The cystatin C/creatinine ratio, a marker of glomerular filtration quality: associated factors, reference intervals, and prediction of morbidity and mortality in healthy seniors
The cystatin C/creatinine ratio, a marker of glomerular filtration quality: associated factors, reference intervals, and prediction of morbidity and mortality in healthy seniors
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DOI：
10.1016/j.trsl.2015.11.001
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发表时间：
2016-03-01
影响因子：
7.8
通讯作者：
Risch, Martin
中科院分区：
文献类型：
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作者：
Purde, Mette-Triin;Nock, Stefan;Risch, Martin
胱抑素 C (cysC) 与肌酐 (crea) 的比率被认为是与心血管疾病相关的肾小球滤过质量的标志。我们试图确定老年人血清 cysC-crea 比率的参考区间。此外，我们试图确定其他低分子量分子是否在肾小球滤过质量改变的个体中表现出类似的行为。最后，我们调查了与不良结果的关联。共有 1382 名 60 岁或以上主观健康的瑞士志愿者参与了这项研究。参考区间根据临床和实验室标准协会 (CLSI) 指南 EP28-A3c 计算。基线检查后，为期 4 年的跟踪调查记录了总体发病率和死亡率的信息。女性的 cysC-crea 比率（平均 0.0124 +/- 0.0026 mg/mu mol）显着较高，并且随着年龄的增长而逐渐增加。其他相关因素包括血红蛋白 A1c、平均动脉压和 C 反应蛋白（全部 P < 0.05）。表现出毛孔收缩综合征的参与者的 3.5-66.5 kDa 分子（脑钠肽、甲状旁腺激素、β(2)-微球蛋白、半胱氨酸蛋白酶抑制剂 C、视黄醇结合蛋白、促甲状腺激素、α(1)-酸性糖蛋白、脂肪酶、 淀粉酶、前白蛋白和白蛋白）和肌酐。极低分子量分子（尿素、尿酸）与肌酐的比率或大于 66.5 kDa 的分子（转铁蛋白、触珠蛋白）与肌酐的比率没有这种差异。在调整多个因素的逻辑回归模型中，cysCcrea 比率可显着预测随访时的死亡率和主观总体发病率。 cysCcrea 比率显示了老年人的年龄和性别特异性参考区间。总之，cysC-crea 比率可能表明生物活性低分子量化合物的相对保留，并可以独立预测老年人总体死亡率和发病率的风险。
The ratio of cystatin C (cysC) to creatinine (crea) is regarded as a marker of glomerular filtration quality associated with cardiovascular morbidities. We sought to determine reference intervals for serum cysC-crea ratio in seniors. Furthermore, we sought to determine whether other low-molecular weight molecules exhibit a similar behavior in individuals with altered glomerular filtration quality. Finally, we investigated associations with adverse outcomes. A total of 1382 subjectively healthy Swiss volunteers aged 60 years or older were enrolled in the study. Reference intervals were calculated according to Clinical & Laboratory Standards Institute (CLSI) guideline EP28-A3c. After a baseline exam, a 4-year follow-up survey recorded information about overall morbidity and mortality. The cysC-crea ratio (mean 0.0124 +/- 0.0026 mg/mu mol) was significantly higher in women and increased progressively with age. Other associated factors were hemoglobin A1c, mean arterial pressure, and C-reactive protein (P < 0.05 for all). Participants exhibiting shrunken pore syndrome had significantly higher ratios of 3.5-66.5 kDa molecules (brain natriuretic peptide, parathyroid hormone, beta(2)-microglobulin, cystatin C, retinol-binding protein, thyroid-stimulating hormone, alpha(1)-acid glycoprotein, lipase, amylase, prealbumin, and albumin) and creatinine. There was no such difference in the ratios of very low-molecular weight molecules (urea, uric acid) to creatinine or in the ratios of molecules larger than 66.5 kDa (transferrin, haptoglobin) to creatinine. The cysCcrea ratio was significantly predictive of mortality and subjective overall morbidity at follow-up in logistic regression models adjusting for several factors. The cysCcrea ratio exhibits age- and sex-specific reference intervals in seniors. In conclusion, the cysC-crea ratio may indicate the relative retention of biologically active low-molecular weight compounds and can independently predict the risk for overall mortality and morbidity in the elderly.