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Creatinine-Cystatin C Ratio and Mortality in Patients Receiving Intensive Care and Continuous Kidney Replacement Therapy: A Retrospective Cohort Study

Authors
 Chan-Young Jung  ;  Young Su Joo  ;  Hyung Woo Kim  ;  Seung Hyeok Han  ;  Tae-Hyun Yoo  ;  Shin-Wook Kang  ;  Jung Tak Park 
Citation
 AMERICAN JOURNAL OF KIDNEY DISEASES, Vol.77(4) : 509-516.e1, 2021-04 
Journal Title
 AMERICAN JOURNAL OF KIDNEY DISEASES 
ISSN
 0272-6386 
Issue Date
2021-04
Keywords
Creatinine ; acute kidney injury (AKI) ; continuous kidney replacement therapy (CKRT) ; critical illness ; cystatin C ; intensive care unit (ICU) ; mortality ; muscle mass ; risk assessment
Abstract
Rationale & objective: Studies have suggested associations between lower ratios of serum creatinine to cystatin C with both lower muscle mass and adverse clinical outcomes in multiple disease conditions. Identifying risk factors for mortality among patients with acute kidney injury (AKI) undergoing continuous kidney replacement therapy (CKRT) may improve assessment of prognosis. We sought to evaluate the association of creatinine-cystatin C ratio with outcomes in patients with AKI undergoing CKRT. Study design: Retrospective cohort study. Setting & participants: 1,588 patients treated with intensive care and CKRT for AKI at a tertiary Korean medical center. Predictor: Baseline serum creatinine-cystatin C ratio at the time of CKRT initiation. Outcomes: Age- and sex-adjusted 90-day mortality after CKRT initiation. Analytical approach: Cox proportional hazard models to estimate the association between creatinine-cystatin C ratio and outcome. Results: Mean age was 64.7 ± 14.5 years and 635 patients (40.0%) were women. The range of creatinine-cystatin C ratios was 0.08 to 10.48. The 30- and 90-day mortality rates were significantly lower for the higher creatinine-cystatin C ratio groups. Multivariable Cox proportional hazards regression analyses revealed that mortality risk became successively lower across quartiles of greater creatinine-cystatin C ratio. When creatinine-cystatin C ratio was evaluated using cubic spline analyses, risks for both 30- and 90-day mortality were lower with higher creatinine-cystatin C ratios. These associations remained significant even after adjustment for confounding variables. Limitations: Retrospective analysis, serum creatinine and cystatin C may not be in steady state in the setting of AKI. Conclusions: Higher serum creatinine-cystatin C ratios were associated with better survival in patients receiving intensive care and CKRT.
Full Text
https://www.sciencedirect.com/science/article/pii/S0272638620310465
DOI
10.1053/j.ajkd.2020.08.014
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Kang, Shin Wook(강신욱) ORCID logo https://orcid.org/0000-0002-5677-4756
Kim, Hyung Woo(김형우) ORCID logo https://orcid.org/0000-0002-6305-452X
Park, Jung Tak(박정탁) ORCID logo https://orcid.org/0000-0002-2325-8982
Yoo, Tae Hyun(유태현) ORCID logo https://orcid.org/0000-0002-9183-4507
Joo, Young Su(주영수) ORCID logo https://orcid.org/0000-0002-7890-0928
Han, Seung Hyeok(한승혁) ORCID logo https://orcid.org/0000-0001-7923-5635
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/182369
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