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Cystatin C and beta2-microglobulin: markers of glomerular filtration in critically ill children
José David Herrero-Morín1, Serafín Málaga, Nuria Fernández
1Hospital Universitario Central de Asturias, University of Oviedo, Julian Claveria Street, 33006, Oviedo, Spain. josedahm@yahoo.es
Insights
Serum cystatin C and beta2-microglobulin (B2M) are effective biomarkers for detecting reduced kidney function in critically ill children. These markers show greater accuracy than serum creatinine for identifying acute kidney injury in pediatric intensive care units.
Area of Science:
- Pediatric Nephrology
- Critical Care Medicine
- Biomarker Discovery
Background:
- Assessing renal function in pediatric intensive care units (PICU) presents challenges due to suboptimal parameters.
- Current methods may not accurately reflect glomerular filtration rate (GFR) in critically ill children.
Purpose of the Study:
- To evaluate the effectiveness of serum cystatin C and beta2-microglobulin (B2M) in identifying decreased GFR in critically ill children.
- To compare the diagnostic utility of cystatin C and B2M against serum creatinine.
Main Methods:
- A prospective, observational study involving 25 children in an eight-bed PICU.
- Correlated inverse of serum creatinine, cystatin C, and B2M with 24-hour urine creatinine clearance (CrC) and estimated CrC (Schwartz formula).
- Utilized receiver operating characteristic (ROC) curve analysis to assess diagnostic performance for GFR < 80 ml/min/1.73 m(2).
Main Results:
- Serum B2M and cystatin C showed stronger correlations with CrC and Schwartz estimations compared to serum creatinine.
- ROC analysis indicated superior ability of cystatin C (AUC 0.851, 0.792) and B2M (AUC 0.802, 0.799) over creatinine (AUC 0.633, 0.625) in detecting reduced GFR.
- 14 children had CrC < 80 ml/min/1.73 m(2), and 9 had Schwartz < 80 ml/min/1.73 m(2).
Conclusions:
- Serum cystatin C and B2M are valuable and accessible markers for diagnosing acute kidney injury in critically ill children.
- These biomarkers demonstrate improved accuracy compared to serum creatinine for renal function assessment in this population.
Introduction:
Parameters allowing regular evaluation of renal function in a paediatric intensive care unit (PICU) are not optimal. The aim of the present study was to analyse the utility of serum cystatin C and beta2-microglobulin (B2M) in detecting decreased glomerular filtration rate in critically ill children.
Methods:
This was a prospective, observational study set in an eight-bed PICU. Twenty-five children were included. The inverses of serum creatinine, cystatin C, and B2M were correlated with creatinine clearance (CrC) using a 24-hour urine sample and CrC estimation by Schwartz formula (Schwartz). The diagnostic value of serum creatinine, cystatin C, and B2M to identify a glomerular filtration rate under 80 ml/minute per 1.73 m(2) was evaluated using receiver operating characteristic (ROC) curve analysis.
Results:
Mean age was 2.9 years (range, 0.1 to 13.9 years). CrC was less than 80 ml/minute per 1.73 m(2) in 14 children, and Schwartz was less than 80 ml/minute per 1.73 m(2) in 9 children. Correlations between inverse of B2M and CrC (r = 0.477) and between inverse of B2M and Schwartz (r = 0.697) were better than correlations between inverse of cystatin C and CrC (r = 0.390) or Schwartz (r = 0.586) and better than correlations between inverse of creatinine and CrC (r = 0.104) or Schwartz (r = 0.442). The ability of serum cystatin C and B2M to identify a CrC rate and a Schwartz CrC rate under 80 ml/minute per 1.73 m(2) was better than that of creatinine (areas under the ROC curve: 0.851 and 0.792 for cystatin C, 0.802 and 0.799 for B2M, and 0.633 and 0.625 for creatinine).
Conclusion:
Serum cystatin C and B2M were confirmed as easy and useful markers, better than serum creatinine, to detect acute kidney injury in critically ill children.
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