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Detecting Neonatal AKI by Serum Cystatin C.
1Division of Nephrology, National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Nanfang Hospital, Southern Medical University, Guangzhou, China.
Journal of the American Society of Nephrology : JASN
|March 28, 2023
Summary
Serum cystatin C (Cys-C) offers a sensitive biomarker for neonatal acute kidney injury (AKI), outperforming traditional creatinine markers. The new cystatin C-related criteria (CyNA) identify more at-risk neonates for improved mortality prediction.
Area of Science:
- Neonatology
- Nephrology
- Biomarker Discovery
Background:
- Serum creatinine is an insensitive biomarker for neonatal acute kidney injury (AKI) due to confounding factors.
- A more sensitive biomarker and criterion for neonatal AKI are needed.
Purpose of the Study:
- To establish reference limits for serum cystatin C (Cys-C) in neonates.
- To propose and validate cystatin C-related criteria (CyNA) for neonatal AKI detection.
- To compare CyNA's performance against modified KDIGO creatinine criteria.
Main Methods:
- A multicenter cohort study of 52,333 hospitalized Chinese neonates.
- Estimation of upper normal limit (UNL) and reference change value (RCV) for serum Cys-C.
- Development of CyNA criteria using Cys-C UNL and RCV as cutoffs.
- Assessment of CyNA-detected AKI association with in-hospital mortality risk.
Main Results:
- Serum Cys-C levels were stable in neonates, independent of gestational age and birth weight.
- CyNA criteria identified AKI in 9.8% of neonates, compared to 0.8% by KDIGO creatinine criteria alone.
- CyNA-detected AKI was associated with a 2.86-fold increased risk of in-hospital mortality.
Conclusions:
- Serum Cys-C is a robust and sensitive biomarker for neonatal AKI.
- CyNA demonstrates 6.5 times greater sensitivity than modified KDIGO creatinine criteria in identifying neonates at high risk for mortality.
- CyNA is a promising, easily applicable tool for neonatal AKI detection.
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