Serum cystatin C is a potential predictor of short-term mortality and acute kidney injury in acute aortic dissection patients: a retrospective cohort study

Jun Wang; Biwen Yang; Meili Liu; Tao You; Han Shen; Yihuan Chen; Haoyue Huang; Shifeng Li; Zhiyang Wang; Xinyue Li; Fang Huang; Xiaomei Teng

doi:10.21037/jtd-22-937

Serum cystatin C is a potential predictor of short-term mortality and acute kidney injury in acute aortic dissection patients: a retrospective cohort study

J Thorac Dis. 2022 Aug;14(8):2977-2986. doi: 10.21037/jtd-22-937.

Authors

Jun Wang^#^{1

2}, Biwen Yang^#¹, Meili Liu^#², Tao You^#³, Han Shen¹, Yihuan Chen¹, Haoyue Huang¹, Shifeng Li², Zhiyang Wang², Xinyue Li², Fang Huang², Xiaomei Teng¹

Affiliations

¹ Department of Cardiovascular Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China.
² Department of Intensive Care Medicine, The First Affiliated Hospital of Soochow University, Suzhou, China.
³ Department of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, China.

^# Contributed equally.

Abstract

Background: Serum cystatin C concentration is associated with cardiovascular disease. However, the relationship between cystatin C and acute aortic dissection (AAD) remains unclear. In the current study, we aim to evaluate the predictive value of cystatin C in the occurrence of acute kidney injury (AKI) and the prognosis of AAD patients.

Methods: The patients with AAD admitted to our hospital from November 2019 through January 2022 were consecutively included in the retrospective cohort study. A complete blood cell count, serum biochemistry tests, including cystatin C and creatinine, in-hospital mortality and the incidence of AKI were recorded. All the patients were categorized into four groups according to the quartile of their serum cystatin C levels. Multivariate logistic and Cox regression analyses were conducted to determine the independent risk factors for the incidence of AKI and the prognosis of AAD patients, respectively. Kaplan-Meier analyses and log-rank tests were used to evaluate differences in survival. Receiver operating characteristic (ROC) curves were used to assess the predictive value of cystatin C for short-term mortality and the incidence of AKI in AAD patients.

Results: A total of 357 patients were included in this study. The results showed that the higher the concentration of cystatin C, the higher the level of serum creatinine and the higher the incidence of AKI. Mortality was significantly higher in the group with serum cystatin C levels >1.18 mg/L. Type A AAD, white blood cell count >10×10⁹/L, platelet count <100×10⁹/L, and serum cystatin C concentration >1.18 mg/L [adjusted hazards ratio (HR) =2.405, 95% confidence interval (CI), 1.029-4.063, P=0.041] were independent risk factors for in-hospital mortality. Cystatin C levels >1.18 mg/L remained an independent predictor of AKI in AAD after adjusting for the confounding [odds ratio (OR) 76.489, 95% CI, 25.586-228.660]. The areas under the ROC curves of cystatin C in predicting the mortality and incidence of AKI in AAD patients were 0.655 (95% CI, 0.551-0.760) and 0.807 (95% CI, 0.758-0.856), respectively.

Conclusions: In sum, serum cystatin C concentration is a potential predictor of short-term mortality and the incidence of AKI in AAD patients.

Keywords: Acute aortic dissection (AAD); acute kidney injury (AKI); cystatin C; mortality; prognosis.