• Erik Linné, Alma Elfström, Anna Åkesson, Jane Fisher, Anders Grubb, Ville Pettilä, Suvi T Vaara, Adam Linder, and Peter Bentzer.
• Department of Anesthesiology and Intensive Care, Helsingborg Hospital, Helsingborg, Sweden. Electronic address: erik.linne@med.lu.se.
• J Crit Care. 2022 Dec 1; 72: 154148154148.

PurposeTo assess the association between cystatin C-derived estimates of kidney function and mortality and acute kidney injury (AKI) in sepsis.Materials And MethodsPost-hoc analysis of sepsis patients in the FINNAKI-cohort (n = 802). Primary outcome was 90-day mortality. We measured plasma cystatin C and creatinine at intensive care unit (ICU) admission and estimated glomerular filtration rates (eGFRcys, eGFRcrea) and shrunken pore syndrome (SPS; defined as eGFRcys/eGFRcrea ratio < 0.7). Associations were assessed using Cox- or logistic regression.ResultsIncreased cystatin C and decreased eGFRcys were associated with mortality in unadjusted analyses and in analyses adjusted for illness severity and creatinine. Hazard ratios (HRs) in unadjusted analyses were 3.30 (95% CI; 2.12-5.13, p < 0.001) and 3.26 (95% CI; 2.12-5.02, p < 0.001) respectively. SPS was associated with mortality in an unadjusted- (HR 1.78, 95% CI; 1.33-2.37, p < 0.001) and in an adjusted analysis (HR 1.54, 95% CI; 1.07-2.22, p = 0.021). All cystatin C-derived measures were associated with mortality also after adjustment for AKI development. Cystatin C was associated with AKI in unadjusted analyses but not in analyses adjusted for creatinine.ConclusionCystatin C and derived measures of kidney function at ICU admission are associated with an increased 90-day mortality. Increased AKI incidence does not fully explain this association.Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.

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