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Discordances between Preoperative Creatinine- and Cystatin C-based Estimated Glomerular Filtration Rate and Outcomes
Shao-Hui Lei1, Xiao-Yu Zhuo2, Li Qu3
1Shao-Hui Lei, M.D.: Department of Anesthesiology, Nanfang Hospital, Southern Medical University, Guangzhou, China; and Guangdong Provincial Key Laboratory of Precision Anesthesia and Perioperative Organ Protection, Guangzhou, China.
Insights
Lower cystatin C-based estimated glomerular filtration rate (eGFR) compared to creatinine-based eGFR in surgical patients indicates a higher risk of postoperative complications. This eGFR difference may serve as a novel perioperative risk marker.
Area of Science:
- Nephrology
- Surgical Outcomes
- Biomarkers
Background:
- Estimated glomerular filtration rate (eGFR) differences between cystatin C and creatinine are linked to adverse outcomes.
- The significance of these eGFR differences in surgical patients remains largely unknown.
- This study investigated the association between eGFR differences and postoperative complications.
Purpose of the Study:
- To determine if a lower cystatin C-based eGFR relative to creatinine-based eGFR is associated with increased risks of postoperative complications.
- To evaluate the potential of eGFR difference as a novel risk marker for perioperative stratification.
Main Methods:
- Retrospective cohort study involving major noncardiac surgery patients from two large Chinese hospitals.
- Exposure defined as the difference between preoperative eGFRcys and eGFRcr (eGFRdiff).
- Primary outcome: composite of postoperative complications and death, analyzed using logistic regression.
Main Results:
- Over 58,000 patients included across two cohorts.
- More negative eGFRdiff values consistently correlated with a higher risk of the primary outcome (ORs 1.11-1.12 per 10 mL/min/1.73 m² decrease).
- Associations were significant for cardiovascular events, acute kidney injury, infections, pulmonary complications, and death.
Conclusions:
- A more negative preoperative eGFRdiff is independently associated with increased postoperative complication risk in Asian patients undergoing noncardiac surgery.
- eGFRdiff shows potential as a novel risk marker for perioperative risk stratification.
Background:
Differences between cystatin C- and creatinine-based estimated glomerular filtration rate (eGFR) have been associated with adverse outcomes in both chronic disease and general population cohorts, but their significance in surgical patients is unknown. The hypothesis of this study was that lower cystatin C-based relative to creatinine-based eGFR would be associated with higher risks of postoperative complications.
Methods:
This was a retrospective cohort study of patients who had major noncardiac surgery at two large hospitals in China, located in geographically distant regions and with differing ethnic compositions. The exposure was different in preoperative eGFR based on cystatin C and creatinine (eGFRdiff = eGFRcys - eGFRcr). The primary outcome was a composite of postoperative complications and death. Associations were assessed using logistic regression models adjusting for demographics, comorbidities, surgery characteristics, and laboratory results.
Results:
A total of 35,488 patients from the Nanfang cohort and 23,417 from the Xinjiang cohort were included. The primary outcome occurred in 8.4 and 14.4% of patients, respectively. More negative eGFRdiff values were consistently associated with higher risk of the primary outcome (adjusted odds ratio per 10 ml · min -1 · 1.73 m -2 decrease was 1.12 [95% confidence interval, 1.09 to 1.15] in the Nanfang cohort and 1.11 [95% confidence interval, 1.09 to 1.14] in the Xinjiang cohort; both P < 0.001). Associations were also observed across categories of component outcomes (cardiovascular events, acute kidney injury, infections, pulmonary complications, and death).
Conclusions:
More negative preoperative eGFRdiff was independently associated with higher risk of postoperative complications in Asian patients undergoing noncardiac surgery. eGFRdiff may represent a novel risk marker with potential utility for perioperative risk stratification.
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