{"title":"血浆胱抑素 C 和肾脏阻力指数对重症患者急性肾损伤的诊断准确性:一项前瞻性观察研究","authors":"Munna Lal Patel, Himanshu Mishra, Rekha Sachan, Vipin Kumar Singh, Radheyshyam Gangwar, Wahid Ali","doi":"10.60787/NMJ-64-5-292","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Acute kidney injury (AKI) is a quite common problem in critically ill patients. Serum cystatin C has emerged as a marker of AKI. This study was aimed to evaluate the diagnostic ability of serum Cystatin-C and Renal Resistive Index in prediction of AKI among critically ill patients.</p><p><strong>Methodology: </strong>This prospective observational study was carried out in the department of Medicine, over a period of one year. After informed consent and ethical clearance total 120 critically ill patients suffering from sepsis were enrolled, out of which 70 patients developed AKI while 50 did not develop AKI during treatment in Intensive care unit (ICU). Serum cystatin C was measured on day 1 by particle-enhanced immune nephelometric assay, Renal resistive index (RRI) calculated by ratio of the velocities of arterial perfusion throughout the cardiac phase and glomerular filtration rate was measured on days 1, 3, and 7 respectively.</p><p><strong>Results: </strong>S. cystatin C value was significantly higher(>3times) in AKI patients (14.07±4.8 mcg/ml) as compared to those who did not develop AKI (4.28±3.27 mcg/ml) (p<0.001). After ROC analysis it was found that day1, S. cystatin C, at cut off value of ≥9.29 mcg/ml had diagnostic accuracy 90% with sensitivity 91%, specificity89% and PPV 95.5%. While RRI value on day 7, at cut-off value of ≥0.72, had diagnostic accuracy 98%, sensitivity (98.6%) and specificity (96.7%) for AKI with 98.6% PPV, 96.7% NPV.</p><p><strong>Conclusion: </strong>Serum cystatin C appears to be a promising bio- markers for early diagnosis of AKI in critically ill patients. Whereas, RRI although non-invasive had good diagnostic accuracy but it diagnosed AKI after few days thus diagnosis of kidney injury delayed.</p>","PeriodicalId":94346,"journal":{"name":"Nigerian medical journal : journal of the Nigeria Medical Association","volume":null,"pages":null},"PeriodicalIF":0.0000,"publicationDate":"2023-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11218858/pdf/","citationCount":"0","resultStr":"{\"title\":\"Diagnostic Accuracy of Plasma Cystatin C and Renal Resistive Index for Acute Kidney Injury in Critically Ill Patients: A Prospective Observational Study.\",\"authors\":\"Munna Lal Patel, Himanshu Mishra, Rekha Sachan, Vipin Kumar Singh, Radheyshyam Gangwar, Wahid Ali\",\"doi\":\"10.60787/NMJ-64-5-292\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Acute kidney injury (AKI) is a quite common problem in critically ill patients. Serum cystatin C has emerged as a marker of AKI. This study was aimed to evaluate the diagnostic ability of serum Cystatin-C and Renal Resistive Index in prediction of AKI among critically ill patients.</p><p><strong>Methodology: </strong>This prospective observational study was carried out in the department of Medicine, over a period of one year. After informed consent and ethical clearance total 120 critically ill patients suffering from sepsis were enrolled, out of which 70 patients developed AKI while 50 did not develop AKI during treatment in Intensive care unit (ICU). Serum cystatin C was measured on day 1 by particle-enhanced immune nephelometric assay, Renal resistive index (RRI) calculated by ratio of the velocities of arterial perfusion throughout the cardiac phase and glomerular filtration rate was measured on days 1, 3, and 7 respectively.</p><p><strong>Results: </strong>S. cystatin C value was significantly higher(>3times) in AKI patients (14.07±4.8 mcg/ml) as compared to those who did not develop AKI (4.28±3.27 mcg/ml) (p<0.001). After ROC analysis it was found that day1, S. cystatin C, at cut off value of ≥9.29 mcg/ml had diagnostic accuracy 90% with sensitivity 91%, specificity89% and PPV 95.5%. While RRI value on day 7, at cut-off value of ≥0.72, had diagnostic accuracy 98%, sensitivity (98.6%) and specificity (96.7%) for AKI with 98.6% PPV, 96.7% NPV.</p><p><strong>Conclusion: </strong>Serum cystatin C appears to be a promising bio- markers for early diagnosis of AKI in critically ill patients. Whereas, RRI although non-invasive had good diagnostic accuracy but it diagnosed AKI after few days thus diagnosis of kidney injury delayed.</p>\",\"PeriodicalId\":94346,\"journal\":{\"name\":\"Nigerian medical journal : journal of the Nigeria Medical Association\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2023-12-28\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11218858/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Nigerian medical journal : journal of the Nigeria Medical Association\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.60787/NMJ-64-5-292\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2023/9/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Nigerian medical journal : journal of the Nigeria Medical Association","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.60787/NMJ-64-5-292","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2023/9/1 0:00:00","PubModel":"eCollection","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0
摘要
背景:急性肾损伤(AKI)是危重病人的常见问题。血清胱抑素 C 已成为急性肾损伤的标志物。本研究旨在评估血清胱抑素 C 和肾脏阻力指数在预测重症患者 AKI 方面的诊断能力:这项前瞻性观察研究在医学系进行,为期一年。经过知情同意和伦理审查,共有 120 名脓毒症重症患者被纳入研究,其中 70 名患者在重症监护室(ICU)接受治疗期间出现了 AKI,50 名患者没有出现 AKI。第 1 天采用颗粒增强免疫肾图测定法测量血清胱抑素 C,第 1、3 和 7 天分别测量肾脏阻力指数(RRI)(根据整个心动期动脉灌注速度与肾小球滤过率的比值计算得出):结果:与未发生 AKI 的患者(4.28±3.27 mcg/ml)相比,AKI 患者的血清胱抑素 C 值(14.07±4.8 mcg/ml)明显升高(>3 倍)(p 结论:血清胱抑素 C 值的升高可能与 AKI 有关:血清胱抑素 C 似乎是一种很有前途的生物标记物,可用于危重病人 AKI 的早期诊断。而 RRI 虽然是非侵入性的,但诊断准确性很高,但它在几天后才诊断出 AKI,从而延误了肾损伤的诊断。
Diagnostic Accuracy of Plasma Cystatin C and Renal Resistive Index for Acute Kidney Injury in Critically Ill Patients: A Prospective Observational Study.
Background: Acute kidney injury (AKI) is a quite common problem in critically ill patients. Serum cystatin C has emerged as a marker of AKI. This study was aimed to evaluate the diagnostic ability of serum Cystatin-C and Renal Resistive Index in prediction of AKI among critically ill patients.
Methodology: This prospective observational study was carried out in the department of Medicine, over a period of one year. After informed consent and ethical clearance total 120 critically ill patients suffering from sepsis were enrolled, out of which 70 patients developed AKI while 50 did not develop AKI during treatment in Intensive care unit (ICU). Serum cystatin C was measured on day 1 by particle-enhanced immune nephelometric assay, Renal resistive index (RRI) calculated by ratio of the velocities of arterial perfusion throughout the cardiac phase and glomerular filtration rate was measured on days 1, 3, and 7 respectively.
Results: S. cystatin C value was significantly higher(>3times) in AKI patients (14.07±4.8 mcg/ml) as compared to those who did not develop AKI (4.28±3.27 mcg/ml) (p<0.001). After ROC analysis it was found that day1, S. cystatin C, at cut off value of ≥9.29 mcg/ml had diagnostic accuracy 90% with sensitivity 91%, specificity89% and PPV 95.5%. While RRI value on day 7, at cut-off value of ≥0.72, had diagnostic accuracy 98%, sensitivity (98.6%) and specificity (96.7%) for AKI with 98.6% PPV, 96.7% NPV.
Conclusion: Serum cystatin C appears to be a promising bio- markers for early diagnosis of AKI in critically ill patients. Whereas, RRI although non-invasive had good diagnostic accuracy but it diagnosed AKI after few days thus diagnosis of kidney injury delayed.