Serum CysC Research Articles

The effect of increased frequency of hemodialysis on serum cystatin C and β2-microglobulin concentrations: A secondary analysis of the frequent hemodialysis network (FHN) trial.

Small molecular weight toxin clearance is the main method of assessment of hemodialysis efficiency. Middle molecules including cystatin C (CysC) and Beta-2 microglobulin (β2-M) are understudied. We hypothesized that lowering of predialysis CysC and β2-M serum concentrations would be affected by switching to more frequent hemodialysis. Predialysis CysC and β2-M serum concentrations were measured from serum samples of the Frequent Hemodialysis Network (FHN) Daily and Nocturnal Trials. The differences between predialysis concentrations at baseline (while on conventional thrice weekly dialysis) and those after 12-months of study (on more frequent dialysis) were compared separately by trial (Nocturnal, Daily). We tested the associations between predialysis serum CysC and β2-M concentrations and outcomes. Forty-nine percent and 52% of the patients from the FHN Daily and Nocturnal Trials respectively were included in this ancillary study. Predialysis serum CysC concentrations remained unchanged after intensifying hemodialysis dose by either modality. There was significant lowering of the serum β2-M concentrations in the frequent Daily Trial hemodialysis group at 12 months in all patients and in patients without residual renal function at baseline (-3.8 ± 12.62 μg/mL, P = 0.004; -5.9 ± 12.99 μg/mL, P = 0.02, respectively). There were no significant differences between the baseline and the 12-months predialysis β2-M serum concentrations in the two control groups (Daily 3× and Nocturnal 3× groups). No association between the changes in the two biomarkers between baseline and 12-months and in changes in left ventricular mass, physical-health composite scores, hospitalization rate, and death were found. The numbers of hospitalizations and deaths were small. β2-M may be a better biomarker of dialysis dose than CysC. Reduction in the concentration of potentially toxic long-lived proteins of the size of β-2M is one potential long-term benefit of more intensive dialysis that may be explored.

Relationship of High Circulating Cystatin C to Biochemical Markers of Bone Turnover and Bone Mineral Density in Elderly Males with a Chronic Heart Failure.

SummaryBackgroundThe aim of the study was to investigate the association of Cystatin C (CysC) to biochemical markers of bone turnover and bone mass, and to evaluate its prognostic significance in elderly males with chronic heart failure (CHF).MethodsA prospective cohort study was executed on sixtyeight males (mean age 68±7 years) with mild to moderate CHF, together with 19 of corresponding age- and body mass index-matched healthy individuals who underwent cardio vascular, bone mineral density (BMD), and body com position assessment. Biochemical assessment of all subjects included NT-pro-BNP, parathyroid hormone (PTH), 25-hydroxy vitamin D (25(OH)D), CysC, and biochemical markers of bone turnover including osteocalcin (OC), alkaline phosphatase (ALP), β-CrossLaps (β-CTx), osteoprotegerin (OPG), and receptor activator of nuclear factor κB ligand (RANKL).ResultsSerum CysC was significantly increased in males with CHF in comparison to healthy control ones. A significant positive association was found between CysC levels and OC in males with CHF, while OC and β-CTx increased in increasing CysC tertiles. In multivariate regression analysis, OC and smoking were a significant determinant of CysC in males with CHF. Level of CysC was found to be positively associated with an increased fatal risk in males with CHF.ConclusionsSerum osteocalcin is an independent predictor of CysC level in elderly males with CHF. Higher CysC level showed a negative relation to survival and bone loss in males with CHF. Further research is needed to confirm the potential role of CysC in the crosstalk between heart, kidney, bone, and energy metabolism in CHF.

Multi-Imaging Investigation to Evaluate the Relationship between Serum Cystatin C and Features of Atherosclerosis in Non-ST-Segment Elevation Acute Coronary Syndrome

Objectives: High cystatin C(CysC) levels are associated with impaired cardiovascular outcome. Whether CysC levels are independently related to the atherosclerosis burden is still controversial. Methods: We enrolled 31 non-ST-segment elevation acute coronary syndrome patients undergoing percutaneous coronary intervention. Patients were divided into 2 groups on the basis of median value of serum CysC. Using the high CysC group as a dependent variable, univariable and multivariable analyses were used to evaluate the association between CysC and three different features of atherosclerosis: 1) coronary plaque vulnerability as assessed by optical coherence tomography (OCT), 2) coronary artery calcium (CAC) by means of computed tomography scan, and 3) aortic wall metabolic activity, as assessed using 18F-Fluorodeoxyglucose-positron emission tomography (18F-FDG-PET). Results: After univariable and multivariable analyses, 18F-FDG uptake in the descending aorta (DA) was independently associated with a low level of CysC [(Odds Ratio = 0.02; 95%CI 0.0004–0.89; p = 0.044; 18F-FDG uptake measured as averaged maximum target to blood ratio); (Odds Ratio = 0.89; 95%CI 0.82–0.98, p = 0.025; 18F-FDG uptake measured as number of active slices)]. No trend was found for the association between CysC and characteristics of OCT-assessed coronary plaque vulnerability or CAC score. Conclusions: In patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS), 18F-FDG uptake in the DA was associated with a low level of serum CysC. There was no relation between CysC levels and OCT-assessed coronary plaque vulnerability or CAC score. These findings suggest that high levels of CysC may not be considered as independent markers of atherosclerosis.

Abstract WP253: Cystatin C and the Risk of Cardioembolic Stroke in Patients Without Chronic Kidney Disease

Background and Objectives: Atrial fibrillation (AF) is well-established risk factor for cardioembolic stroke. Epidemiological evidence indicates that there is increased risk of AF with chronic kidney disease (CKD) and impaired renal function. Cystatin C (Cys-C) is now considered as a specific marker for detection of renal impairment. However, there are no data about the potential association of Cys-C with AF and cardioembolic stroke in the subjects without evident CKD. We investigated whether serum Cys-C level is associated with development of cardioembolic stroke in patients with AF. Methods: Consecutive data were collected retrospectively at the Seoul National University Hospital (SNUH). Patients with ischemic stroke with subtypes of large artery atherosclerosis, small vessel occlusion and cardioembolism who admitted at the SNUH between November 2014 and November 2017 were screened. We excluded the patient who have a history of secondary hypertension, CKD (estimated glomerular filtration rate < 60 mL/min/1.73 m 2 ), valvular heart disease, congenital heart disease, dilated or hypertrophy cardiomyopathy and thyroid disease. Results: Among the total 627 patients, 61.8% were male, with a mean age of 67.9 years. Compared to the other stroke mechanisms, a stepwise logistic regression analysis showed that AF was independently associated with size of left atrium (OR, 1.196, 95% CI: 1.160-1.266), initial stroke severity (NIH Stroke Scale) (OR, 1.126, 95% CI: 1.083-1.189), and Cys-C (OR, 2.472, 95% CI: 1.255-15.129), but not with eGFR (OR 0.993, 95% CI: 0.977-1.009). Conclusion: Cys-C is a superior predictor for cardioembolic stroke due to AF in patients without evident CKD.

Colour Doppler and Biomarkers Utility for Renal Damage due to Congenital Hydronephrosis.

To determine colour doppler and serum biomarkers spectrum in children with congenital hydronephrosis. An observational study. Department of Pediatric Nephrology, West China 2nd University Hospital of Sichuan University and Key Laboratory of Birth Defects and Related Disease of Women and Children (Sichuan University), China, from January to December 2017. A total of 95 children with hydronephrosis were selected as case group. According to the degree of hydronephrosis, the patients were divided into mild hydronephrosis group, moderate hydronephrosis group, and severe hydronephrosis group. Forty children with normal renal function were selected as normal comparison group. Peak systolic velocity (Vmax), end diastolic velocity (Vmin), resistance index (RI), pulsatility index (PI), and serum cystatin C (CysC), β2-microglobulin (β2-MG), and 1-microglobulin (β1-MG) of all subjects in both groups were recorded and compared. The Vmax, Vmax of main renal artery (MRA) and interlobar renal artery (IRA) in case group were lower than those of normal group (all p<0.001). RI of MRA and IRA in case group were higher than those of normal control group (both p<0.001). There were no significant differences in the PI of MRA and IRA between the two groups (p=0.700, and 0.250 respectively). The levels of serum CysC, β2-MG and α1-MG in normal control group, mild hydronephrosis group, moderate hydronephrosis group, and severe hydronephrosis group were significantly different (all p<0.001), and the levels of serum CysC, β2-MG, α1-MG were also different in children with different degrees of hydronephrosis. Combined detection of colour doppler and serum biomarkers CysC, β2-MG and α1-MG in the diagnosis of renal damage in congenital hydronephrosis is feasible and reliable.

Serum Homocysteine, cystatin C as Biomarkers for Progression of Diabetic Nephropathy

Abstract Objective To investigate the clinical efficacy of serological level homocysteine (Hcy) and cystatin C (Cys-C) as biomarkers for progression of diabetic nephropathy (DN). Methods Seventy-five patients with type 2 diabetes mellitus (DM) hospitalized in Lishui People’s Hospital from January 2015 to May 2018 were included in the present study. Of the 75 cases, 28 were simple DM, 25 were early stage DN (DNe) and other 22 subjects were clinical stage DN (DNc). The serum level of Hcy and Cys-C were detected and compared among the DM, DNe and DNc groups. The efficacy of serological levels of Hcy, and Cys-C as biomarkers for diagnosis of early stage diabetic nephropathy was calculated. Results The serological levels of Hcy were 11.53±3.05 μmol/L, 15.39±4.58 μmol/L and 18.14±7.03 μmol/L for DM, DNe and DNc groups respectively (P&lt;0.001). Serum level of Cys-C, were 0.89±0.23 mg/L, 1.51±0.60 mg/L and 2.63±0.90 mg/L respectively for DM, DNe and DNc groups respectively (P&lt;0.001). Significant positive correlation between serum Cys-C and Hcy was detected in DNe (rpearson=0.55, P=0.004) and DNc (rpearson=0.44, P=0.04) groups. However, there was no significant correlation of serological Cys-C and Hcy in DM group (rpearson=0.08, P=0.70). The sensitivity and specificity in diagnosis of early stage DN were 76.0 (95%CI:54.87-90.64)%, 64.29 (544.07-81.36)% for serological Hcy and 80.0 (559.30-93.17)%, 89.29 (571.77-97.73)% for serum Cys-C respectively. The diagnostic area under the ROC curve (AUC) was 0.76 (0.63 to 0.90) and 0.84 (0.72-0.96) respectively for serum Hcy and Cys-C in detection early stage DN. Conclusion: Serum levels of Hcy and Cys-C in diabetic nephropathy patients were elevated compared to that of simple DM cases, making them potential biomarkers for diagnosis of early DN from DM patients.

Relevance research on carotid atherosclerosis and levels of serum cathepsin K and cystatin C on patients with ischemic cerebral vascular disease

The relationship between carotid atherosclerosis (AS) and levels of serum cathepsin K (CatK) and cystatin C (CysC) on patients with ischemic cerebral vascular disease (ICVD) was explored. In total, 266 patients with ICVD who were admitted in our hospital were enrolled. According to the results of carotid ultrasound, they were randomly divided into plaque group (n = 133) and control group (n = 133). According to atherosclerotic plaque type distribution, the plaque group was divided into stable plaque group and unstable group. The relationship between levels of serum CatK and CysC of two groups and carotid AS indicator (such as intima-media thickness (IMT)) were analyzed with Spearman’s correlation. Spearman’s correlation analysis showed that IMT level was positively correlated with stability of carotid atherosclerotic plaque ( P &lt; 0.05). The level of serum CatK in plaque group was significantly higher than control group, and the level of serum CysC in plaque group was significantly lower than control group ( P &lt; 0.05); the level of serum CatK in unstable plaque group was significantly higher than stable plaque group, and the level of serum CysC in unstable plaque group was significantly lower than stable plaque group ( P &lt; 0.05). Serum CatK and IMT levels were positively correlated, and serum CysC and CatK levels were negatively correlated ( P &lt; 0.05). CatK and CysC levels may be used as serum markers for predicting carotid AS plaque instability, providing a new observational index for prevention and treatment of ICVD caused by carotid AS plaque.

The Relevance of Serum Cystatin C Level of Different Classification of Atrial Fibrillation

Objective: To investigate the relationship between serum level of cystatin C (Cys-C) and AF (atrial fibrillation) and its clinical classification. Method: From January 2017 to April 2019, 168 cases of Xiaogan Central Hospital were chosen as the object of this study. The subjects were divided into 86 patients with AF and 82 patients in the control group. The AF group was divided into paroxysmal AF group (29 cases), persistent AF group (27 cases) and permanent AF group (29 cases) according to the European atrial fibrillation management guidelines and the North America Society of Pacing and Electrophysiology (NASPE) arrhythmia group organized the categorization of AF. Results: Compared with the control group, the level of the serum Cys-C was significantly higher in the AF group, the difference was statistically significant (P < 0.05). There was significant difference in Cys-C level in patients with different types of AF (P < 0.05). The levels of neutrophil percentage, low density lipoprotein cholesterol (LDL-C), left ventricular diameter, left atrial diameter, C-reactive protein (CRP) and homocysteine in the AF group were significantly higher than those in the control group (P < 0.05). The difference of neutrophil percentage, LDL-C, left ventricular ejection fraction, left atrial diameter, CRP and homocysteine levels in patients with different types of atrial fibrillation was statistically significant (P < 0.05). Logistic analysis showed that the serum Cys-C level, CRP, homocysteine, left ventricular diameter, left atrial diameter could be used as an independent predictor of atrial fibrillation when other factors were corrected. Conclusion: Serum Cys-C level in atrial fibrillation group is significantly higher than the control group, there are differences between different atrial fibrillation clinical classification, its level increased with duration of atrial fibrillation. Serum Cys-C level and inflammatory markers CRP, WBC and neutrophilic granulocyte percentage were positively correlated, indicating that serum cystatin C is associated with chronic inflammation, involved in the occurrence of atrial fibrillation, maintain and recurrence. Logistic analysis showed that the serum cystatin C level could be used as an independent predictor of atrial fibrillation when other factors were corrected.

The Value of Serum Levels of Apela and Cystatin C in Evaluation of Renal Insufficiency in Patients with Heart Failure

Objective: To explore the value of serum levels of Apela and Cystatin C (Cys-C) in evaluation of renal insufficiency in patients with heart failure (HF). Methods: Total 89 patients were divided into HF with normal renal function group (HF group, 20 cases); HF with renal insufficiency (RI) in compensatory stage group (HF with compensatory RI group, 40 cases); HF with RI in decompensatory stage group (HF with decompensatory RI group, 29 cases). The serum concentration of Apela, Cys-C and nitrogen-terminal pro-brain natriuretic peptide (NT-pro BNP) was detected by ELISA, and left ventricular ejection fraction (LVEF) was determined by echocardiography. Results: The LVEF level was significantly lower (43.1% ± 1.7% vs. 48.9% ± 2.0%, P < 0.05), but the average level of NT-pro BNP (6174 ± 1002 pg/ml vs. 3400 ± 661.3 pg/ml, P < 0.05) was remarkably higher in HF with decompensatory RI group than that in HF group. With the deterioration of renal function in patients with heart failure, the levels of BUN, Cr and Cys-C increased gradually, while the levels of eGFR decreased gradually. Compared to HF group (0.84 ± 0.55 ng/ml), the serum level of Apela was higher in patients with compensatory (1.16 ± 0.34 ng/ml) or decompensatory RI (1.23 ± 0.53 ng/ml). The serum Cys-C level was negatively correlated with eGFR (r = −0.7763, p < 0.0001). Conclusion: With the occurrence of RI in HF patients, serum Apela and Cys-C increased gradually, and the level of serum Cys-C was well correlated with eGFR. It suggested that endogenous Apela and Cys-C levels could be used as biomarkers for evaluating early RI in patients with heart failure.

A study of the utility of novel non-invasive urinary and serum biomarkers of blunt kidney injury in a rat model: NGAL, KIM-1, and IL-18.

This study investigated changes in the concentrations of serum and urine neutrophil gelatinase lipocalin (NGAL), kidney injury molecule 1 (KIM-1), interleukin 18 (IL-18), and cystatin-C (Cys-C) induced by parenchymal and tubular damage following blunt kidney trauma, as well as their potential utility as biomarkers in the detection and follow-up of patients with suspected blunt renal trauma. Three-month-old male Sprague-Dawley rats (n = 18) were divided into three groups (n = 6 in each): group 1: control group (no intervention); group 2: sham group (explorative surgery and exposure of the left kidneys); and group 3: trauma group (explorative surgery and induction of blunt renal trauma of the left kidneys). Serum and urine samples were collected before and 12-24, 36-48, and 60-72 hours later for NGAL, KIM-1, IL-18, and Cys-C measurements. In the trauma group, there was a statistically significant increase in post-operative NGAL, KIM-1, and IL-18 values after 12-24 h and 36-48 h, as compared with pre-operative values. There was also a statistically significant increase in post-operative serum and urine Cys-C values after 60-72 h, as compared with pre-operative values. NGAL, KIM-1, and IL-18 may represent novel non-invasive descriptive candidate biomarkers of early-stage tubular damage in children with renal trauma.

Serum NGAL Is Superior to Cystatin C in Predicting the Prognosis of Acute-on-Chronic Liver Failure

Introduction and aim. Acute-on-chronic liver failure (ACLF) is a syndrome with high short-term mortality, and predicting the prognosis is challenging. This study aimed to compare the performance of neutrophil gelatinase-associated lipocalin (NGAL) and cystatin C (CysC) in predicting the 90-day mortality in patients with hepatitis B virus (HBV)-associated ACLF (HBV-ACLF). Materials and methods. This prospective, observational study enrolled 54 patients with HBV-ACLF. The serum NGAL and CysC levels were determined. A multivariate logistic regression analysis was used to analyze the independent risk factors of mortality. Results. Serum NGAL, but not CysC, was found to significantly correlate with the total bilirubin, international normalized ratio, and model for end-stage liver disease (MELD). Serum NGAL [odds ratio (OR), 1.008; 95% confidence interval (CI), 1.004-1.012; P < 0.01], but not CysC, was an independent risk factor for developing hepatorenal syndrome. Moreover, NGAL (OR, 1.005; 95% CI, 1.001-1.010; P < 0.01) along with the MELD score was independently associated with the overall survival in patients with HBV-ACLF. Patients with HBV-ACLF were stratified into two groups according to the serum NGAL level at baseline (low risk: <217.11 ng/mL and high risk: ≥ 217.11 ng/mL). The 90-day mortality rate was 22.73% (5/22) in the low-risk group and 71.88% (23/32) in the high-risk group. Moreover, NGAL, but not CysC, significantly improved the MELD score in predicting the prognosis of HBV-ACLF. Conclusion. The serum NGAL might be superior to CysC in predicting the prognosis of HBV-ACLF with the normal creatinine level.

Cystatin C as a novel predictor of preterm labor in severe preeclampsia.

BackgroundThe most common cause of acute kidney injury (AKI) in pregnancy is preeclampsia. Serum cystatin C (CysC) is a potential biomarker of early kidney damage as its levels are not disturbed by volume status changes in pregnancy, and serum CysC levels could serve as a replacement for conventionally used creatinine. In this study, we investigated the serum levels of CysC in severe preeclampsia cases and the associations between CysC levels and poor obstetric outcomes.MethodsOur cohort included severe preeclampsia patients with a normal serum creatinine level. Creatinine was measured to calculate estimated glomerular filtration rate (eGFR) based on the Cockcroft and Gault, Modification of Diet in Renal Disease Study (MDRD), and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations, while CysC was measured to calculated eGFR based on a CysC-based equation. We then evaluated the correlations between serum CysC level, eGFR, and obstetric outcomes.ResultsTwenty-six patients were evaluated of which 38.5% delivered preterm and 30.8% had low-birth weight babies. Unlike creatinine-based eGFR and CysC-based eGFR, serum CysC demonstrate significant negative correlation with gestational age. Receiver operating characteristic curve analysis indicated that serum CysC is a potential biomarker of preterm delivery with a cut-off serum level of 1.48 mg/L with 80% sensitivity and 75% specificity.ConclusionGFR estimation using CysC is likely to be inaccurate in pregnancy. However, we found a significant correlation between preterm delivery and serum CysC level. Our results suggest that serum CysC level has the potential to predict preterm delivery in severe preeclampsia patients.

Emerging biomarker for predicting acute kidney injury after cardiac surgery: cystatin C

Cardiopulmonary bypass (CPB)-associated acute kidney injury (AKI) is a common situation and rapid diagnosis and risk classification are important in the prevention and management of AKI. Changes in serum creatinine (SCr) levels in the current consensus criteria do not allow clinicians to diagnose CPB-associated AKI until 48 h after surgery. We conducted a prospective single center study involving 57 patients who underwent cardiac surgery with CBP to compare serum beta-trace protein (BTP), neutrophil gelatinase-associated lipocalin-2 (NGAL), and cystatin C (CysC) levels with SCr for early diagnosis of CPB associated AKI. We defined AKI according to KDIGO criteria. AKI was diagnosed in 24 (42.1%) patients. Mean duration of postoperative intensive care unit stay was 4.79 (± 6.12) days for the AKI+ group and 2.15 (± 0.56) days for the AKI– group. The average length of hospital stay was 8.13 (± 5.75) days for the AKI+ group and 7.21 (± 3.68) days for the AKI– group, which was significantly longer in the AKI+ group (P < 0.001, P = 0.011). Unlike other biomarkers, a significant increase in postoperative CysC levels was always found in patients with AKI during follow-up when compared to patients in whom AKI did not develop (P < 0.001). Increase in serum CysC levels showed a significant positive correlation with increase in SCr levels. We have not seen this correlation between other biomarkers and SCr. According to our study, serum CysC was a reliable biomarker that may aid in the early detection and follow-up of AKI after cardiac surgery.

Serum Cystatin C Levels in COPD: Potential Diagnostic Value and Relation between Respiratory Functions.

SummaryBackgroundThe aim of this study was to determine the level of serum cystatin C (CysC) in patients with Chronic Obstructive Pulmonary Disease (COPD) during exacerbation and stable periods and to investigate its potential diagnostic value and the relationship between CysC levels and the pulmonary function test (PFT).MethodsOne hundred twenty-six patients with COPD (68 in stable periods, 58 during exacerbation periods) and 50 healthy subjects were included in the study. PFT, body mass index (BMI), white blood cell counts, C-reactive protein (CRP), serum urea and creatinine levels were evaluated in both groups of patients. CysC levels were measured in all participants.ResultsSerum CysC levels were statistically higher in both COPD groups than the control group (p<0.001 for both) although there was no statistically significant difference between COPD groups (p>0.05). CysC levels showed negative correlation with forced expiratory volume in 1 second (FEV1) and a positive correlation with C-reactive protein (CRP) levels in patients with stable COPD. There was a positive correlation between serum CysC levels and serum urea, creatinine, CRP levels in patients with COPD exacerbation (r=0.333, p=0.011; r=0.260, p=0.049; r=0.414, p<0.01 respectively). When stable COPD and control groups were evaluated, serum CysC had an area under the curve (AUC) in the receiver operating characteristic (ROC) curve of 0.951 (0.909–0.994 95% CI: p<0.001).ConclusionsOur results showed that CysC levels increased in both COPD groups. Increased CysC levels may be related with lung function decline and inflammation in COPD patients. In addition, CysC levels may be a potential indicator for the diagnosis of COPD.

Cystatin C serum levels in healthy children are related to age, gender, and pubertal stage

BackgroundThis study aims to establish age- and gender-specific cystatin C (CysC) reference values for healthy infants, children, and adolescents and to relate them to pubertal stage, height, weight, and body mass index (BMI).MethodsSerum CysC and creatinine levels of 6217 fasting, morning venous blood samples from 2803 healthy participants of the LIFE Child study (age 3 months to 18 years) were analyzed by an immunoassay. Recruitment started in 2011; 1636 participants provided at least one follow-up measurement. Percentiles for CysC were calculated. Age- and gender-related effects of height, weight, BMI, and puberty status were assessed through linear regression models.ResultsOver the first 2 years of life, median CysC levels decrease depending on height (ß = − 0.010 mg/l/cm, p < 0.001) and weight (ß = − 0.033 mg/l/kg, p < 0.001) from 1.06 to 0.88 mg/l for males and from 1.04 to 0.87 mg/l for females. Following the second year of age, the levels remain stable for eight years. From 11 to 14 years of age, there is an increase of median CysC levels in males to 0.98 mg/l and a decrease in females to 0.86 mg/l. The change is associated with puberty (ß = 0.105 mg/l/Tanner stage, p < 0.001 in males and ß = − 0.093 mg/l/Tanner stage, p < 0.01 in females) and in males with height (ß = 0.003 mg/l/cm, p < 0.001).ConclusionsCysC levels depend on age, gender, and height, especially during infancy and puberty. We recommend the use of age- and gender-specific reference values for CysC serum levels for estimating kidney function in clinical practice.

The preoperative serum cystatin-C as an independent prognostic factor for survival in upper tract urothelial carcinoma

Cystatin-C (Cys-C) has been reported as a valuable prognostic biomarker in various malignancies. However, its effect on upper tract urothelial carcinoma (UTUC) patients has not been investigated before. Thus, to explore the impact of Cys-C on survival outcomes in patients undergoing radical nephroureterectomy (RNU), a total of 538 patients with UTUC who underwent RNU between 2005 and 2014 in our center (West China Hospital, Chengdu, China) were included in this study. Kaplan–Meier method and Cox regression analyses were performed to assess the relationship between Cys-C and survival outcomes using SPSS version 22.0. The cutoff value of Cys-C was set as 1.4 mg l−1 using the receiver operating characteristic (ROC) curves and Youden index. The mean age of patients included was 66.1 ± 11.1 years, and the median follow-up duration was 38 (interquartile range: 19–56) months. Overall, 162 (30.1%) patients had elevated Cys-C, and they were much older and had worse renal function than those with Cys-C <1.4 mg l−1 (both P < 0.001). Meanwhile, Kaplan–Meier analysis revealed that the group with elevated Cys-C had worse cancer-specific survival (CSS, P = 0.001), disease recurrence-free survival (RFS, P = 0.003), and overall survival (OS, P < 0.001). Multivariable Cox analysis suggested that the elevated Cys-C was identified as an independent prognostic predictor of CSS (hazard ratio [HR]: 1.997, 95% confidential interval [CI]: 1.331–2.996), RFS (HR: 1.429, 95% CI: 1.009–2.023), and OS (HR: 1.989, 95% CI: 1.366–2.896). In conclusion, our result revealed that the elevated preoperative serum Cys-C was significantly associated with worse outcomes in UTUC patients undergoing RNU.

Serum cystatin C, impaired kidney function, and geriatric depressive symptoms among older people living in a rural area: a population-based study

BackgroundThe relationship between kidney function and depressive symptoms among elderly people has been rarely investigated in settings of the general population. The aim of our study was to examine the association of serum cystatin C (cysC) and impaired kidney function with geriatric depressive symptoms among older people living in a rural community in China.MethodsThis population-based cohort study included 1440 individuals (age ≥ 60 years) who were recruited for the Confucius Hometown Aging Project in 2010–2011; of the 1124 persons who were free of depressive symptoms, 669 (59.5%) were re-examined in 2014–2016. At baseline, data on demographics, lifestyle factors, health conditions, and medical history were collected through interviews, clinical examinations, and laboratory tests. We defined impaired kidney function as the cystatin C-based estimated glomerular filtration rate (eGFRcysC) < 60 ml/min/1.73 m2, and depressive symptoms as a score ≥ 5 on the 15-item Geriatric Depression Scale. Data were analyzed using multiple logistic and Cox proportional-hazards models.ResultsOf the 1440 participants, 316 (21.9%) were defined to have geriatric depressive symptoms at baseline. Serum cysC levels of 1.01–1.25 and > 1.25 mg/L (vs. ≤1.00 mg/L) were associated with a multiple-adjusted odds ratio (OR) of 1.41 (95% CI 1.01–1.97) and 3.20 (2.32–4.41), respectively, for having geriatric depressive symptoms (Ptrend < 0.001). Of the 669 people who were free of depressive symptoms at baseline, 157 had incident depressive symptoms at the follow-up examination. The multiple-adjusted hazard ratio (HR) for incident depressive symptoms were 2.16 (95% CI 1.43–3.27) for serum cysC > 1.25 mg/L (vs. < 1.00 mg/L). Impaired kidney function was cross-sectionally (multiple-adjusted OR = 2.95; 95% CI 2.22–3.92) and longitudinally (multiple-adjusted HR 1.54; 95% CI 1.03–2.30) associated with an increased risk of geriatric depressive symptoms.ConclusionElevated serum cysC levels and impaired kidney function are associated with an increased risk of geriatric depressive symptoms among Chinese older people living in a rural community.

The value of measuring cysC, β2-microglobulin and neutrophil gelatinase-associated lipocalin as a test panel for detection of early renal damage in lung cancer patients receiving chemotherapy

Objective To compare the value of serum cystatin C (CysC), urine β2-microglobulin (β2-MG), and neutrophil gelatinase-associated lipocalin (NGAL) as a test panel with that of traditional indicators, serum Cr and urea, for detection of early renal damage in lung cancer patients after chemotherapy. Methods This prospective study collected data at our hospital on levels of serum cystatin C (CysC), urine β2-microglobulin (β2-MG), and neutrophil-gelatinase associated lipocalin (NGAL) from 63 lung cancer patients aged 60 and over.In addition, levels of traditional indicators including serum Cr and urea were also measured.Participants were divided into three groups: a pre-chemotherapy group, an under chemotherapy group, and a post-chemotherapy group. Results Levels of serum CysC, urine β2-MG, and NGAL in the post-chemotherapy group markedly increased, whereas levels of serum Cr and urea had no significant increase; furthermore, levels of serum CysC, urine β2-MG, and NGAL went up steadily as the time of exposure to chemotherapy drugs increased.Pearson’s test showed that the sensitivity of CysC, beta 2-MG and NGAL as a panel was statistically significant for both the under chemotherapy group and the post-chemotherapy group (χ2=31.32, P=0.00; χ2=60.38, P=0.00). Conclusions Serum CysC, urine β2-MG and NGAL as a panel have good diagnostic value for early renal function damage in lung cancer patients after chemotherapy and are superior to traditional renal function indicators such as serum creatinine and urea. Key words: Lung neoplasm; Chemotherapy protocols; Renal function damage; Neutrophil gelatinase-associated lipocalin; Cystatin C

Hypertonic saline resuscitation protects against kidney injury induced by severe burns in rats

BackgroundProper fluid resuscitation can relieve visceral damage and improve survival in severely burned patients. This study compared the effectiveness of resuscitation with 400mEq/L hypertonic saline (HS) and sodium lactate Ringer’s solution (LR) in rats with kidney injury caused by burn trauma. MethodsRats (Sprague-Dawley) underwent burn injury and were randomized into sham, LR, and HS groups. Samples from the kidney were assayed for water content ratio, histopathology, and oxidative stress (superoxide dismutase (SOD) and malondialdehyde (MDA)). Serum sodium, renal function (creatinine and cystatin (Cys)-C), and inflammatory response (tumor necrosis factor (TNF)-α, interleukin (IL)-1β, and high mobility group protein box (HMGB)-1) were also examined as serum markers. ResultsHypertonic saline resuscitation reduced the renal water content ratio and improved renal histopathology caused by severe burns. This effect was accompanied by reductions in serum creatinine and Cys-C as well as TNF-α, IL-1β, and HMGB1. Serum sodium concentration and SOD activity were increased, whereas MDA content was decreased in the kidney tissue of the HS group. ConclusionsThe data indicate that 400mEq/L HS solution reduces hyponatremia and renal edema, inhibits the release of inflammatory mediators, and alleviates oxidative stress injury, thus protecting against kidney injury induced by severe burns.

Clinical research of serum CysC combined with APACHEII score in predicting acute kidney injury in patients with sepsis

Objective To investigate the clinical value of serum cystatin C (sCysC) and APACHEⅡ score in predicting diagosis and prognosis of acute kidney injury(AKI) in patients with sepsis. Methods In this study, we prospectively enrolled 138 adult patients with sepsis who had been admitted to the mixed ICU of Xiaolan Hospital of Southern Medical University during March 2015 to January 2016. According to the Kidney Disease Improving Global Outcomes (KDIGO) criterion, the patients were divided into non-AKI group and AKI group (including mild AKI and severe AKI). The receiver operating characteristic(ROC) curve and the area under curve(AUC) were used to evaluate these indexes’ capability of detecting septic AKI and its prognosis. Results In this study,72 patients (52.2%) developed AKI. The levels of sCysC and APACHEⅡ score were significantly higher in AKI than in non-AKI (P<0.05). In total, 33 patients (23.9%) developed severe AKI. The levels of sCysC and APACHEⅡ score were significantly higher in severe AKI than in non-AKI and mild AKI (P<0.05) . Combination of sCysC and APACHEⅡ score predicted AKI and severe AKI after ICU admission with a higher AUC value (0.880&0.930) than each biomarker alone. In this cohort, in-hospital mortality was 19.6% and renal replacement therapy rate was 9.4%,which were strikingly higher in AKI group than non AKI group (P<0.05). Conclusions sCysC is a novel indexes for predicting AKI and its prognosis in patients with sepsis. Combinating with APACHEⅡ score can further improve its predictive performance of AKI detection and short-term prognosis. Key words: Sepsis; Acute kidney injury; Cystatin C; APACHEⅡscore; Diagnosis and prognosis