Predictive power of serum cystatin C to detect acute kidney injury and pediatric-modified RIFLE class in children undergoing cardiac surgery
Pediatric Critical Care, 07/09/2012
Clinical Article
Hassinger AB et al. – Cystatin C is an early predictor of acute kidney injury in children after cardiopulmonary bypass. Cystatin C is a good predictor of pediatric RIFLE (Risk, Injury, Failure, Loss, End–stage kidney disease) classification and of decreased estimated glomerular filtration rate after cardiopulmonary bypass. Serum cystatin C may be cleared by ultrafiltration.
Methods- One hundred pediatric patients who underwent cardiac surgery involving cardiopulmonary bypass.
- Acute kidney injury was defined as a 50% increase in serum creatinine from a preoperative baseline anytime through postoperative day 4.
- Severity of acute kidney injury was determined by pediatric RIFLE class using estimated glomerular filtration rate criteria only.
- Renal injury was also determined by an absolute estimated glomerular filtration rate <80mL/min/1.73m2.
- Cystatin C levels were measured before and after ultrafiltration.
- Twenty–eight patients (28%) developed acute kidney injury.
- Cystatin C predicted acute kidney injury as early as 8hrs after surgery.
- When applying pediatric RIFLE criteria to the entire study, 30 patients reached “risk” and five developed “injury.”
- Cystatin C was a good predictor of the development of “injury” (under the receiver operating characteristic curve, 0.834–0.875) and of renal injury by estimated glomerular filtration rate (under the receiver operating characteristic curve, 0.717–0.835) (all p<.05).
- Cystatin C levels decreased perioperatively and correlated with volume of fluid removed by ultrafiltration.
