Role of Cystatin C in predicting acute kidney injury after surgery

• Main Authors: Mustapha, Muhammad Ikhwan, Othman, Ahmad Faidzal, Mat Nor, Mohd Basri, Md Ralib, Azrina, Ab Rahman, Jamalludin, Elagili, Faisal
• Format: Conference or Workshop Item
• Language: English
• Published: 2022
• Subjects: RD Surgery
• Online Access: http://irep.iium.edu.my/101941/1/e-book_ebpomv14.pdf; http://irep.iium.edu.my/101941/

Introduction Surgery is a known risk factor for acute kidney injury (AKI) which causes considerable implications on mortality and morbidity. We investigated the incidence of AKI following surgery and determine the diagnostic capability of Cystatin C (CysC) in diagnosing and predicting AKI. Method This is a single centre, prospective study of patients who underwent surgery under general or regional anaesthesia between September 2021 to February 2022. Serum Creatinine and plasma CysC were measured at three intervals (admission, within 24 hours and 72 hours following surgery). Area under receiver operating characteristic curve (AUROC) analysis was used to derive the CysC cut-off value to diagnose and predict AKI. AKI was defined based on creatinine criteria of the Kidney Disease: Improving Global Outcome (KDIGO) criteria. Result A total of 100 patients included with mean age of 58 ± 14 years old and 51% were male. AKI occurred in 20 (20%) patients, mainly stage 1 (55%), followed by stage 2 (30%) and stage 3 (15%). On AUROC analysis, CysC has the highest AUC at 0.93 (Sensitivity 87.7%, Specificity 86.7%) with a cut-off value at 1.67mg/dL for AKI on day three after surgery. Post operative day one CysC predicts day three AKI at a cut-off value of 1.595mg/dL AUC=0.86, (Sensitivity 87.5%, Specificity 79.5%)]. Conclusion Cystatin C is a strong predictor for AKI as early as 1 day following surgery with a cut-off value at 1.595mg/dL. Early recognition of patients at risk to develop AKI may prompt surgeons to be vigilant in managing at-risk patients postoperatively.