%0 Journal Article
%T Cystatin C at Admission in the Intensive Care Unit Predicts Mortality among Elderly Patients
%A Maria Aparecida Dalboni
%A Daniel de Oliveira Beraldo
%A Beata Marie Redublo Quinto
%A Rosangela Blaya
%A Roberto Narciso
%A Moacir Oliveira
%A J¨²lio C¨¦sar Martins Monte
%A Marcelino de Souza Dur£¿o
%A Miguel Cendoroglo
%A Oscar Fernando Pav£¿o
%A Marcelo Costa Batista
%J ISRN Nephrology
%D 2013
%R 10.5402/2013/673795
%X Introduction. Cystatin C has been used in the critical care setting to evaluate renal function. Nevertheless, it has also been found to correlate with mortality, but it is not clear whether this association is due to acute kidney injury (AKI) or to other mechanism. Objective. To evaluate whether serum cystatin C at intensive care unit (ICU) entry predicts AKI and mortality in elderly patients. Materials and Methods. It was a prospective study of ICU elderly patients without AKI at admission. We evaluated 400 patients based on normality for serum cystatin C at ICU entry, of whom 234 (58%) were selected and 45 (19%) developed AKI. Results. We observed that higher serum levels of cystatin C did not predict AKI ( versus £¿mg/L; ). However, it was an independent predictor of mortality, H.R. = 6.16 (95% CI 1.46¨C26.00; ), in contrast with AKI, which was not associated with death. In the ROC curves, cystatin C also provided a moderate and significant area (0.67; ) compared to AKI (0.47; ) to detect death. Conclusion. We demonstrated that higher cystatin C levels are an independent predictor of mortality in ICU elderly patients and may be used as a marker of poor prognosis. 1. Introduction It has been reported that critically ill elderly patients in the intensive care unit (ICU) have a higher risk of developing acute kidney injury (AKI) [1, 2]. Despite significant improvements in therapeutics, AKI remains one of the main risk factors that contribute to morbidity (distant organ injury, prolonged ICU, and hospital stay) and high mortality rate in this population [3¨C5]. A rapid decline of glomerular filtration rate (GFR) and an increase in serum creatinine are still routinely used to characterize AKI [6, 7], promoting a delay in its clinical diagnosis and less opportunity for therapeutic intervention before injury becomes more established. Thus, there is an urgent need to investigate new biomarkers to improve the early detection of renal function damage and avoid poor outcomes. Recently, urinary biomarkers, such as interleukin-18 (IL-18), kidney injury molecule-1 (KIM-1), and neutrophil gelatinase-associated lipocalin (NGAL), have been used for the early detection of acute kidney injury [8]. However, these markers have the disadvantage of urine collection, which is costly and may delay the initiation and adjustment of the treatment of critically ill patients. Nowadays, some plasma biomarkers have also been proposed for the early diagnosis of the AKI and its clinical outcomes in a variety of clinical settings [9, 10]. Cystatin C is an endogenous 13£¿kDa
%U http://www.hindawi.com/journals/isrn.nephrology/2013/673795/