The prognostic value of cystatin C compared with trauma scores in multiple blunt trauma: a prospective cohort study

Many scoring systems have been developed to predict the prognosis of the traumatized patients in Emergency Departments, and the necessary calculations make complex scoring systems difficult to use as a part of the initial trauma patient assessment, and they also have limited accuracy.

This study compares the accuracy of cystatin C with trauma scoring systems in predicting the mortality of trauma patients.

Serum cystatin C levels were measured upon arrival in consecutive adult multiple blunt trauma patients during a 12-month period. Correlation analysis was used to assess the relationship between Injury Severity Score (ISS), Revised Trauma Score (RTS), Glasgow Coma Scale (GCS) Score, and cystatin C. Trauma scores and cystatin C were used in Cox regression models to predict trauma patients' risk of death.

During the study period, 153 patients were enrolled and 18 died. There were negative correlations between cystatin C levels and the GCS (r = -0.666, p < 0.001) as well as the RTS (r = -0.229, p = 0.004). A moderate correlation was found between the ISS and the cystatin C level (r = 0.492, p < 0.001). In Cox regression models, every increase in units of cystatin C levels and ISS (the cut-off levels were 0.93 mg/L and ≥ 16, respectively) results in a 4.22- and 1.068-fold increase in mortality, respectively.

Cystatin C may represent an important severity-of-illness indicator, easily available to clinicians during the initial assessment of trauma victims on admission.