Detecting Neonatal AKI by Serum Cystatin C

Authors：Xu, Xin^*; Nie, Sheng; Xu, Hong; Liu, Bicheng; Weng, Jianping; Chen, Chunbo; Liu, Huafeng; Yang, Qiongqiong; Li, Hua; Kong, Yaozhong; Li, Guisen; Wan, Qijun; Zha, Yan; Hu, Ying; Xu, Gang; Shi, Yongjun; Zhou, Yilun; Su, Guobin; Tang, Ying; Li, Yanqin; Su, Licong; Chen, Ruixuan; Cao, Yue; Gao, Peiyan; Zhou, Shiyu; Zhang, Xiaodong; Luo, Fan; Xu, Ruqi; Gao, Qi; Hou, Fan Fan^*

Source：Journal of the American Society of Nephrology : JASN , 2023, 34(7): 1253-1263.

DOI：10.1681/ASN.0000000000000125

• ACUTE KIDNEY INJURY
• INFANTS

Background Serum creatinine is not a sensitive biomarker for AKI in neonates. A better biomarker-based criterion for neonatal AKI is needed. @@@ Methods In this large multicenter cohort study, we estimated the upper normal limit (UNL) and reference change value (RCV) of serum cystatin C (Cys-C) in neonates and proposed cystatin C-based criteria (CyNA) for detecting neonatal AKI using these values as the cutoffs. We assessed the association of CyNA-detected AKI with the risk of in-hospital death and compared CyNA performance versus performance of modified Kidney Disease Improving Global Outcomes (KDIGO) creatinine criteria. @@@ Results In this study of 52,333 hospitalized neonates in China, Cys-C level did not vary with gestational age and birth weight and remained relatively stable during the neonatal period. CyNA criteria define AKI by a serum Cys-C of >2.2 mg/L (UNL) or an increase in Cys-C of >25% (RCV) during the neonatal period. Among 45,839 neonates with measurements of both Cys-C and creatinine, 4513 (9.8%) had AKI detected by CyNA only, 373 (0.8%) by KDIGO only, and 381 (0.8%) by both criteria. Compared with neonates without AKI by both criteria, neonates with AKI detected by CyNA alone had an increased risk of in-hospital mortality (hazard ratio [HR], 2.86; 95% confidence interval [95% CI], 2.02 to 4.04). Neonates with AKI detected by both criteria had an even higher risk of in-hospital mortality (HR, 4.86; 95% CI, 2.84 to 8.29). @@@ Conclusions Serum Cys-C is a robust and sensitive biomarker for detecting neonatal AKI. Compared with modified KDIGO creatinine criteria, CyNA is 6.5 times more sensitive in identifying neonates at elevated risk of in-hospital mortality.

• Institution
  1; 南方医科大学; 佛山市第一人民医院; 电子科技大学; 广东省人民医院; 华中科技大学; 广东医学院; 贵州大学; 中山大学; 复旦大学; 浙江大学; 广州中医药大学