Abstract
Background: Coronavirus disease- (COVID-19-) related renal function abnormality is associated with poor prognosis. However, the clinical significance of dynamic changes in renal function indicators has not been studied, and no studies have evaluated the renal function in COVID-19 patients by cystatin C. Objective: This study aimed to evaluate the effect of abnormal renal function on admission on prognosis of COVID-19 patients and the prognostic value of various renal function indicators. Methods: A total of 1,764 COVID-19 patients without a history of chronic kidney disease were categorized into two groups, an elevated cystatin C group and a normal cystatin C group, based on the results of renal function tests on admission. The clinical characteristics were compared between the two groups, and logistic or Cox regression analyses were performed to explore the associations between elevated cystatin C/serum creatinine levels and disease severity and survival. We also performed receiver operating characteristic (ROC) curve, Kaplan–Meier survival, and curve fitting analyses. Results: When adjusted for several significant clinical variables, elevated cystatin C levels on admission were independent predictors of disease severity (p < 0.001), and elevated creatinine levels were independent predictors of death (p = 0.020). Additionally, the ROC curve analysis shows that elevated cystatin C levels [area under the curve (AUC): 0.656] have a better predictive value for disease severity than elevated creatinine levels (AUC: 0.540). The survival curves of patients with elevated cystatin C/creatinine levels show a sharper decline than those of patients with normal cystatin C/creatinine levels (p < 0.001). The curve fitting analysis revealed that, compared to the flat curves of cystatin C and creatinine levels for patients who survived, the curves for patients who died kept rising, and cystatin C levels rose above the normal range earlier than creatinine. Conclusions: Elevated cystatin C, which occurs earlier than serum creatinine, is useful for the early detection of renal function abnormality and might have better predictive value for disease severity in COVID-19 patients, while elevated serum creatinine may have a better predictive value for risks of death.
Highlights
As of this writing, coronavirus disease (COVID-19) has affected more than 93 million people and led to over 2 million deaths (World Health Organization, 2021)
In this study, we aimed to evaluate the effect of abnormal renal function on admission on the prognosis of COVID-19 patients and the prognostic value of various renal function indicators in a large group of patients with no history of chronic renal disease
1,764 patients were enrolled in this study and categorized into two groups based on the results of renal function tests on admission: one group consisted of patients who had normal cystatin C levels (n 1,562) and the other group consisted of patients who had elevated cystatin C levels (n 202)
Summary
Coronavirus disease (COVID-19) has affected more than 93 million people and led to over 2 million deaths (World Health Organization, 2021). AKI in hospitalized COVID-19 patients is associated with higher mortality (Ali et al, 2020; Cheng et al, 2020; Li et al, 2020; Selby et al, 2020). These studies did not differentiate between pre- and post-COVID-19 kidney function abnormality. These studies assessed indicators, such as blood urea nitrogen (BUN) and serum creatinine, which cannot reflect early abnormalities in renal function. The clinical significance of dynamic changes in renal function indicators has not been studied, and no studies have evaluated the renal function in COVID-19 patients by cystatin C
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