Cystatin C as a predictor of contrast-induced nephropathy in critically-ill patients

Abstract EN

Background : Contrast-induced nephropathy (CIN) is a leading cause of acute kidney injury (AKI) in hospitalized patients and is associated with considerable morbidity and mortality.

An increased serum creatinine level to define kidney injury is a poor marker.

Although current evidence is conflicting, Cystatin C has been suggested to be a more sensitive early marker of AKI.

Objective : To evaluate Cystatin C as a marker of CIN in intensive care unit (ICU) patients administered with contrast media for diagnostic or therapeutic intervention.

Design : A prospective study.

Setting : Intensive Care Unit (ICU), King Abdul-Aziz University Hospital.

Method : A prospective study involving laboratory investigations : urea, creatinine, serum electrolytes, Cystatin-C and lactic acid were performed on 84 patients admitted to ICU from January 2010 to December 2011.

Result : During the 72 hour post-contrast follow-up period, 21 (25 %) patients developed CIN ; 14 (66.7 %) on day one, 4 (19 %) on day two and 3 (14.3 %) on day three.

Cystatin C levels pre-contrast administration were significantly higher in patients who developed CIN compared to those who did not (p = 0.012).

There were significant increases in Cystatin C and urea levels in CIN groups at 24-48 and 24-72 hours post-contrast.

Creatinine levels in CIN group increased significantly at 72 hours post-contrast (p = 0.009).

Mortality rate was significantly high in CIN patients (p = 0.038) irrespective of the lengths of hospital or ICU stay.

Conclusion : The incidence of CIN in ICU patients is fairly high and is associated with increased mortality.

Cystatin C may represent a useful biomarker for prediction and early detection of CIN.