Published online Oct 26, 2020. doi: 10.12998/wjcc.v8.i20.4726
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
Coronavirus disease 2019 (COVID-19) is an acute infectious disease caused by a new coronavirus, which is clinically categorized into mild, moderate, severe, and critical illness. Severe and critically ill patients progress rapidly with dyspnea, hypoxemia, and even life-threatening complications such as multiple organ dysfunction syndrome, sepsis, and shock. 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.
A rapid, effective, and accurate biomarker is urgently needed to predict the prognosis of patients with COVID-19. Serum cystatin C (sCys C) has a predictive value in the prognosis of critically ill patients such as those with acute cerebral infarction, acute myocardial infarction, heart failure, and sepsis. However, the predictive value of sCys C for severe and critically ill COVID-19 patients has not been confirmed. We designed this study to confirm whether sCys C can be used as a prognostic indicator for COVID-19 patients.
The main objective of this study was to determine the predictive value of sCys C for the prognosis of severe and critically ill COVID-19 patients.
A total of 101 severe or critically ill patients with COVID-19 were divided into a discharge group (64 cases) and a death group (37 cases). We compared the general information, underlying diseases, and laboratory examination indexes of the two groups. Multivariate Cox regression was used to explore the relationship between sCys C and prognosis. In addition, we used the receiver operating characteristic curve to assess the cut-off value of sCys C in predicting the death of patients.
sCys C, creatine kinase-MB, aspartate aminotransferase, albumin, and serum calcium were independent risk factors for death in severe and critically ill patients. sCys C had an AUC of 0.755, sensitivity of 0.865, and specificity of 0.562. Patients with a sCys C level of 0.80 or greater were at a high risk of death.
sCys C is superior to sCr in predicting the risk of death in severe and critically ill patients with COVID-19. Patients with sCys C ≥ 0.80 mg/L are at a high risk of death.
sCys C could be a marker of mortality in severe and critically ill COVID-19 patients.