Predictive value of serum cystatin C for risk of mortality in severe and critically ill patients with COVID-19

Yan Li; Shuang Yang; Ding Peng; Hong-Ming Zhu; Bang-Yi Li; Xiaojiao Yang; Xue-Lian Sun; Mei Zhang

doi:10.12998/wjcc.v8.i20.4726

Predictive value of serum cystatin C for risk of mortality in severe and critically ill patients with COVID-19

World J Clin Cases. 2020 Oct 26;8(20):4726-4734. doi: 10.12998/wjcc.v8.i20.4726.

Authors

Yan Li¹, Shuang Yang², Ding Peng², Hong-Ming Zhu², Bang-Yi Li², Xiaojiao Yang³, Xue-Lian Sun⁴, Mei Zhang⁵

Affiliations

¹ Department of Pulmonology, Xuanwu Hospital of Capital Medical University, Beijing 100053, China.
² Department of Gastroenterology, Xuanwu Hospital of Capital Medical University, Beijing 100053, China.
³ School of Human Nutrition, Faculty of Agricultural and Environmental Sciences, McGill University, Montreal H9X 3V9, Quebec, Canada.
⁴ Department of Emergency Medicine, Xuanwu Hospital of Capital Medical University, Beijing 100053, China.
⁵ Department of Gastroenterology, Xuanwu Hospital of Capital Medical University, Beijing 100053, China. zhang2955@sina.com.

Abstract

Background: The outbreak of coronavirus disease 2019 (COVID-19) has rapidly evolved into a global pandemic. COVID-19 is clinically categorized into mild, moderate, severe, and critical illness. Acute kidney injury is an independent risk factor for poor prognosis in patients with. Serum cystatin C (sCys C) is considered a more sensitive biomarker for early renal insufficiency than conventional indicators of renal function. Early detection of risk factors that affect the prognosis of severe and critically ill patients while using active and effective treatment measures is very important and can effectively reduce the potential mortality rate.

Aim: To determine the predictive value of sCys C for the prognosis of patients with COVID-19.

Methods: The clinical data of 101 severe and critically ill patients with COVID-19 at a designated hospital in Wuhan, Hubei Province, China were analyzed retrospectively. According to the clinical outcome, the patients were divided into a discharge group (64 cases) and a death group (37 cases). The general information, underlying diseases, and laboratory examination indexes of the two groups were compared. Multivariate Cox regression was used to explore the relationship between sCys C and prognosis. The receiver operating characteristic (ROC) curve was used to demonstrate the sensitivity and specificity of sCys C and its optimal cut-off value for predicting death.

Results: There were significant differences in age, sCys C, creatinine, C-reactive protein, serum albumin, creatine kinase-MB, alkaline phosphatase, lactate dehydrogenase, neutrophil count, and lymphocyte count between the two groups (P < 0.001). Multivariate logistic regression analysis showed that sCys C was an independent risk factor for death in patients with COVID-19 (Odds ratio = 1.812, 95% confidence interval [CI]: 1.300-2.527, P < 0.001). The area under the ROC curve was 0.755 (95%CI: 1.300-2.527), the cut-off value was 0.80, the specificity was 0.562, and the sensitivity was 0.865.

Conclusion: sCys C is an independent risk factor for death in patients with COVID-19. Patients with a sCys C level of 0.80 mg/L or greater are at a high risk of death.

Keywords: Acute kidney injury; COVID-19; Coronavirus infections; Cystatin C; Multiple organ dysfunction syndrome; Renal function.