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Open Access Highly Accessed Research article

Detection of decreased glomerular filtration rate in intensive care units: serum cystatin C versus serum creatinine

Pierre Delanaye1*, Etienne Cavalier2, Jérôme Morel3, Manolie Mehdi4, Nicolas Maillard4, Guillaume Claisse4, Bernard Lambermont5, Bernard E Dubois1, Pierre Damas6, Jean-Marie Krzesinski1, Alexandre Lautrette7 and Christophe Mariat4

Author Affiliations

1 Department of Nephrology-Dialysis, University of Liège, CHU Sart Tilman, Liège 4000, Belgium

2 Department of Clinical Chemistry, University of Liège, CHU Sart Tilman, Belgium

3 Department of General Intensive care, University Jean Monnet, Hôpital Nord, Saint-Etienne, France

4 Department of Nephrological Intensive Care, University Jean Monnet, Hôpital Nord, Saint-Etienne, France

5 Department of Medical Intensive Care, University of Liège, CHU Sart Tilman, Belgium

6 Department of General Intensive care, University of Liège, CHU Sart Tilman, Belgium

7 Department of Intensive Care Unit, University of Clermont-Ferrand, Clermont-Ferrand, France

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BMC Nephrology 2014, 15:9  doi:10.1186/1471-2369-15-9

Published: 13 January 2014

Abstract

Background

Detecting impaired glomerular filtration rate (GFR) is important in intensive care units (ICU) in order to diagnose acute kidney injuries and adjust the dose of renally excreted drugs. Whether serum Cystatin C (SCysC) may better reflect glomerular filtration rate than serum creatinine (SCr) in the context of intensive care medicine is uncertain.

Methods

We compared the performance of SCysC and SCr as biomarkers of GFR in 47 critically ill patients (median SOFA (Sepsis-related Organ Failure Assessment) score of 5) for whom GFR was measured by a reference method (urinary clearance of iohexol).

Results

Mean Iohexol clearance averaged 96 ± 54 mL/min and was under 60 mL/min in 28% of patients. Mean SCr and SCysC concentrations were 0.70 ± 0.33 mg/dL and 1.26 ± 0.61 mg/L, respectively. Area under the ROC curve for a GFR threshold of 60 mL/min was 0.799 and 0.942 for SCr and SCysC, respectively (p = 0.014).

Conclusions

We conclude that ScysC significantly outperfoms SCr for the detection of an impaired GFR in critically ill patients.

Trial registration

ClinicalTrials.gov: B7072006347

Keywords:
Kidney failure; Cystatin C; Creatinine