Serum cystatine c vs serum cpk for diagnosis of aki after trauma in adults according to rifle criteria in ic us within first 24hr

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Serum cystatin-c and creatine phosphokinase were evaluated to predict acute kidney injury (AKI) according to RIFLE criteria in adult trauma patients within the first 24 hours of intensive care unit admission. Serum cystatin-c, but not creatine phosphokinase, was found to be independently associated with higher risk of early AKI. While both markers showed some ability to diagnose AKI, neither cystatin-c nor creatine phosphokinase demonstrated high sensitivity and specificity for early AKI prediction based on receiver operating characteristic curve analysis.

Health & Medicine

Serum cystatin-c versus creatine phosphokinase
to predict acute kidney injury according to rifle criteria
in adult trauma intensive care units within first 24 hours
H.R. Jamaati , M. Masjedi , F. Zand, S.M.R. Hashemian, G. Sabetian, G. Abbasi, V. Khaloo,
S.H. Tabei , A. Kafilzadeh , H. Haddad Bakhodaei
1
Presented by : Mansoor Masjedi MD
Ass. Prof. of anesthesia & Critical care consultant
Shiraz university of medical sciences ,Iran
Milan , Italy - October , 2016

• INTRODUCTION
 AKI is a common clinical problem in critically ill pts which independently
predicts poor outcome.
 Despite significant improvements in therapeutics, its mortality and morbidity
remains high.
 A major reason for this is the lack of early markers for AKI and hence an
unacceptable delay in initiating therapy.
 AKI, as a component of the crush syndrome, is the 2nd cause of death after
direct trauma, although it can be prevented by early and vigorous intravenous
fluid therapy .
 Few studies have evaluated the predictive value of biomarkers for early
diagnosis of AKI in trauma.
2
Serum Cys-c vs CPK to predict AKI according to Rifle criteria
in adult trauma ICUs within first 24 hrs

• OBJECTIVES
To evaluate and compare
the predictive value of serum Cys-c with CPK
for early diagnosis of AKI
in adult trauma pts admitted in ICU
3
Serum Cys-c vs CPK to predict AKI according to Rifle criteria
in adult trauma ICUs within first 24 hrs

• METHODS
o Retrospective interrogation of prospectively collected data of 300 adult
trauma pts aged≥18 yrs admitted and stayed more than 24 hrs in ICU.
o We measured Cys-c & CPK of previously collected and freezed serum samples
o Impression of AKI was applied according to RIFLE criteria in ICU within first
24hr ( early AKI)
o Association of Cys-c and CPK with different stages of AKI were evaluated &
compared
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Serum Cys-c vs CPK to predict AKI according to Rifle criteria
in adult trauma ICUs within first 24 hrs

• RESULTS
 The median age was 34.8 ( 18 - 80 ) yrs, 90% were male .
 The crude prevalence of AKI was 193 ( 65%) with a maximum RIFLE category of :
• Risk in 121 ( 40.3% )
• Injury in 67 (22.3%)
• Failure 5 (1.7%)
 Younger age and male sex were independently associated with higher risk of AKI in the
first 24 hrs after trauma .
 Mean APACHE IV score between AKI and Non-AKI groups were not statistically different
5
Serum Cys-c vs CPK to predict AKI according to Rifle criteria
in adult trauma ICUs within first 24 hrs

• RESULTS (cont'd)
• Considering serum Cys-c ,
• lower frequency of AKI ( 144 , 63.2% ) in pts with Cys-c < 0.78
• higher ( 49 , 71 % ) in pts with Cys-c ≥ 0.78
( p value = 0.001 ).
• According to serum CPK ,
• lowest frequency of AKI ( 87, 56.1 % ) in pts with CPK < 2000
• highest ( 18 , 90% ) in pts with CPK of 5000-10000
( p value = 0.003)
6
Serum Cys-c vs CPK to predict AKI according to Rifle criteria
in adult trauma ICUs within first 24 hrs

• RESULTS (cont'd)
Diagnosis of AKI ,
• Cys-c; significant odds ratio of 5.874 ( p value: 0.003 with 95% CI ; 1,79-1 9.23 )
in comparison with
• CPK; no correlation (odds ratio of 1 ).
7
Serum Cys-c vs CPK to predict AKI according to Rifle criteria
in adult trauma ICUs within first 24 hrs

RESULTS (cont'd)
Sensitivity and specificity ,
Both Cys-c and CPK of 1st day could not be
considered to have high sensitivity and
specificity (area under the curve 0.565
and 0.61 8 , respectively ) by plotting ROC
curve
8
Serum Cys-c vs CPK to predict AKI according to Rifle criteria
in adult trauma ICUs within first 24 hrs

CONCLUSION
In adult trauma victims admitted in ICU,
serum Cys-c but not CPK
could predict development of early AKI
9
Serum Cys-c vs CPK to predict AKI according to Rifle criteria
in adult trauma ICUs within first 24 hrs

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