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Early Acute Kidney Injury based on Serum Creatinine or Cystatin C in Intensive Care Unit after Major Trauma

 

Farid Zand1,MD; Golnar Sabetian2,MD; Ghasem Abbasi3,MD; Abbas Rezaianzadeh4,MD,PhD; Alireza Salehi5,MD,PhD; Abbas Khosravi2,MD; Bita Geramizadeh6,MD; Shuja Ulhaq Taregh2,MD; Shohreh Javadpour7,MSc

1Shiraz Anesthesiology and Critical Care Research Center,Shiraz University of Medical Sciences,Shiraz,Iran;

2Trauma Research Center,Shiraz University of Medical Sciences,Shiraz,Iran;

3Department of Anesthesia,School of Medicine,Shiraz University of Medical Sciences,Shiraz,Iran;

4Department of Epidemiology,School of Medicine,Shiraz University of Medical Sciences,Shiraz,Iran;

5Research Center in Traditional Medicine and History of Medicine,Shiraz University of Medical Sciences,Shiraz,Iran;

6Shiraz Transplant Research Center,Shiraz University of Medical Sciences,Shiraz,Iran;

7Department of Critical Care Nursing,Jahrom University of Medical Sciences,Shiraz,Iran

 

Correspondence:

Golnar Sabetian,MD; Trauma Research Center,Rajaee Hospital,Chamran Blvd.,Shiraz,Iran

Tel: +98 71 36360697

Fax: +98 71 36248980

Email: gsabetian@yahoo.com

 

Abstract

Background: Acute kidney injury (AKI) is a common problem in critically ill patients and is independently associated with increased morbidity and mortality. Recently,serum cystatin C has been shown to be superior to creatinine in early detection of renal function impairment. We compared estimated GFR based on serum cystatin C with estimated GFR based on serum creatinine for early detection of renal dysfunction according to the RIFLE criteria.

Methods: During 9 months,three hundred post trauma patients that were referred to the intensive care unit of a referral trauma hospital were recruited. Serum creatinine and serum cystatin C were measured and the estimated GFR within 24 hours of ICU admission was calculated. The primary outcome was the incidence of AKI according to the RIFLE criteria within 2nd to 7th day of admission.

Results: During the first week of ICU admission,21% of patients experienced AKI. After adjusting for major confounders,only the patients with first day's serum cystatin level higher than 0.78 mg/l were at higher risk of first week AKI (OR=6.14,95% CI: 2.5-14.7,P<0.001). First day’s serum cystatin C and injury severity score were the major risk factors for ICU mortality (OR=3.54,95% CI: 1.7-7.4,P=0.001) and (OR=4.6,95% CI: 1.5-14,P=0.007),respectively.

Conclusion: Within 24 hours after admission in ICU due to multiple trauma,high serum cystatin C level may have prognostic value in predicting early AKI and mortality during ICU admission. However,such correlation was not seen neither with creatinine nor cystatin C based GFR.

Keywords: Acute kidney injury,Trauma,Cystatin C,Creatinine,Glomerular filtration rate