Filtration Rate

Lund Malmö-revised

Modification in Diet in Renal Disease

Non-Steroidal Anti-Inflammatory Drug

Renal Replacement Therapy

Simplified Acute Physiology Score

Shrunken Pore Syndrome

© 2022 The Authors. Published by Elsevier Inc.