• Max Bell, Fredrik Granath, Johan Mårtensson, Erland Löfberg, Anders Ekbom, Claes-Roland Martling, and KING (Karolinska Intensive care Nephrology Group).
• Department of Anaesthesiology and Intensive Care, Karolinska University Hospital, Solna, Sweden. max.bell@karolinska.se
• Nephrol. Dial. Transplant. 2009 Oct 1; 24 (10): 3096-102.

BackgroundRecent research has shown cystatin C to predict mortality and cardiovascular morbidity independent of renal function. The aim of this study was to evaluate the prognostic value of cystatin C on mortality in adult general ICU patients with acute kidney injury (AKI). We later expanded the study and included patients without signs of AKI.MethodsA total of 845 ICU patients were analysed for cystatin C and classified according to the RIFLE criteria. Of these, 271 patients with either creatinine >150 micromol/l, urea >25 or anuria/oliguria entered the AKI cohort. The remaining 562 patients entered the non-AKI cohort. Both cohorts were divided into quartiles according to cystatin C at entry. In the non-AKI cohort, we split the highest cystatin C quartile into two. The relationship between the different cystatin C quartiles and mortality in patients with and without AKI was estimated by hazard ratios (HR) derived from the Cox proportional hazards regression model.ResultsA relationship between cystatin C and mortality was found in patients with and without AKI, being stronger in patients without AKI. In AKI patients, the HR comparing cystatin C above and below the median more than doubled from the second year on compared to the first year follow-up. After exclusion of patients in the non-AKI cohort with 'potential AKI' (creatinine >100 micromol/l or urea > 20 mmol/l), the correlation between cystatin C levels and risk of death was strengthened.ConclusionsCystatin C is correlated with mortality independently of renal function measured by creatinine in patients entering the general ICU.

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