Impact of sepsis on levels of plasma cystatin C in AKI and non-AKI patients
Impact of sepsis on levels of plasma cystatin C in AKI and non-AKI patients
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DOI：
10.1093/ndt/gfr358
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发表时间：
2012-02-01
影响因子：
6.1
通讯作者：
Bell, Max
中科院分区：
文献类型：
--
作者：
Martensson, Johan;Martling, Claes-Roland;Bell, Max
胱抑素C是急性肾损伤（阿基）的标志物。然而，与脓毒症相关的全身性炎症（一种常见的AKI触发因素）可能会影响胱抑素C。我们研究了脓毒症对血浆中胱抑素C水平的影响。此外，我们研究了脓毒症的存在是否影响半胱氨酸蛋白酶抑制剂C的预测特性。327名重症监护病房（ICU）患者在ICU的第一周内被分类为：既没有阿基也没有脓毒症（n = 151），脓毒症没有阿基（n = 80），阿基没有脓毒症（n = 24）或阿基和脓毒症（n = 72）。使用重复测量方差分析分析，分析了伴和不伴脓毒症或阿基的患者中半胱氨酸蛋白酶抑制剂C和肌酐随时间的变化。根据受试者工作特征曲线下面积（AUC-ROC）分别评估了脓毒症和非脓毒症患者入院时半胱氨酸蛋白酶抑制剂C预测持续性阿基、恶化阿基或死亡的性能。无阿基的脓毒症和非脓毒症患者的胱抑素C或肌酐变化无显著差异。即使在阿基患者中，脓毒症患者和非脓毒症患者之间的胱抑素C变化也没有显著差异。脓毒症患者和非脓毒症患者预测复合结局的AUC-ROC分别为0.80和0.78，差异无统计学意义（P = 0.76）。脓毒症诱导的炎症反应对ICU第一周内血浆胱抑素C水平无影响。
Cystatin C is a marker of acute kidney injury (AKI). However, systemic inflammation associated with sepsis, a common AKI-trigger, may affect cystatin C. We studied the impact of sepsis on cystatin C levels in plasma. Furthermore, we investigated whether the presence of sepsis affects the predictive properties of cystatin C.Three hundred and twenty-seven intensive care unit (ICU) patients were categorized as having: neither AKI nor sepsis (n = 151), sepsis without AKI (n = 80), AKI without sepsis (n = 24) or AKI and sepsis (n = 72) during their first week in the ICU. Changes in cystatin C and creatinine over time in patients with and without sepsis or AKI were analysed using repeated measures analysis of variance. The performance of cystatin C on admission to predict sustained AKI, worsened AKI or death was assessed from the area under the receiver-operating characteristic curve (AUC-ROC) in septic and non-septic patients separately.In non-AKI patients, cystatin C increased and creatinine decreased significantly over the first week. The change in cystatin C or creatinine did not differ significantly between septic and non-septic patients without AKI. Even in AKI patients, the cystatin C change did not differ significantly between septic and non-septic patients. The AUC-ROCs for prediction of the composite outcome were 0.80 and 0.78 in patients with and without sepsis, respectively, and did not differ significantly (P = 0.76).The inflammatory response induced by sepsis has no impact on the levels of cystatin C in plasma during the first week in the ICU.