Title: Serum Cystatin C as an Early Indicator for Acute Kidney Injury in Critically Ill Children in Pediatric Intensive Care Units
Authors: Mohsen Taha Elkeiy, Moftah Mohamed Rabeea, Ahmed Mohsen Abd Alhakeem, Ahmed Abdou Ellawah, Ahmed Raafat Elsalamouny
DOI: https://dx.doi.org/10.18535/jmscr/v5i1.01
Abstract
Background: Acute kidney injury (AKI) has been associated with high morbidity and mortality rates among critically ill children. Cystatin C is a protease inhibitor, and studies have shown that it is a promising marker for the early diagnosis of AKI. Our goal in this study was to evaluate the accuracy of cystatin C as a marker of AKI in critically ill children.
Subjects and Methods: This cross sectional study was undertaken in the pediatric intensive care unit at Bab El-Sharyea University Hospital. It included 200 critically ill children according to certain inclusion criteria. Serum creatinine and cystatin C levels were measured in all patients within 48 hours of admission. AKI was diagnosed according to the pediatric RIFLE criteria. Receiver operating characteristic (ROC) curve analysis was performed.
Results: In our study, 112 cases (56%) were diagnosed as AKI. The area under the ROC curve for serum cystatin c indicated that it was a good marker for the diagnosis of AKI, with a sensitivity of 93.75%. However, the specificity of serum cystatin C 57.95%. The optimal cutoff value was 0.749 mg/L. The area under the ROC curve for serum creatinine showed a sensitivity of 86.61% and a specificity of 60.23%. The optimal cutoff value for serum creatinine was 0.5 mg/dl.
Conclusion: Serum cystatin is a sensitive marker for the early diagnosis of AKI in critically ill children. It is superior to traditional markers, namely blood urea & serum creatinine.
Keywords: Pediatric, Acute kidney injury, Cystatin C, Creatinine.
References
1. Watkins SC, Williamson K, Davidson M, Donahue BS. Long-term mortality associated with acute kidney injury in children following congenital cardiac surgery. Paediatr Anaesth 2014;24:919–26.
2. Hassinger AB, Backer CL, Lane JC, Haymond S, Wang D, Wald EL. Predictive power of serum cystatin C to detect acute kidney injury and pediatricmodified RIFLE class in children undergoing cardiac surgery. Pediatr Crit Care Med 2012;13:435–40.
3. Sutherland SM, Byrnes JJ, Kothari M, Longhurst CA, Dutta S, Garcia P. AKI in hospitalized children: comparing the pRIFLE, AKIN, and KDIGO definitions. Clin J Am Soc Nephrol 2015;10:554–61.
4. Finney H, Newman DJ, Price CP.Adult reference for serum cystatin C, creatinine and predicted creatinine clearance. Ann Clin Biochem 2000; 37:49–59.
5. Goldstein SL, Zappitelli M. Evaluation and Management of Acute Kidney Injury in Children. In: Avner E, Harmon W, Niaudet P, Yoshikawa N, editors. Pediatric Nephrology, 7th edition. Springer‐Verlag Berlin Heidelberg, 2016:2139-67.
6. Ataei N, Bazargani B, Ameli S, Madani A, Javadilarijani F, Moghtaderi M. Early detection of acute kidney injury by serum cystatin C in critically ill children. Pediatr Nephrol 2014;29:133–8.
7. Schwartz GJ, Brion LP, Spitzer A. The use of plasma creatinine concentration for estimating glomerular filtration rate in infants, children, and adolescents. Pediatr Clin North Am 1987; 34: 571–90.
8. Akcan-Arikan A, Zappitelli M, Loftis LL.Modified RIFLE criteria incritically ill children with acute kidney injury. Kidney Int 2007; 71: 1028–35.
9. Herrero-Morin JD, Malaga S, Fernandez N. Cystatin C and β2-microglobulin: markers of glomerular filtration in critically ill children. Crit Care 2007; 11:59.
10. Safdar OY, Shalaby M, Khathlan N, Elattal B, Bin Joubah M, Bukahri E, Saber M, Alahadal A, Aljariry H, Gasim S, Hadadi A, Alqahtani A, Awleyakhan R, Kari JA. Serum cystatin is a useful marker for the diagnosis of acute kidney injury in critically ill children: prospectivecohort study. BMC Nephrol 2016;17(1):130.
11. Naik S, Sharma J, Yengkom R, Kalrao V, Mulay A. Acute kidney injury in critically ill children: risk factors and outcomes. Indian J Crit Care Med 2014;18:129–33.
12. Sadeghi-Bojd S, Noori NM, Mohammadi M, Teimouri A. Clinical characteristics and mortality risk prediction in children with acute kidney injury. Niger Med J 2015;56(5):327-32.
13. Jenssen GR, Hovland E, Bangstad HJ, Nygård K, Vold L, Bjerre A (2014): The incidence and aetiology of acute kidney injury in children in Norway between 1999 and 2008. Acta Paediatr;103(11):1192-7.
14. Franco M, Nishida SK, Sesso R. GFR Estimated From Cystatin C Versus Creatinine in Children Born Small for Gestational Age. Am J Kidney Dis 2008; 51:925-32.
15. Schanz M1, Pannes D, Dippon J, Wasser C, Alscher MD, Kimmel M. The Influence of Thyroid Function, Inflammation, and Obesity on Risk Prediction of Acute Kidney Injury by Cystatin C in the Emergency Department. Kidney Blood Press Res 2016;41(5):604-13.
16. Wang GN, Sun K, Hu DL, Wu HH, Wang XZ, Zhang JS. Serum cystatin C levels are associated with coronary artery disease and its severity. Clinical Biochemistry 2014; 47:176–81.
17. Volpon LC, Sugo EK, Carlotti AP. Diagnostic and prognostic value of serum cystatin C in critically ill children with acute kidney injury. Volpon LC1, Sugo EK, Carlotti AP. Pediatr Crit Care Med 2015;16(5):e125-31.
18. Lagos‑Arevalo P, Palijan A, Vertullo L (2015): Cystatin C in acute kidney injury diagnosis: early biomarker or alternative to serum creatinine? Pediatr Nephrol;30: 665‑76.
19. Hamed HM, El-Sherbini SA, Barakat NA, Farid TM, Rasheed EA. Serum cystatin C is a poor biomarker for diagnosing acute kidney injury in critically-ill children. Indian J Crit Care Med 2013;17(2):92-8.
20. Royakkers AA, Korevaar JC, van Suijlen JD, Hofstra LS, Kuiper MA, Spronk PE. Serum and urine cystatin C are poor biomarkers for acute kidney injury and renal replacement therapy. Intensive Care Med;37:493–501.