Evaluation of renal function in intensive care: plasma cystatin C vs. creatinine and derived glomerular filtration rate estimates
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Thierry Le Bricon
Abstract
Plasma cystatin C, a new marker of glomerular filtration rate (GFR), was prospectively evaluated in surgical intensive care. Cystatin C was measured (immunonephelometry, Dade-Behring) in 10 patients selected to cover a full range of GFR (phase I) and in 28 unselected consecutive patients followed for 5days post-admission (phase II). Results were compared with 51Cr-EDTA clearance (phase I only), plasma creatinine (kinetic Jaffe, Roche), 24-h or estimated by Cockcroft and Gault (CG) creatinine clearance (CrCl), and modified diet in renal disease (MDRD)-estimated GFR. In phase I, the highest correlation with 51Cr-EDTA clearance (22–198mL/min) was noted for CG CrCl (r 2: 0.883, p<0.001). During phase II follow-up, 24-h CrCl could not be calculated in 25% of daily evaluations. Cystatin C correlated with creatinine (0.856, p<0.0001) and CG CrCl with MDRD GFR (0.926, p<0.0001) in renal failure (10–78mL/min, n=60). There was a +40% (p<0.001) median difference between cystatin C and creatinine (as a % of upper normal cut-off). Sensitivity/specificity to detect a <80mL/min CG CrCl was 88/97% for cystatin C vs. 48/100% for creatinine (laboratory cut-off). In patients with normal and stable renal function (n=14), day-to-day intra-individual variation was 7.4% for cystatin C (vs. 10.6% for creatinine). In intensive care unit surgical adult patients, CG CrCl provides an easy and cost-effective estimate of GFR. Superior to creatinine, plasma cystatin C can be measured in selected patients where CG CrCl is known to be inaccurate.
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©2005 by Walter de Gruyter Berlin New York
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Articles in the same Issue
- The future of clinical laboratories: more testing or knowledge services?
- Apolipoprotein A5 and triglyceridemia. Focus on the effects of the common variants
- Genotyping of the 19-bp insertion/deletion polymorphism in the 5′ flank of β-hydroxylase gene by dissociation analysis of allele-specific PCR products
- APOE genotypes and dyslipidemias in a sample of the Portuguese population
- Serum proteins profile as an indicator of malignancy: multivariate logistic regression and ROC analyses
- Mean fluorescence intensity rate is a useful marker in the detection of paroxysmal nocturnal hemoglobinuria clones
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- Erythrocyte zinc content in critically ill patients
- Systemic levels of interleukin-6 and matrix metalloproteinase-9 in patients with multiple myeloma may be useful as prognostic indexes of bone disease
- Analysis of the applicability of artificial neural networks for studying blood plasma: determination of magnesium ion concentration as a case study
- The effect of long-term storage on measured plasma lactate concentrations and prospective lactate results from a multicenter trial of antiretroviral therapy
- Evaluation of renal function in intensive care: plasma cystatin C vs. creatinine and derived glomerular filtration rate estimates
- Multicentre physiological reference values for some urinary component-to-creatinine (creatininium) concentration ratios
- Diagnostic and analytical performance of a screening panel for allergy
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- The Asp298 but not the C-786 genotype of the endothelial nitric oxide synthase is reduced with age in healthy Swiss men
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