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Cystatin C predicts long term mortality better than creatinine in a nationwide study of intensive care patients

Johanna Helmersson-Karlqvist1, Miklos Lipcsey2, Johan Ärnlöv3,4

  • 1Department of Medical Sciences/Clinical Chemistry, Uppsala University, 751 85, Uppsala, Sweden. johanna.helmersson_karlqvist@medsci.uu.se.

Scientific Reports
|March 16, 2021
PubMed

Insights

For critically ill patients, cystatin C estimated glomerular filtration rate (eGFR) better predicts long-term mortality risk than creatinine-based eGFR. Cystatin C equations improve risk prediction accuracy.

Area of Science:

  • Nephrology
  • Critical Care Medicine
  • Epidemiology

Background:

  • Decreased glomerular filtration rate (GFR) is associated with poor survival outcomes.
  • The predictive capabilities of creatinine-based versus cystatin C-based estimated GFR (eGFR) in critically ill populations remain understudied.
  • Accurate GFR assessment is crucial for risk stratification in intensive care settings.

Purpose of the Study:

  • To compare the long-term mortality risk prediction of different eGFR equations in critically ill patients.
  • To evaluate the performance of creatinine-based (CKD-EPI), cystatin C-based (CAPA), and combined equations for eGFR.
  • To determine if cystatin C-based eGFR offers superior prognostic value over creatinine-based eGFR in this cohort.

Main Methods:

  • Analysis of 22,488 critically ill patients admitted to Swedish University Hospitals between 2004 and 2015.
  • Measurement of both serum creatinine and cystatin C from the same blood sample at admission.
  • Utilized Cox regression models to assess the association between eGFR and long-term mortality over a median follow-up of 5.1 years.

Main Results:

  • Reduced eGFR by all assessed equations was significantly linked to increased mortality.
  • Patients reclassified to a lower GFR category by cystatin C-based equations exhibited significantly higher mortality risk compared to those not reclassified.
  • The cystatin C equation demonstrated superior predictive performance, significantly increasing C-statistics for mortality prediction compared to creatinine and combined equations.

Conclusions:

  • The sole use of cystatin C-based equations for estimating GFR provides superior risk prediction for long-term mortality in critically ill patients.
  • Cystatin C-based eGFR offers enhanced prognostic accuracy compared to creatinine-based or combined equations in this patient population.
  • Routine implementation of cystatin C-based eGFR may improve risk stratification and clinical decision-making for critically ill patients.

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