Retrospective Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Oct 26, 2020; 8(20): 4726-4734
Published online Oct 26, 2020. doi: 10.12998/wjcc.v8.i20.4726
Predictive value of serum cystatin C for risk of mortality in severe and critically ill patients with COVID-19
Yan Li, Shuang Yang, Ding Peng, Hong-Ming Zhu, Bang-Yi Li, Xiaojiao Yang, Xue-Lian Sun, Mei Zhang
Yan Li, Department of Pulmonology, Xuanwu Hospital of Capital Medical University, Beijing 100053, China
Shuang Yang, Ding Peng, Hong-Ming Zhu, Bang-Yi Li, Mei Zhang, Department of Gastroenterology, Xuanwu Hospital of Capital Medical University, Beijing 100053, China
Xiaojiao Yang, School of Human Nutrition, Faculty of Agricultural and Environmental Sciences, McGill University, Montreal H9X 3V9, Quebec, Canada
Xue-Lian Sun, Department of Emergency Medicine, Xuanwu Hospital of Capital Medical University, Beijing 100053, China
Author contributions: Li Y wrote the paper; Zhang M designed and supervised the research; Zhu HM and Yang S performed the research; Peng D and Yang X performed data and statistical analyses; Peng D and Li BY analyzed the data; Sun XL collected the data; all authors approved the final version of the article.
Institutional review board statement: This survey is a retrospective study, only collecting the clinical data of patients. Since it will not bring risks to patients' physiology and do not interfere with patients' treatment plan, and researchers will protect patients' information from disclosure, Xuanwu Hospital of Capital Medical University agreed to exempt this study from ethical review.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data.
Conflict-of-interest statement: The authors declare no conflict of interest regarding the manuscript.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Mei Zhang, MD, Chief Physician, Professor, Department of Gastroenterology, Xuanwu Hospital of Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing 100053, China. zhang2955@sina.com
Received: July 4, 2020
Peer-review started: July 4, 2020
First decision: July 24, 2020
Revised: August 5, 2020
Accepted: September 3, 2020
Article in press: September 3, 2020
Published online: October 26, 2020
Processing time: 114 Days and 2.8 Hours
Abstract
BACKGROUND

The outbreak of coronavirus disease 2019 (COVID-19) has rapidly evolved into a global pandemic. COVID-19 is clinically categorized into mild, moderate, severe, and critical illness. Acute kidney injury is an independent risk factor for poor prognosis in patients with. Serum cystatin C (sCys C) is considered a more sensitive biomarker for early renal insufficiency than conventional indicators of renal function. Early detection of risk factors that affect the prognosis of severe and critically ill patients while using active and effective treatment measures is very important and can effectively reduce the potential mortality rate.

AIM

To determine the predictive value of sCys C for the prognosis of patients with COVID-19.

METHODS

The clinical data of 101 severe and critically ill patients with COVID-19 at a designated hospital in Wuhan, Hubei Province, China were analyzed retrospectively. According to the clinical outcome, the patients were divided into a discharge group (64 cases) and a death group (37 cases). The general information, underlying diseases, and laboratory examination indexes of the two groups were compared. Multivariate Cox regression was used to explore the relationship between sCys C and prognosis. The receiver operating characteristic (ROC) curve was used to demonstrate the sensitivity and specificity of sCys C and its optimal cut-off value for predicting death.

RESULTS

There were significant differences in age, sCys C, creatinine, C-reactive protein, serum albumin, creatine kinase-MB, alkaline phosphatase, lactate dehydrogenase, neutrophil count, and lymphocyte count between the two groups (P < 0.001). Multivariate logistic regression analysis showed that sCys C was an independent risk factor for death in patients with COVID-19 (Odds ratio = 1.812, 95% confidence interval [CI]: 1.300-2.527, P < 0.001). The area under the ROC curve was 0.755 (95%CI: 1.300-2.527), the cut-off value was 0.80, the specificity was 0.562, and the sensitivity was 0.865.

CONCLUSION

sCys C is an independent risk factor for death in patients with COVID-19. Patients with a sCys C level of 0.80 mg/L or greater are at a high risk of death.

Keywords: COVID-19; Cystatin C; Acute kidney injury; Renal function; Coronavirus infections; Multiple organ dysfunction syndrome

Core Tip: The novel coronavirus epidemic has become a major public health event in the world. The mortality rate of severe and critical patients is high. It is very important to find an available, cheap, and sensitive biomarker to predict mortality. Cystatin C is a predictor of renal injury. We compared 101 severe and critical patients with coronavirus disease 2019 (COVID-19) in Wuhan, China, and found that patients with a cystatin C level of 0.80 mg/L or greater were at a high risk of death. Therefore, cystatin C may have an important role in the prognosis of severe and critical patients with COVID-19.