血肌酐联合胱抑素C根据KDIGO标准诊断急性肾损伤

Combined criteria of both serum cystatin c and creatinine for acute kidney injury based on KDIGO and its clinical implications

目的研究血肌酐联合胱抑素C诊断急性肾损伤(AKI)的临床价值。方法回顾性分析7 627例住院患者临床资料。根据全球肾脏病预后组织(KDIGO)标准分别用肌酐或胱抑素C判断有无AKI。结果最高血胱抑素C水平和肌酐值显著相关(Spearman相关系数0.699,P<0.001)。最高胱抑素C水平预测院内死亡的受试者工作特征曲线下面积0.761(95%可信区间0.693~0.828)。符合血肌酐和胱抑素C标准的AKI分别有1 004例(13.2%)和173例(2.3%)。血肌酐联合胱抑素C判断AKI,1 119例(14.7%)发生AKI。在多变量Logistic回归模型中,和血肌酐(-)胱抑素C(-)组比较,血肌酐(-)胱抑素(+)显著增加死亡的风险(OR值15.524,95%可信区间5.110~47.166)。结论联合胱抑素C能提高血肌酐诊断AKI的敏感性,有助于识别高危住院人群。

Objective We aimed to investigate the clinical values of combination of blood creatinine andcystatin C for acute kidney injury(AKI)diagnosi. Methods Total 7 627 patients were studied retrospectively.The AKI was classified by creatinine or cystatin C according to the Kidney Disease:Improving Global Outcomescriteria. Results The maximum levels of cystatin C and creatinine were correlated(Spearman′s rank coefficient0.699,P < 0.001). The area under a receiver operating characteristic curve of maximum cystatin C value for pre-dicting in-hospital death was 0.761(95% confidence interval 0.693 ~ 0.828). Total 1 004 and 173 patients wereclassified into AKI by blood creatinine or by cystatin C(13.2% vs. 2.3%,P < 0.001),respectively. The total inci-dence of AKI was 14.7% diagnosed by the combination of the two markers. In multivariable logistic model,the cre-atinine negative plus cystatin C positive group was associated with a higher in-hospital death compared with the cre-atinine and cystatin C double negative group(OR 15.524,95% confidence interval 5.110 ~ 47.166,P < 0.001).Conclusion Combination of cystatin C increased sensitivity of creatinine for AKI diagnosis and facilitated to iden-tify in-hospital patients with high risk.