Predictive performance of glomerular filtration rate equations based on cystatin C, creatinine and their combination in critically ill patients.

IF 1.6 4区 医学 Q3 PHARMACOLOGY & PHARMACY European journal of hospital pharmacy : science and practice Pub Date : 2024-10-25 DOI:10.1136/ejhpharm-2023-003738
Marta Albanell-Fernández, Carla Bastida, Ángel Marcos Fendian, Jordi Mercadal, Pedro Castro-Rebollo, Dolors Soy-Muner
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Abstract

Objective: 24-hour urine creatinine clearance (ClCr 24 hours) remains the gold standard for estimating glomerular filtration rate (GFR) in critically ill patients; however, simpler methods are commonly used in clinical practice. Serum creatinine (SCr) is the most frequently used biomarker to estimate GFR; and cystatin C, another biomarker, has been shown to reflect GFR changes earlier than SCr. We assess the performance of equations based on SCr, cystatin C and their combination (SCr-Cyst C) for estimating GFR in critically ill patients.

Methods: Observational unicentric study in a tertiary care hospital. Patients with cystatin C, SCr and ClCr 24 hours measurements in ±2 days admitted to an intensive care unit were included. ClCr 24 hours was considered the reference method. GFR was estimated using SCr-based equations: Chronic Kidney Disease Epidemiology Collaboration based on creatinine (CKD-EPI-Cr) and Cockcroft-Gault (CG); cystatin C-based equations: CKD-EPI-CystC and CAPA; and Cr-CystC-based equations: CKD-EPI-Cr-CystC. Performance of each equation was assessed by calculating bias and precision, and Bland-Altman plots were built. Further analysis was performed with stratified data into CrCl 24 hours <60, 60-130 and ≥130 mL/min/1.73 m2.

Results: We included 275 measurements, corresponding to 186 patients. In the overall population, the CKD-EPI-Cr equation showed the lowest bias (2.6) and best precision (33.1). In patients with CrCl 24 hours <60 mL/min/1.73 m2, cystatin-C-based equations showed the lowest bias (<3.0) and CKD-EPI-Cr-CystC was the most accurate (13.6). In the subgroup of 60≤ CrCl 24 hours <130mL/min/1.73 m2, CKD-EPI-Cr-CystC was the most precise (20.9). However, in patients with CrCl 24 hours ≥130mL/min/1.73 m2, cystatin C-based equations underestimated GFR, while CG overestimated it (22.7).

Conclusions: Our study showed no evidence of superiority of any equation over the others for all evaluated parameters: bias, precision and Lin's concordance correlation coefficient. Cystatin C-based equations were less biased in individuals with impaired renal function (GFR <60 mL/min/1.73 m2). CKD-EPI-Cr-CystC performed properly in patients with GFR from 60-130 mL/min/1.73 m2 and none of them were accurate enough in patients ≥130 mL/min/1.73 m2.

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基于胱抑素 C、肌酐及其组合的重症患者肾小球滤过率方程的预测性能。
目的:24 小时尿肌酐清除率(ClCr 24 小时)仍是估算重症患者肾小球滤过率(GFR)的黄金标准;然而,临床实践中通常使用更简单的方法。血清肌酐(SCr)是估算肾小球滤过率最常用的生物标志物;而另一种生物标志物胱抑素 C 则比 SCr 更早反映肾小球滤过率的变化。我们评估了基于 SCr、胱抑素 C 及其组合(SCr-胱抑素 C)的方程在估算重症患者 GFR 方面的性能:方法:在一家三级医院进行的单中心观察研究。研究对象包括重症监护病房的胱抑素 C、SCr 和 ClCr 24 小时测量值在±2 天内的患者。ClCr 24 小时测定被视为参考方法。使用基于 SCr 的方程估算 GFR:慢性肾脏病流行病学协作组基于肌酐(CKD-EPI-Cr)和Cockcroft-Gault(CG)的公式;基于胱抑素C的公式:基于胱抑素 C 的方程:CKD-EPI-CystC 和 CAPA;以及基于 Cr-CystC 的方程:CKD-EPI-Cr-CystC。通过计算偏差和精确度来评估每个方程的性能,并绘制布兰-阿尔特曼图。进一步的分析是根据 CrCl 24 小时 2 的分层数据进行的:我们共纳入了 275 项测量数据,对应 186 名患者。在总体人群中,CKD-EPI-Cr 方程的偏差最小(2.6),精确度最高(33.1)。在 CrCl 24 小时为 2 的患者中,基于胱抑素-C 的方程偏差最小(2),CKD-EPI-Cr-CystC 的精确度最高(20.9)。然而,对于 24 小时 CrCl≥130 毫升/分钟/1.73 平方米的患者,基于胱抑素 C 的方程低估了 GFR,而 CG 则高估了 GFR(22.7):我们的研究表明,在偏差、精确度和林氏一致性相关系数等所有评估参数方面,没有证据表明任何方程优于其他方程。基于胱抑素 C 的方程在肾功能受损(肾小球滤过率 2)的个体中偏差较小。CKD-EPI-Cr-CystC 在肾小球滤过率为 60-130 mL/min/1.73 m2 的患者中表现良好,而在肾小球滤过率≥130 mL/min/1.73 m2 的患者中,它们都不够准确。
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来源期刊
CiteScore
3.40
自引率
5.90%
发文量
104
审稿时长
6-12 weeks
期刊介绍: European Journal of Hospital Pharmacy (EJHP) offers a high quality, peer-reviewed platform for the publication of practical and innovative research which aims to strengthen the profile and professional status of hospital pharmacists. EJHP is committed to being the leading journal on all aspects of hospital pharmacy, thereby advancing the science, practice and profession of hospital pharmacy. The journal aims to become a major source for education and inspiration to improve practice and the standard of patient care in hospitals and related institutions worldwide. EJHP is the only official journal of the European Association of Hospital Pharmacists.
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