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Tăluță C, Ștefănescu H, Crișan D. Seeing and Sensing the Hepatorenal Syndrome (HRS): The Growing Role of Ultrasound-Based Techniques as Non-Invasive Tools for the Diagnosis of HRS. Diagnostics (Basel) 2024; 14:938. [PMID: 38732353 PMCID: PMC11083774 DOI: 10.3390/diagnostics14090938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 04/23/2024] [Accepted: 04/26/2024] [Indexed: 05/13/2024] Open
Abstract
More than half of patients hospitalized with liver cirrhosis are dealing with an episode of acute kidney injury; the most severe pattern is hepatorenal syndrome due to its negative prognosis. The main physiopathology mechanisms involve renal vasoconstriction and systemic inflammation. During the last decade, the definition of hepatorenal syndrome changed, but the validated criteria of diagnosis are still based on the serum creatinine level, which is a biomarker with multiple limitations. This is the reason why novel serum and urinary biomarkers have been intensively studied in recent years. Meanwhile, the imaging studies that use shear wave elastography are using renal stiffness as a surrogate for an early diagnosis. In this article, we focus on the physiopathology definition and highlight the novel tools used in the diagnosis of hepatorenal syndrome.
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Affiliation(s)
- Cornelia Tăluță
- Liver Unit, Regional Institute of Gastroenterology and Hepatology, 400162 Cluj-Napoca, Romania;
| | - Horia Ștefănescu
- Liver Unit, Regional Institute of Gastroenterology and Hepatology, 400162 Cluj-Napoca, Romania;
| | - Dana Crișan
- 5th Medical Clinic, Department of Internal Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, 400139 Cluj-Napoca, Romania;
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Yajima T, Yajima K. Serum creatinine-to-cystatin C ratio as an indicator of sarcopenia in hemodialysis patients. Clin Nutr ESPEN 2023; 56:200-206. [PMID: 37344074 DOI: 10.1016/j.clnesp.2023.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 05/12/2023] [Accepted: 06/04/2023] [Indexed: 06/23/2023]
Abstract
BACKGROUND AND AIMS In hemodialysis patients, sarcopenia is common and related to morbidity and mortality. In non-dialysis patients, the serum creatinine-to-cystatin C (Cre/Cys-C) ratio is a marker of sarcopenia. Its clinical utility in hemodialysis populations, however, is still unknown. Our study aimed to determine whether sarcopenia could be detected using the Cre/Cys-C ratio in hemodialysis patients. METHODS This retrospective cross-sectional study included 85 hemodialysis patients whose handgrip strength (HGS) and bioimpedance analysis-estimated skeletal muscle index (SMI) were assessed. Sarcopenia was diagnosed as a combination of reduced muscle strength (women: HGS <18 kg; men: HGS <28 kg) and decreased muscle mass volume (women: SMI <5.7 kg/m2; men: SMI <7.0 kg/m2). RESULTS Sarcopenia was observed in 33 (38.8%) patients. Patients with sarcopenia had a significantly lower Cre/Cys-C ratio than those without (1.3 ± 0.2 vs 1.7 ± 0.3, respectively; p < 0.0001). The Cre/Cys-C ratio was independently associated with HGS (β = 0.303, p = 0.011) and SMI (β = 0.376, p = 0.0007). After adjustment for sex and age, the C-statistic of the Cre/Cys-C ratio that predicted sarcopenia was 0.898 (95% CI [0.827, 0.969], p < 0.0001). Moreover, as Cre/Cys-C ratios increased, the risk of sarcopenia significantly decreased (adjusted OR: 0.665 for each 0.1 increase in the Cre/Cys-C ratio) (95% CI [0.501, 0.857], p = 0.0002). CONCLUSION The Cre/Cys-C ratio may be a helpful prediction tool for sarcopenia in patients receiving hemodialysis.
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Affiliation(s)
- Takahiro Yajima
- Department of Nephrology, Matsunami General Hospital, Gifu, 501-6062, Japan.
| | - Kumiko Yajima
- Department of Internal Medicine, Matsunami General Hospital, Gifu, 501-6062, Japan
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Zeng J, Zhang L, Zhang J, Zhou W, Zhang T, Wang J, Zhao H, Zhang C. Imprecision remains to be improved in the measurement of serum cystatin C with heterogeneous systems. Clin Chem Lab Med 2023; 61:1455-1462. [PMID: 36866730 DOI: 10.1515/cclm-2022-1299] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 02/03/2023] [Indexed: 03/04/2023]
Abstract
OBJECTIVES Except for the large bias of some measurement systems for serum cystatin C (CysC) measurements, unacceptable imprecision has been observed for the heterogenous system. This study analyzed the external quality assessment (EQA) results in 2018-2021 to provide an insight into the imprecision of CysC assays. METHODS Five EQA samples were sent to participating laboratories every year. Participants were divided into reagent/calibrator-based peer groups, for which the robust mean of each sample and robust coefficient of variation (CV) were calculated by Algorithm A from ISO 13528. Peers with more than 12 participants per year were selected for further analysis. The limit of CV was determined to be 4.85% based on clinical application requirements. The concentration-related effect on CVs was investigated using logarithmic curve fitting; the difference in medians and robust CVs between instrument-based subgroups was also evaluated. RESULTS The total number of participating laboratories increased from 845 to 1,695 in four years and heterogeneous systems remained the mainstream (≥85%). Of 18 peers with ≥12 participants, those using homogeneous systems showed relatively steady and small CVs over four years, with the mean four-year CVs ranging from 3.21 to 3.68%. Some peers using heterogenous systems showed reduced CVs over four years, while 7/15 still had unacceptable CVs in 2021 (5.01-8.34%). Six peers showed larger CVs at the low or high concentrations, and some instrument-based subgroups presented greater imprecision than others. CONCLUSIONS More efforts should be made to improve the imprecision of heterogeneous systems for CysC measurement.
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Affiliation(s)
- Jie Zeng
- National Center for Clinical Laboratories, Chinese Academy of Medical Sciences, Beijing Hospital/National Center of Gerontology, Beijing Engineering Research Center of Laboratory Medicine, Institute of Geriatric Medicine, Beijing, P.R. China
| | - Li Zhang
- National Center for Clinical Laboratories, Chinese Academy of Medical Sciences, Beijing Hospital/National Center of Gerontology, Beijing Engineering Research Center of Laboratory Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College, Institute of Geriatric Medicine, Beijing, P.R. China
| | - Jiangtao Zhang
- National Center for Clinical Laboratories, Chinese Academy of Medical Sciences, Beijing Hospital/National Center of Gerontology, Beijing Engineering Research Center of Laboratory Medicine, Institute of Geriatric Medicine, Beijing, P.R. China
| | - Weiyan Zhou
- National Center for Clinical Laboratories, Chinese Academy of Medical Sciences, Beijing Hospital/National Center of Gerontology, Beijing Engineering Research Center of Laboratory Medicine, Institute of Geriatric Medicine, Beijing, P.R. China
| | - Tianjiao Zhang
- National Center for Clinical Laboratories, Chinese Academy of Medical Sciences, Beijing Hospital/National Center of Gerontology, Beijing Engineering Research Center of Laboratory Medicine, Institute of Geriatric Medicine, Beijing, P.R. China
| | - Jing Wang
- National Center for Clinical Laboratories, Chinese Academy of Medical Sciences, Beijing Hospital/National Center of Gerontology, Beijing Engineering Research Center of Laboratory Medicine, Institute of Geriatric Medicine, Beijing, P.R. China
| | - Haijian Zhao
- National Center for Clinical Laboratories, Chinese Academy of Medical Sciences, Beijing Hospital/National Center of Gerontology, Beijing Engineering Research Center of Laboratory Medicine, Institute of Geriatric Medicine, Beijing, P.R. China
| | - Chuanbao Zhang
- National Center for Clinical Laboratories, Chinese Academy of Medical Sciences, Beijing Hospital/National Center of Gerontology, Beijing Engineering Research Center of Laboratory Medicine, Institute of Geriatric Medicine, Beijing, P.R. China
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Optimal Glomerular Filtration Rate Equations for Various Age Groups, Disease Conditions and Ethnicities in Asia: A Systematic Review. J Clin Med 2023; 12:jcm12051822. [PMID: 36902609 PMCID: PMC10002889 DOI: 10.3390/jcm12051822] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 02/12/2023] [Accepted: 02/14/2023] [Indexed: 03/12/2023] Open
Abstract
(1) Background: The performance of estimated glomerular filtration rate (eGFR) equations in the Asian population has been widely questioned. The primary objective of this study was to gather evidence regarding optimal GFR equations in Asia for various age groups, disease conditions, and ethnicities. The secondary objective was to see whether the equations based on the combination of creatinine and cystatin C biomarkers if employed are satisfactory across different age groups and disease conditions in various ethnicities in Asia compared to those based on either of the single biomarkers. (2) Methods: Validation studies that had both creatinine and cystatin C-based equations either alone or in combination, validated in specific disease conditions, and those which compared the performance of these equations with exogenous markers were eligible only. The bias, precision, and 30% accuracy (P30) of each equation were recorded accordingly. (3) Results: Twenty-one studies consisting of 11,371 participants were included and 54 equations were extracted. The bias, precision, and P30 accuracies of the equations ranged from -14.54 to 9.96 mL/min/1.73 m2, 1.61 to 59.85 mL/min/1.73 m2, and 4.7% to 96.10%. The highest values of P30 accuracies were found for the JSN-CKDI equation (96.10%) in Chinese adult renal transplant recipients, for the BIS-2 equation (94.5%) in Chinese elderly CKD patients, and Filler equation (93.70%) also in Chinese adult renal transplant recipients. (4) Conclusions: Optimal equations were identified accordingly and it was proven that combination biomarker equations are more precise and accurate in most of the age groups and disease conditions. These can be considered equations of choice for the specific age groups, disease conditions, and ethnicities within Asia.
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Yu J, Zhou Q, Xu Y, Wang T, Du J, Zhao L, Li J, Wang H, Xu Q, Lai X, Guo Z. The Relationship Between Serum Folate Level and Residual Renal Function in CAPD Patients. Int J Gen Med 2022; 15:6977-6984. [PMID: 36082108 PMCID: PMC9447445 DOI: 10.2147/ijgm.s379594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 08/23/2022] [Indexed: 11/23/2022] Open
Abstract
Objective To investigate the relationship between serum folate (FA) levels and residual renal function (RRF) in continuous ambulatory peritoneal dialysis (CAPD) patients. Methods Clinical data were collected from 180 hospitalized patients who received CAPD regularly. Patients were divided into the FA deficiency group and the FA non-deficiency group according to serum FA level. Data on age, sex, PD vintage, hemoglobin, mean corpuscular volume, serum FA, total Kt/V, residual kidney Kt/V, peritoneum Kt/V, creatinine clearance (Ccr), ultrafiltration volume, cystatin C (cytC), serum creatinine (Scr), urea nitrogen, retinol-binding protein and the primary disease were gathered from 2 groups. Statistical methods were used to analyze the relationship between serum FA level and RRF. Results Peritoneal Kt/V, cytC, Scr were higher, and residual kidney Kt/V was lower in FA deficiency group than in non-deficiency group. Univariate correlation showed the peritoneal Kt/V, cytC, Scr negatively correlated with serum FA while residual kidney Kt/V positively correlated with serum FA, and there was a simple linear regression relationship between serum FA and residual kidney Kt/V. Differences were statistically significant (P<0.05). Conclusion There is a relationship between serum FA and RRF in CAPD patients. Prospective studies or trials should be performed to clarify the importance of FA supplementation on RRF during peritoneal dialysis.
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Affiliation(s)
- Jianpeng Yu
- Department of Nephrology, Shanghai Changhai Hospital, Shanghai, People’s Republic of China
| | - Qi Zhou
- Department of Nephrology, Shanghai Changhai Hospital, Shanghai, People’s Republic of China
| | - Ying Xu
- Department of Nephrology, Shanghai Changhai Hospital, Shanghai, People’s Republic of China
| | - Tieyun Wang
- Department of Nephrology, Shanghai Changhai Hospital, Shanghai, People’s Republic of China
| | - Jun Du
- Department of Nephrology, Shanghai Changhai Hospital, Shanghai, People’s Republic of China
| | - Lifang Zhao
- Department of Nephrology, Shanghai Changhai Hospital, Shanghai, People’s Republic of China
| | - Juan Li
- Department of Nephrology, Shanghai Changhai Hospital, Shanghai, People’s Republic of China
| | - Haiyan Wang
- Department of Nephrology, Shanghai Changhai Hospital, Shanghai, People’s Republic of China
| | - Qianqian Xu
- Department of Rheumatology and Immunology, Shanghai Changhai Hospital, Shanghai, People’s Republic of China
| | - Xueli Lai
- Department of Nephrology, Shanghai Changhai Hospital, Shanghai, People’s Republic of China
- Correspondence: Xueli Lai; Zhiyong Guo, Email ;
| | - Zhiyong Guo
- Department of Nephrology, Shanghai Changhai Hospital, Shanghai, People’s Republic of China
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Xia F, Hao W, Liang J, Wu Y, Yu F, Hu W, Zhao Z, Liu W. Applicability of Creatinine-based equations for estimating glomerular filtration rate in elderly Chinese patients. BMC Geriatr 2021; 21:481. [PMID: 34481470 PMCID: PMC8418712 DOI: 10.1186/s12877-021-02428-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 08/22/2021] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND The accuracy of the estimated glomerular filter rate (eGFR) in elderly patients is debatable. In 2020, a new creatinine-based equation by European Kidney Function Consortium (EKFC) was applied to all age groups. The objective of this study was to assess the appropriateness of the new EKFC equation with Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI), Lund-Malmö Revised (LMR), Berlin Initiative Study 1 (BIS1), and full age spectrum (FAS) equations based on serum creatinine (SCR) for elderly Chinese patients. METHODS A total of 612 elderly patients with a measured glomerular filtration rate (mGFR) by the dual plasma sample clearance method with Technetium-99 m-diethylenetriamine-pentaacetic acid (Tc-99 m-DTPA) were divided into four subgroups based on age, sex, mGFR, and whether combined with diabetes. The performance of GFR was assessed while considering bias, precision, accuracy, and root-mean-square error (RMSE). Bland-Altman plots, concordance correlation coefficients (CCCs), and correlation coefficients were applied to evaluate the validity of eGFR. RESULTS The median age of the 612 participants was 73 years, and 386 (63.1%) were male. Referring to mGFR (42.1 ml/min/1.73 m2), the CKD-EPI, LMR, BIS1, FAS, and EKFC equations estimated GFR at 44.4, 41.1, 43.6, 41.8 and 41.9 ml/min/1.73 m2, respectively. Overall, the smallest bias was found for the BIS1 equation (- 0.050 vs. range - 3.015 to 0.795, P<0.05, vs. the CKD-EPI equation). Regarding P30, interquartile range (IQR), RMSE, and GFR category misclassification, the BIS1 equation generally performed more accurately than the other eqs. (73.9%, 12.7, 12.9, and 35.3%, respectively). Nevertheless, no equation achieved optimal performance for the mGFR≥60 ml/min/1.73 m2 subgroup. Bland-Altman analysis showed the smallest mean difference (- 0.3 ml/min/1.73 m2) for the BIS1 equation when compared to the other equations. CONCLUSIONS This study suggested that the BIS1 equation was the most applicable for estimating GFR in Chinese elderly patients with moderate to severe renal impairment.
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Affiliation(s)
- Fangxiao Xia
- Department of Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong Provincial Geriatrics Institute, Guangzhou, 510080, China.,The Second School of Clinical Medicine, Southern Medical University, Guangzhou, 510515, China
| | - Wenke Hao
- Department of Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong Provincial Geriatrics Institute, Guangzhou, 510080, China
| | - Jinxiu Liang
- Department of Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong Provincial Geriatrics Institute, Guangzhou, 510080, China.,The Second School of Clinical Medicine, Southern Medical University, Guangzhou, 510515, China
| | - Yanhua Wu
- Department of Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong Provincial Geriatrics Institute, Guangzhou, 510080, China
| | - Feng Yu
- Department of Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong Provincial Geriatrics Institute, Guangzhou, 510080, China
| | - Wenxue Hu
- Department of Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong Provincial Geriatrics Institute, Guangzhou, 510080, China
| | - Zhi Zhao
- Department of Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong Provincial Geriatrics Institute, Guangzhou, 510080, China
| | - Wei Liu
- Department of Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong Provincial Geriatrics Institute, Guangzhou, 510080, China. .,The Second School of Clinical Medicine, Southern Medical University, Guangzhou, 510515, China.
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The Effect of the Hydroalcoholic Extract of Watercress on the Levels of Protein Carbonyl, Inflammatory Markers, and Vitamin E in Chronic Hemodialysis Patients. Biochem Res Int 2021; 2021:5588464. [PMID: 34136285 PMCID: PMC8175173 DOI: 10.1155/2021/5588464] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 05/20/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction Chronic kidney disorder is a main public health concern. Inflammatory processes and oxidative stress are common in end-stage renal disease patients. We aimed to evaluate the effect of the hydroalcoholic extract of watercress (WC) on the inflammatory cytokines and protein carbonyl (PCO) contents in chronic hemodialysis patients. Methods This was a double-blind randomized clinical trial performed on 46 hemodialysis patients. The participants were randomly divided into two groups: intervention group (500 mg hydroalcoholic extract of WC every day for 4 weeks) and control group (500 mg of white flour every night for 4 weeks). The blood samples were taken to determine the levels of vitamin E, PCO, and inflammatory cytokines at baseline and the end of treatment. Results Forty-five patients completed the study (22 patients in the intervention group and 23 patients in the control group). There was a significant reduction in the PCO level (20.33 ± 4.40 vs. 15.06 ± 6.41, P=0.001) in the intervention group; also, this change was statistically significant relative to the control group. Furthermore, there were significant reductions in hs-CRP (8953.30 ± 5588.06 vs. 7249.86 ± 5091.62, P=0.007) and IL-6 (60.10 (55.99, 73.10) vs. 55.21 (53.39, 60.48), P=0.050) in the intervention group, but these changes were not significant in comparison with the control group. Conclusion We conclude that the hydroalcoholic extract of WC reduced the PCO content in hemodialysis patients via inhibition of protein oxidation. Although WC administration had caused a significant reduction in IL-6 and CRP levels, these differences were not statistically significant relative to the control group. Further research is needed to identify the antioxidant and anti-inflammatory effects of WC in hemodialysis patients.
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Yang Y, Ge B, Liu Y, Feng J. The efficacy of biomarkers in the diagnosis of acute kidney injury secondary to liver cirrhosis. Medicine (Baltimore) 2021; 100:e25411. [PMID: 33832138 PMCID: PMC8036071 DOI: 10.1097/md.0000000000025411] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 01/19/2021] [Accepted: 02/08/2021] [Indexed: 01/05/2023] Open
Abstract
ABSTRACT This study is to investigate the role of neutrophil gelatinase-associated lipocalin (NGAL), cystatin C (CysC) and creatinine in the diagnosis of acute kidney injury (AKI) secondary to liver cirrhosis.A total of 825 patients (including 540 liver cirrhosis patients and 285 healthy controls) were enrolled. Liver cirrhosis patients were further subdivided into AKI secondary to liver cirrhosis group (AKI group, 210 patients) and simple liver cirrhosis group (LC group, 330 patients). Serum NGAL/urine NGAL (sNGAL/uNGAL), and serum creatinine (sCr) levels as well as estimated glomerular filtration rates were measured. The diagnostic performances of these indicators in AKI secondary to liver cirrhosis were evaluated.The levels of sNGAL, uNGAL, CysC and sCr in the AKI group were significantly higher than those of LC and healthy control groups. However, the eGFR and c-aGFR of AKI group were significantly lower. With the progression of AKI (AKI-S1→AKI-S2→AKI-S3), the levels of sNGAL, uNGAL, CysC and sCr increased gradually, while the levels of c-aGFR and eGFR decreased gradually. The sNGAL, uNGAL and CysC were positively correlated with sCr (r = 0.638, 0.635, and 0.650), but negatively correlated with c-aGFR (r = -0.617, -0.606 and -0.655). However, eGFR had a negative correlation with sCr (r = -0.711), but a positive correlation with c-aGFR (r = 0.736). ROC curve analysis showed that the area under the curve for uNGAL was the largest (0.976), followed by sNGAL (0.967). The diagnostic efficacy of uNGAL and sNGAL in AKI group were 0.907 and 0.870, and the risk degrees were OR = 54.524 and 5.115, respectively.NGAL might perform better than sCr and CysC in the diagnosis of AKI secondary to liver cirrhosis, while uNGAL might be a better indicator than sNGAL in AKI diagnosis.
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Affiliation(s)
- Yuwei Yang
- Department of Laboratory Medicine, Mianyang Central Hospital, Affiliated to Southwest Medical University, Mianyang
| | - Bin Ge
- Department of Laboratory Medicine, Pidu District People's Hospital, Chengdu, Sichuan, China
| | - Yan Liu
- Department of Laboratory Medicine, Pidu District People's Hospital, Chengdu, Sichuan, China
| | - Jiafu Feng
- Department of Laboratory Medicine, Mianyang Central Hospital, Affiliated to Southwest Medical University, Mianyang
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Deng F, Peng M, Li J, Chen Y, Zhang B, Zhao S. Nomogram to predict the risk of septic acute kidney injury in the first 24 h of admission: an analysis of intensive care unit data. Ren Fail 2020; 42:428-436. [PMID: 32401139 PMCID: PMC7269058 DOI: 10.1080/0886022x.2020.1761832] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 04/21/2020] [Accepted: 04/21/2020] [Indexed: 02/03/2023] Open
Abstract
Background: Acute kidney injury (AKI) is a significant cause of morbidity and mortality, especially in sepsis patients. Early prediction of AKI can help physicians determine the appropriate intervention, and thus, improve the outcome. This study aimed to develop a nomogram to predict the risk of AKI in sepsis patients (S-AKI) in the initial 24 h following admission.Methods: Sepsis patients with AKI who met the Sepsis 3.0 criteria and Kidney Disease: Improving Global Outcomes criteria in the Massachusetts Institute of Technology critical care database, Medical Information Mart for Intensive Care (MIMIC-III), were identified for analysis. Data were analyzed using multiple logistic regression, and the performance of the proposed nomogram was evaluated based on Harrell's concordance index (C-index) and the area under the receiver operating characteristic curve.Results: We included 2917 patients in the analysis; 1167 of 2042 patients (57.14%) and 469 of 875 patients (53.6%) had AKI in the training and validation cohorts, respectively. The predictive factors identified by multivariate logistic regression were blood urea nitrogen level, infusion volume, lactate level, weight, blood chloride level, body temperature, and age. With the incorporation of these factors, our model had well-fitted calibration curves and achieved good C-indexes of 0.80 [95% confidence interval (CI): 0.78-0.82] and 0.79 (95% CI: 0.76-0.82) in predicting S-AKI in the training and validation cohorts, respectively.Conclusion: The proposed nomogram effectively predicted AKI risk in sepsis patients admitted to the intensive care unit in the first 24 h.
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Affiliation(s)
- Fuxing Deng
- Department of Critical Care Medicine & National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Hunan, China
| | - Milin Peng
- Department of Critical Care Medicine & National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Hunan, China
| | - Jing Li
- Department of Critical Care Medicine & National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Hunan, China
| | - Yana Chen
- Department of Critical Care Medicine & National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Hunan, China
| | - Buyao Zhang
- Department of Critical Care Medicine & National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Hunan, China
| | - Shuangping Zhao
- Department of Critical Care Medicine & National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Hunan, China
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Li Y, Ji H, Shen L, Shi X, Wang J. An LC-MS/MS assay with a label-free internal standard for quantitation of serum cystatin C. Anal Biochem 2019; 587:113451. [PMID: 31562851 DOI: 10.1016/j.ab.2019.113451] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 09/22/2019] [Accepted: 09/22/2019] [Indexed: 11/18/2022]
Abstract
Cystatin C is considered as an alternative to the evaluation of glomerular filtration rate. In this study, we highlighted an LC-MS/MS approach for the absolute quantitation of serum cystatin C based on label-free internal standards. A tryptic peptide (ALDFAVGEYNK) was selected as the surrogate whilst analogue (ALDFAVGEYQK) served as an internal standard. After denaturation, reduction, alkylation, digestion and concentration, the target peptides were separated on an LC column and monitored under MRM. The calibration range was from 0.25 mg/L to 15 mg/L with LLOQ of 0.05 mg/L and LOD of 0.03 mg/L, respectively. The certified reference material (ERM-DA471) was determined at 5.12 mg/L with bias of 6.57%. The recovery was between 89.68% and 92.43%. The RSD of intra- and inter-assay imprecision were both <10%. Good stability was also observed. The assay also demonstrated that the quantification of native cystatin C in human serum could be achieved using label-free internal standards. The assay was robust, cheap and sensitive.
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Affiliation(s)
- Yanan Li
- Department of Laboratory Medicine, Affiliated Hospital of Nantong University, Nantong, 226001, China
| | - Huoyan Ji
- Department of Laboratory Medicine, Affiliated Hospital of Nantong University, Nantong, 226001, China
| | - Lei Shen
- Department of Laboratory Medicine, Affiliated Hospital of Nantong University, Nantong, 226001, China
| | - Xiuying Shi
- Department of Laboratory Medicine, Affiliated Hospital of Nantong University, Nantong, 226001, China
| | - Jianxin Wang
- Department of Laboratory Medicine, Affiliated Hospital of Nantong University, Nantong, 226001, China.
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Hu C, Li D, Yin W, Zuo X. Evaluation of cystatin C-derived glomerular filtration rate equations in Chinese population. Scandinavian Journal of Clinical and Laboratory Investigation 2019; 79:629-634. [PMID: 31709845 DOI: 10.1080/00365513.2019.1689575] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
ABTRACTGlomerular filtration rate (GFR) has become the best indicator for assessing renal function. This study aims to validate the existing cystatin C (CysC)-derived estimated glomerular filtration rate (eGFR) equations in Chinese patients to explore whether the reported CysC-derived eGFR formulas could be applied to the Chinese population. This study validated the equations in a population totaling 1816 inpatients. We calculated eGFR by different CysC-derived equations, then compared with the mGFR. Equation performance was assessed by bias (mean difference between mGFR and eGFR), precision (inter-quartile range of difference) and accuracy (mainly, accuracy within 30% [P30]). All equations expressed poor performance in dialysis patients (n = 345), and the performance for non-dialysis patients (n = 1471) were significantly greater than that in dialysis patients. Feng and Pei equations had higher P30 (50.82% and 49.73%, respectively) than the widely used CKD-EPICysC (41.10%) and MacIsaac equations (48.23%), and the distribution of eGFR values is more similar to the distribution of mGFR in non-dialysis patients. Similar trends showed in mGFR, sex, age, and BMI subgroups. However, no equation met the guideline standard of P30 ≥ 75%. Our results suggest that the published CysC-based eGFR equations are not suitable for dialysis patients, and the accuracy of equations for non-dialysis patients significantly better than the dialysis ones. Moreover, Feng and Pei equation showed better performance in non-dialysis patients.
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Affiliation(s)
- Can Hu
- Department of Pharmacy, Third Xiangya Hospital, Central South University, Changsha, China
| | - Daiyang Li
- Department of Pharmacy, Third Xiangya Hospital, Central South University, Changsha, China
| | - Wenjun Yin
- Department of Pharmacy, Third Xiangya Hospital, Central South University, Changsha, China
| | - Xiaocong Zuo
- Department of Pharmacy, Third Xiangya Hospital, Central South University, Changsha, China.,Center of Clinical Pharmacology, Third Xiangya Hospital, Central South University, Changsha, China
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