Abstract
Purpose of the study. To assess the clinical and prognostic significance of serum and urinary cystatin C (uCys-C and sCys-C) in patients undergoing radical cystectomy (RC) in relation to AKI.Patients and methods. In this prospective study, uCys-C and sCys-C levels were measured during the first week after undergoing RC in a heterogeneous group of patients undergoing RC (n=186), mean age 59.5±11.4 years. The observation period of the patients was 6 months. The diagnosis of AKI that developed within the first week after surgery was based on the KDIGO criteria.Results. Of the 186 examined patients, 43 developed AKI according to generally accepted criteria. During the follow-up period, no patient required renal replacement therapy. AKI patients had a longer hospital stay (22.4±22.9 versus 13.0±4.1). The sCys-C levels were significantly associated with the occurrence of AKI and CKD in the long-term postoperative period and had an area under the ROC curve of 0.76 and 0.81, respectively, for predicting severe outcomes. At an optimal cut-off value of 161.17 ng/ml, sCys-C showed a sensitivity of 65 % and a specificity of 58 % for predicting AKI. The greatest increase in the concentration of sCys-C was detected 6-12 hours after surgery, followed by a decrease in the long-term follow-up.Conclusion. Peak sCys-C levels are associated with AKI and independently predict the development of AKI in patients after RC and the onset of CKD within 6 months.
Highlights
Острое повреждение почек (ОПП) – частое заболевание с высоким риском смерти
UCys-C and sCys-C levels were measured during the first week after undergoing radical cystectomy (RC) in a heterogeneous group of patients undergoing RC (n=186), mean age 59.5±11.4 years
The diagnosis of acute kidney injury (AKI) that developed within the first week after surgery was based on the KDIGO criteria
Summary
ФГБОУ ВО «Башкирский государственный медицинский университет» Министерства здравоохранения Российской Федерации, 450008, Российская Федерация, г. Выявить ассоциацию концентрации uCys-C и sCys-C с возникновением острого почечного повреждения (ОПП) и неблагоприятными исходами у пациентов, перенесших радикальную цистэктомию (РЦЭ). В этом проспективном исследовании уровни uCys-C и sCys-C были измерены в течение первой недели после перенесенной РЦЭ в гетерогенной группе пациентов, перенесших РЦЭ (n=186), средний возраст 59,5±11,4 лет. Уровни sCys-C были значимо связаны с возникновением ОПП и ХБП в отдаленном послеоперационном периоде и имели площадь под кривой ROC 0,76 и 0,81, соответственно, для прогнозирования тяжелых исходов. Пиковый уровни sCys-C связаны с ОПП и независимо служат для прогнозирования развития ОПП у пациентов после РЦЭ и возникновения хронической болезни почек в течение 6 месяцев. Цистатин С как предиктор острого почечного повреждения после радикального хирургического лечения пациентов с мышечно-инвазивным раком мочевого пузыря. Bashkir State Medical University, 3 Lenina str., Ufa 450008, Russian Federation
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