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Urinary cystatin C is diagnostic of acute kidney injury and sepsis, and predicts mortality in the intensive care unit

机译：尿半胱氨酸蛋白酶抑制剂C可诊断急性肾损伤和败血症，并预测重症监护病房的死亡率

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IntroductionTo evaluate the utility of urinary cystatin C (uCysC) as a diagnostic marker of acute kidney injury (AKI) and sepsis, and predictor of mortality in critically ill patients.MethodsThis was a two-center, prospective AKI observational study and post hoc sepsis subgroup analysis of 444 general intensive care unit (ICU) patients. uCysC and plasma creatinine were measured at entry to the ICU. AKI was defined as a 50% or 0.3-mg/dL increase in plasma creatinine above baseline. Sepsis was defined clinically. Mortality data were collected up to 30 days. The diagnostic and predictive performances of uCysC were assessed from the area under the receiver operator characteristic curve (AUC) and the odds ratio (OR). Multivariate logistic regression was used to adjust for covariates.ResultsEighty-one (18%) patients had sepsis, 198 (45%) had AKI, and 64 (14%) died within 30 days. AUCs for diagnosis by using uCysC were as follows: sepsis, 0.80, (95% confidence interval (CI), 0.74 to 0.87); AKI, 0.70 (CI, 0.64 to 0.75); and death within 30 days, 0.64 (CI, 0.56 to 0.72). After adjustment for covariates, uCysC remained independently associated with sepsis, AKI, and mortality with odds ratios (CI) of 3.43 (2.46 to 4.78), 1.49 (1.14 to 1.95), and 1.60 (1.16 to 2.21), respectively. Concentrations of uCysC were significantly higher in the presence of sepsis (P < 0.0001) or AKI (P < 0.0001). No interaction was found between sepsis and AKI on the uCysC concentrations (P = 0.53).ConclusionsUrinary cystatin C was independently associated with AKI, sepsis, and death within 30 days.Trial registrationAustralian New Zealand Clinical Trials Registry ACTRN012606000032550.
机译：简介评价尿半胱氨酸蛋白酶抑制剂C（uCysC）作为急性肾损伤（AKI）和败血症的诊断标志物以及危重患者死亡率的预测指标的方法。方法这是一项两中心，前瞻性AKI观察性研究和事后脓毒症亚组444名普通重症监护病房（ICU）患者的临床分析。在进入ICU时测量uCysC和血浆肌酐。 AKI被定义为血浆肌酐高于基线水平增加50％或0.3-mg / dL。败血症的临床定义。死亡率数据收集长达30天。 uCysC的诊断和预测性能是根据接收器操作员特征曲线（AUC）和优势比（OR）评估的。结果：30天内有81名（18％）败血症患者，198名（45％）患有AKI，64名（14％）死亡。使用uCysC诊断的AUC如下：败血症，0.80，（95％置信区间（CI），0.74至0.87）; AKI：0.70（CI：0.64至0.75）;并在30天内死亡0.64（CI，0.56至0.72）。调整协变量后，uCysC仍与败血症，AKI和死亡率独立相关，比值比（CI）分别为3.43（2.46至4.78），1.49（1.14至1.95）和1.60（1.16至2.21）。在存在败血症（P <0.0001）或AKI（P <0.0001）的情况下，uCysC的浓度明显更高。在uCysC浓度上脓毒症和AKI之间未发现相互作用（P = 0.53）。结论尿半胱氨酸蛋白酶抑制剂C与30天之内的AKI，脓毒症和死亡无关。试验注册澳大利亚新西兰临床试验注册中心ACTRN012606000032550。

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