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BMC Nephrology
Published in: BMC Nephrology 1/2020

01-12-2020 | Acute Kidney Injury | Research article

The effect of glucocorticoids on serum cystatin C in identifying acute kidney injury: a propensity-matched cohort study

Authors: Silin Liang, Mai Shi, Yunpeng Bai, Yujun Deng, Miaoxian Fang, Jiaxin Li, Yijin Wu, Wenying Peng, Yating Hou, Heng Fang, Huidan Zhang, Chunbo Chen

Published in: BMC Nephrology | Issue 1/2020

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Abstract

Background

Glucocorticoids may impact the accuracy of serum cystatin C (sCysC) in reflecting renal function. We aimed to assess the effect of glucocorticoids on the performance of sCysC in detecting acute kidney injury (AKI) in critically ill patients.

Methods

A prospective observational cohort study was performed in a general intensive care unit (ICU). Using propensity score matching, we successfully matched 240 glucocorticoid users with 960 non-users among 2716 patients. Serum creatinine (SCr) and sCysC were measured for all patients at ICU admission. Patients were divided into four groups based on cumulative doses of glucocorticoids within 5 days before ICU admission (Group I: non-users; Group II: 0 mg < prednisone ≤50 mg; Group III: 50 mg < prednisone ≤150 mg; Group IV: prednisone > 150 mg). We compared the performance of sCysC for diagnosing and predicting AKI in different groups using the area under the receiver operator characteristic curve (AUC).

Results

A total of 240 patients received glucocorticoid medication within 5 days before ICU admission. Before and after matching, the differences of sCysC levels between glucocorticoid users and non-users were both significant (P <  0.001). The multiple linear regression analysis revealed that glucocorticoids were independently associated with sCysC (P <  0.001). After matching, the group I had significantly lower sCysC levels than the group III and group IV (P <  0.05), but there were no significant differences in sCysC levels within different glucocorticoids recipient groups (P > 0.05). Simultaneously, we did not find significant differences in the AUC between any two groups in the matched cohort (P > 0.05).

Conclusions

Glucocorticoids did not impact the performance of sCysC in identifying AKI in critically ill patients.
Appendix
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Literature
1.
RPd S, ARS C, LAB P, Ronco C, Macedo E. An epidemiologic overview of acute kidney injury in intensive care units. Rev Assoc Méd Bras. 2019;65:1094–101.CrossRef
2.
Negi S, Koreeda D, Kobayashi S, Yano T, Tatsuta K, Mima T, et al. Acute kidney injury: epidemiology, outcomes, complications, and therapeutic strategies. Semin Dial. 2018;31(5):519–27.PubMedCrossRef
3.
Hoste EAJ, Bagshaw SM, Bellomo R, Cely CM, Colman R, Cruz DN, et al. Epidemiology of acute kidney injury in critically ill patients: the multinational AKI-EPI study. Intensive Care Med. 2015;41(8):1411–23.PubMedCrossRef
4.
Folkestad T, Brurberg KG, Nordhuus KM, Tveiten CK, Guttormsen AB, Os I, et al. Acute kidney injury in burn patients admitted to the intensive care unit: a systematic review and meta-analysis. Crit Care. 2020;24(1):2.PubMedPubMedCentralCrossRef
5.
Jo SK, Rosner MH, Okusa MD. Pharmacologic treatment of acute kidney injury: why drugs haven’t worked and what is on the horizon. Clin J Am Soc Nephrol. 2007;2(2):356–65.PubMedCrossRef
6.
Pakula AM, Skinner RA. Acute kidney injury in the critically ill patient:a current review of the literature. J Intensive Care Med. 2016;31(5):319–24.PubMedCrossRef
7.
Randers E, Erlandsen EJ. Serum cystatin C as an endogenous marker of the renal function--a review. Clin Chem Lab Med. 1999;37(4):389–95.PubMedCrossRef
8.
9.
Teo SH, Endre ZH. Biomarkers in acute kidney injury (AKI). Best Pract Res Clin Anaesthesiol. 2017;31(3):331–44.PubMedCrossRef
10.
Dharnidharka VR, Kwon C, Stevens G. Serum cystatin C is superior to serum creatinine as a marker of kidney function: a meta-analysis. Am J Kidney Dis. 2002;40(2):221–6.PubMedCrossRef
11.
Laterza OF, Price CP, Scott MG. Cystatin C: an improved estimator of glomerular filtration rate? Clin Chem. 2002;48(5):699–707.PubMedCrossRef
12.
Herget-Rosenthal S, Marggraf G, Husing J, Goring F, Pietruck F, Janssen O, et al. Early detection of acute renal failure by serum cystatin C. Kidney Int. 2004;66(3):1115–22.PubMedCrossRef
13.
14.
Deng Y, Chi R, Chen S, Ye H, Yuan J, Wang L, et al. Evaluation of clinically available renal biomarkers in critically ill adults: a prospective multicenter observational study. Crit Care. 2017;21(1):46.PubMedPubMedCentralCrossRef
15.
Deng Y, Yuan J, Chi R, Ye H, Zhou D, Wang S, et al. The incidence, risk factors and outcomes of postoperative acute kidney injury in neurosurgical critically ill patients. Sci Rep. 2017;7(1):4245.PubMedPubMedCentralCrossRef
16.
Deng Y, Ma J, Hou Y, Zhou D, Hou T, Li J, et al. Combining serum Cystatin C and urinary N-acetyl-Beta-D-Glucosaminidase improves the precision foracute kidney injury diagnosis after resection of intracranial space-occupying lesions. Kidney Blood Press Res. 2020;45(1):142-56.
17.
Manetti L, Genovesi M, Pardini E, Grasso L, Lupi I, Linda Morselli L, et al. Early effects of methylprednisolone infusion on serum cystatin C in patients with severe Graves' ophthalmopathy. Clin Chim Acta. 2005;356(1):227–8.PubMedCrossRef
18.
Cimerman N, Brguljan PM, Krašovec M, Šuškovič S, Kos J. Serum cystatin C, a potent inhibitor of cysteine proteinases, is elevated in asthmatic patients. Clin Chim Acta. 2000;300(1):83–95.PubMedCrossRef
19.
Zhang D, Gao L, Ye H, Chi R, Wang L, Hu L, et al. Impact of thyroid function on cystatin C in detecting acute kidney injury: a prospective, observational study. BMC Nephrol. 2019;20(1):41.PubMedPubMedCentralCrossRef
20.
Deng Y, Wang L, Hou Y, Ma J, Chi R, Ye H, et al. The influence of glycemic status on the performance of cystatin C for acute kidney injury detection in the critically ill. Ren Fail. 2019;41(1):139–49.PubMedPubMedCentralCrossRef
21.
Stevens LA, Schmid CH, Greene T, Li L, Beck GJ, Joffe MM, et al. Factors other than glomerular filtration rate affect serum cystatin C levels. Kidney Int. 2009;75(6):652–60.PubMedCrossRef
22.
Royakkers AA, Korevaar JC, van Suijlen JD, Hofstra LS, Kuiper MA, Spronk PE, et al. Serum and urine cystatin C are poor biomarkers for acute kidney injury and renal replacement therapy. Intensive Care Med. 2011;37(3):493–501.PubMedCrossRef
23.
Bjarnadottir M, Grubb A, Olafsson I. Promoter-mediated, dexamethasone-induced increase in cystatin C production by HeLa cells. Scand J Clin Lab Invest. 1995;55(7):617–23.PubMedCrossRef
24.
Munoz J, Soblechero P, Duque FJ, Macias-Garcia B, Ruiz P, Zaragoza C, et al. Effects of Oral prednisone administration on serum Cystatin C in dogs. J Vet Intern Med. 2017;31(6):1765–70.PubMedPubMedCentralCrossRef
25.
Zhu X-R, Ge N, Wang Y, Zhai J-L, Liu C. Corticosteroids significantly increase cystatin C levels in the plasma by promoting cystatin C production in rats. Ren Fail. 2019;41(1):698–703.PubMedPubMedCentralCrossRef
26.
Risch L, Herklotz R, Blumberg A, Huber AR. Effects of glucocorticoid immunosuppression on serum Cystatin C concentrations in renal transplant patients. Clin Chem. 2001;47(11):2055–9.PubMedCrossRef
27.
Poge U, Gerhardt T, Bokenkamp A, Stoffel-Wagner B, Klehr HU, Sauerbruch T, et al. Time course of low molecular weight proteins in the early kidney transplantation period--influence of corticosteroids. Nephrol Dial Transplant. 2004;19(11):2858–63.PubMedCrossRef
28.
Mendiluce A, Bustamante J, Martin D, Santos M, Bustamante R, Pascual P, et al. Cystatin C as a marker of renal function in kidney transplant patients. Transplant Proc. 2005;37(9):3844–7.PubMedCrossRef
29.
Geramizadeh B, Azarpira N, Ayatollahi M, Rais-Jalali G-A, Aghdai M, Yaghoobi R, et al. Value of serum cystatin C as a marker of renal function in the early post kidney transplant period. Saudi J Kidney Dis Transplant. 2009;20(6):1015–7.
30.
von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. PLoS Med. 2007;4(10):e296.CrossRef
31.
Bossuyt PM, Reitsma JB, Bruns DE, Gatsonis CA, Glasziou PP, Irwig LM, et al. Toward complete and accurate reporting of studies of diagnostic accuracy: the STARD initiative. Acad Radiol. 2003;10(6):664–9.PubMedCrossRef
32.
Levey AS, Stevens LA, Schmid CH, Zhang YL, Castro AF 3rd, Feldman HI, et al. A new equation to estimate glomerular filtration rate. Ann Intern Med. 2009;150(9):604–12.PubMedPubMedCentralCrossRef
33.
Khwaja A. KDIGO clinical practice guidelines for acute kidney injury. Nephron Clin Pract. 2012;120(4):c179–84.PubMed
34.
McCullough PA, Shaw AD, Haase M, Bouchard J, Waikar SS, Siew ED, et al. Diagnosis of acute kidney injury using functional and injury biomarkers: workgroup statements from the tenth acute Dialysis quality initiative consensus conference. Contrib Nephrol. 2013;182:13–29.PubMedCrossRef
35.
Endre ZH, Walker RJ, Pickering JW, Shaw GM, Frampton CM, Henderson SJ, et al. Early intervention with erythropoietin does not affect the outcome of acute kidney injury (the EARLYARF trial). Kidney Int. 2010;77(11):1020–30.PubMedCrossRef
36.
Basu RK, Wang Y, Wong HR, Chawla LS, Wheeler DS, Goldstein SL. Incorporation of biomarkers with the renal angina index for prediction of severe AKI in critically ill children. Clin J Am Soc Nephrol. 2014;9(4):654–62.PubMedPubMedCentralCrossRef
37.
Meikle AW, Tyler FH. Potency and duration of action of glucocorticoids: effects of hydrocortisone, prednisone and dexamethasone on human pituitary-adrenal function. Am J Med. 1977;63(2):200–7.PubMedCrossRef
38.
Ragab SM, Helwa MA, Khalaf AA. Serum cystatin C and microalbuminuria in children with immune thrombocytopenia under short course of corticosteroids. Egypt Pediatr Assoc Gaz. 2015;63(2):39–45.CrossRef
39.
Gruev T, Chakalarovski K, Stojceva-Taneva O, Grueva A, Trenceva K. Effects of glucocorticoid immunosuppression on serum cystatin C levels. J Med Biochem. 2009;28(3):191–6.CrossRef
40.
Abbink FCH, Laarman CARC, Braam KI, van Wijk JAE, Kors WA, Bouman AA, et al. Beta-trace protein is not superior to cystatin C for the estimation of GFR in patients receiving corticosteroids. Clin Biochem. 2008;41(4):299–305.PubMedCrossRef
41.
Borges RL, Hirota AH, Quinto BMR, Ribeiro AB, Zanella MT, Batista MC. Is Cystatin C a useful marker in the detection of diabetic kidney disease? Nephron Clin Pract. 2010;114(2):c127–34.PubMedCrossRef
42.
Fricker M, Wiesli P, Brändle M, Schwegler B, Schmid C. Impact of thyroid dysfunction on serum cystatin C. Kidney Int. 2003;63(5):1944–7.PubMedCrossRef
43.
Song T, Jia Z, Guo X, Zhao H, Bao W, Han D, et al. Does hepatic impairment influence renal function parameters in liver cirrhosis? J Transl Int Med. 2018;6(2):90–2.PubMedPubMedCentralCrossRef
44.
45.
Le Bricon T, Thervet E, Froissart M, Benlakehal M, Bousquet B, Legendre C, et al. Plasma Cystatin C is superior to 24-h Creatinine clearance and plasma Creatinine for estimation of glomerular filtration rate 3 months after kidney transplantation. Clin Chem. 2000;46:1206–7.PubMedCrossRef
46.
Silva MV, Moscoso Solorzano G, Nishida SK, Kirsztajn GM. Are serum cystatin C levels infl uenced by steroid doses in lupus nephritis patients? J Bras Nefrol. 2011;33..
47.
El-Esawy NM, Morad MA, Abdin AA. Urinary Creatinine and serum Cystatin C in asthmatic children treated with inhaled corticosteroid and Beta 2 agonist. Alex J Pediatr. 2005;19(2):231.
Metadata
Title
The effect of glucocorticoids on serum cystatin C in identifying acute kidney injury: a propensity-matched cohort study
Authors
Silin Liang
Mai Shi
Yunpeng Bai
Yujun Deng
Miaoxian Fang
Jiaxin Li
Yijin Wu
Wenying Peng
Yating Hou
Heng Fang
Huidan Zhang
Chunbo Chen
Publication date
01-12-2020
Publisher
BioMed Central
Published in
BMC Nephrology / Issue 1/2020
Electronic ISSN: 1471-2369
DOI
https://doi.org/10.1186/s12882-020-02165-1

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