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Vol. 215. Issue 2.
Pages 83-90 (March 2015)
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Vol. 215. Issue 2.
Pages 83-90 (March 2015)
Original article
Cystatin C as an early marker of acute kidney injury in septic shock
Cistatina C como marcador precoz de lesión renal aguda en el shock séptico
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F. Ortuño-Andériz
Corresponding author
portunoa@yahoo.es

Corresponding author.
, N. Cabello-Clotet, N. Vidart-Simón, C. Postigo-Hernández, S. Domingo-Marín, M. Sánchez-García
Servicio de Medicina Intensiva, Sección de Neuro-politraumatizados, Hospital Clínico San Carlos, Madrid, Spain
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Tables (4)
Table 1. Description of the main epidemiological, clinical, hemodynamic, laboratory and healthcare characteristics of the 50 patients included in the study.
Table 2. Comparison of the variables measured on the first day in the intensive care unit and the evolution subsequent to the acute kidney injury categorized as RIFLE-F.
Table 3. Markers of renal function on the first day in the intensive care unit and the evolution subsequent to the acute kidney injury categorized as RIFLE-F.
Table 4. Analysis of the various clinical and laboratory variables measured on the first day in the intensive care unit and 30-day mortality.
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Abstract
Objective

To describe the utility of determining plasma cystatin C concentrations in the diagnosis of acute incident kidney injury in septic shock.

Patients and methods

Prospective series of 50 patients with septic shock and plasma creatinine levels <2mg/dL were hospitalized in an intensive care unit. Clinical and laboratory follow-ups were conducted, with measurements of cystatin C, urea and plasma creatinine levels from the diagnosis of septic shock to 5days later. The severity of the septic shock was assessed with the RIFLE scale.

Results

Twenty patients (40%) developed acute kidney injury: 8 (16%) were categorized as RIFLE-R, 5 (10%) as RIFLE-I and 7 (14%) as RIFLE-F. All patients categorized as RIFLE-F required extracorporeal renal clearance. Eighteen (36%) patients died, 8 (20%) of whom had developed acute kidney injury in their evolution. There was poor correlation between plasma creatinine and cystatin C levels (r=.501; p=.001), which disappeared upon reaching any degree of renal impairment on the RIFLE scale. Cystatin C levels increased earlier on and were better able to identify patients who would develop serious renal function impairment (RIFLE-F) than creatinine and urea levels. The initial cystatin C levels were related to mortality at 30days (OR=1.16; 95% CI: 03–.85).

Conclusions

For patients who developed acute septic kidney injury, the plasma cystatin C levels increased before the classical markers of renal function. Cystatin C also constitutes a severity biomarker that correlates with progression to RIFLE-F, the need for extrarenal clearance and, ultimately, mortality. This precocity could be useful for starting measures that prevent the progression of renal dysfunction.

Keywords:
Acute kidney injury
Acute renal failure
Cystatin C
Creatinine
Urea
Sepsis
Septic shock
Resumen
Objetivo

Describir la utilidad de la determinación de la concentración plasmática de cistatina C en el diagnóstico precoz de la lesión renal aguda en el shock séptico.

Pacientes y métodos

Serie prospectiva de 50 pacientes ingresados en una unidad de cuidados intensivos con shock séptico y creatinina plasmática <2mg/dl. Seguimiento clínico y analítico con determinaciones de cistatina C, urea y creatinina plasmáticas desde el diagnóstico del shock séptico hasta 5días más tarde. Su gravedad se valoró con la escala RIFLE.

Resultados

Veinte pacientes (40%) desarrollaron lesión renal aguda: 8 (16%) RIFLE «R», 5 (10%) RIFLE «I» y 7 (14%) RIFLE «F». Todos los RIFLE «F» precisaron depuración renal extracorpórea. Fallecieron 18 pacientes (36%); de ellos 8 (20%) habían desarrollado lesión renal aguda en su evolución. Hubo una correlación pobre entre creatinina y cistatina C plasmáticas (r=0,501; p=0,001), que desaparecía cuando se alcanzaba cualquier grado de deterioro renal en la escala RIFLE. La cistatina C se elevaba antes e identificaba mejor que la creatinina y la urea a aquellos pacientes que iban a desarrollar un deterioro severo de su función renal (RIFLE «F») y sus valores iniciales se relacionaban con la mortalidad a los 30días (OR=1,16; IC95%: 0,03-0,85).

Conclusiones

En los pacientes que desarrollan lesión renal aguda séptica la cistatina C plasmática se incrementa antes que los marcadores clásicos de función renal. Además constituye un biomarcador de severidad que se correlaciona con la evolución a RIFLE «F», la necesidad depuración extrarrenal y la mortalidad. Esta precocidad puede ser útil para instaurar medidas que eviten la progresión de la disfunción renal.

Palabras clave:
Lesión renal aguda
Fracaso renal agudo
Cistatina C
Creatinina
Urea
Sepsis
Shock séptico

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