Abstract
Objective: Serum cystatin C (sCysC) used clinically for detecting early acute kidney injury (AKI) was reported to be independently associated with hemoglobin (HbA1c) levels, diabetes, and prediabetes. We aimed to assess the influence of HbA1c levels, diabetes, or prediabetes on the performance of sCysC for AKI detection in critically ill adults.Methods: A prospective observational study was conducted in a mixed medical-surgical intensive care unit (ICU). Patients were divided into four quartiles based on levels of HbA1c or serum glucose at ICU admission, respectively. Additionally, patients were stratified into four subgroups according to HbA1c levels and history of diabetes, namely recognized diabetes (previous diagnosis of diabetes), unrecognized diabetes, prediabetes, and normal glycemic status. Comparisons were made using the area under the receiver operator characteristic curve (AUC) for AKI detection, and reassessed after patient stratification by above-mentioned glycemic status.Results: Multivariable linear regression revealed that HbA1c levels and history of diabetes were positively related with sCysC (all p < .05). Although stratification for above-mentioned glycemic status displayed no significant difference between AUC of sCysC (all p > .05), sCysC yielded the highest AUCs for detecting AKI in diabetic patients. Moreover, higher optimal cutoff values of sCysC to detect AKI were observed in patients with versus without diabetes.Conclusion: Glycemic status has no significant impact on the accuracy of sCysC for AKI detection in critically ill adults and a higher optimal cutoff value of sCysC for AKI detection should be considered in diabetic patients.
Highlights
Acute kidney injury (AKI) is prevalent and independently associated with adverse outcomes [1,2], especially in the critically ill [1,3]
Previous studies suggested that cystatin C (CysC) may be a potential AKI biomarker [7,10,14], the inconsistent results [14,15,16] limit its widespread application for AKI detection in clinical practice
The concentrations of serum cystatin C (sCysC), Serum creatinine (sCr), serum glucose, and HbA1c at intensive care unit (ICU) admission were significantly higher in patients with AKI than in non-AKI patients
Summary
Acute kidney injury (AKI) is prevalent and independently associated with adverse outcomes [1,2], especially in the critically ill [1,3]. The unavoidable delay in the identification of AKI has stimulated the development of several novel biomarkers, such as neutrophil gelatinaseassociated lipocalin [4], kidney injury molecule-1 [5], tissue inhibitor of metalloproteinase-2, insulin-like growth factor binding protein 7 [3], and cystatin C (CysC) [6,7,8]. Since clinically available markers can be applicable worldwide [9], sCysC becomes one of the most extensively studied AKI biomarkers [6,10,11]. Previous studies suggested that CysC may be a potential AKI biomarker [7,10,14], the inconsistent results [14,15,16] limit its widespread application for AKI detection in clinical practice
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