The effect of glucocorticoids on serum cystatin C in identifying acute kidney injury: a propensity-matched cohort study
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RESEARCH ARTICLE
Open Access
The effect of glucocorticoids on serum cystatin C in identifying acute kidney injury: a propensity-matched cohort study Silin Liang1,2,3†, Mai Shi4†, Yunpeng Bai5,6†, Yujun Deng2, Miaoxian Fang1, Jiaxin Li1, Yijin Wu1, Wenying Peng1, Yating Hou7, Heng Fang1,2, Huidan Zhang1,2 and Chunbo Chen1,2,3*
Abstract Background: Glucocorticoids may impact the accuracy of serum cystatin C (sCysC) in reflecting renal function. We aimed to assess the effect of glucocorticoids on the performance of sCysC in detecting acute kidney injury (AKI) in critically ill patients. Methods: A prospective observational cohort study was performed in a general intensive care unit (ICU). Using propensity score matching, we successfully matched 240 glucocorticoid users with 960 non-users among 2716 patients. Serum creatinine (SCr) and sCysC were measured for all patients at ICU admission. Patients were divided into four groups based on cumulative doses of glucocorticoids within 5 days before ICU admission (Group I: nonusers; Group II: 0 mg < prednisone ≤50 mg; Group III: 50 mg < prednisone ≤150 mg; Group IV: prednisone > 150 mg). We compared the performance of sCysC for diagnosing and predicting AKI in different groups using the area under the receiver operator characteristic curve (AUC). Results: A total of 240 patients received glucocorticoid medication within 5 days before ICU admission. Before and after matching, the differences of sCysC levels between glucocorticoid users and non-users were both significant (P < 0.001). The multiple linear regression analysis revealed that glucocorticoids were independently associated with sCysC (P < 0.001). After matching, the group I had significantly lower sCysC levels than the group III and group IV (P < 0.05), but there were no significant differences in sCysC levels within different glucocorticoids recipient groups (P > 0.05). Simultaneously, we did not find significant differences in the AUC between any two groups in the matched cohort (P > 0.05). Conclusions: Glucocorticoids did not impact the performance of sCysC in identifying AKI in critically ill patients. Keywords: Acute kidney injury, Cystatin C, Intensive care unit, Renal biomarker
* Correspondence: [email protected] † Silin Liang, Mai Shi and Yunpeng Bai contributed equally to this study, Cofirst author. 1 Department of Intensive Care Unit of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, 96 Dongchuan Road, Guangzhou 510080, Guangdong Province, People’s Republic of China 2 Department of Critical Care Medicine, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Guangzhou 510080, Guangdong Province, People’s Republic of China Full list of author information is available at the end of the article © The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and re
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