Serum creatinine to cystatin C ratio and clinical outcomes in adults with non-dialysis chronic kidney disease

Clinical significance and normal reference value of serum creatinine to cystatin C ratio in children

BACKGROUND & AIMS

Sarcopenia is a serious problem in adults and children. However, limited modalities are available for diagnosing pediatric sarcopenia. The serum creatinine to cystatin C ratio (Cre/CysC ratio) is a promising method for muscle quantification, although its clinical significance in the pediatric population is unknown. This study aimed to evaluate the relationship between the Cre/CysC ratio and physical performance.

METHODS

This was a single-center retrospective study. Patients aged <15 years who had visited the University of Tokyo Hospital for measurements of serum creatinine and cystatin C levels, body height, and body weight were included. The patients were assigned according to their age (<2 or ≥2 years), and the relationship between the Cre/CysC ratio and physical performance at the time of measurement was analyzed.

RESULTS

We included 266 patients, revealing a significant relationship between Cre/CysC ratio and physical performance in children aged ≥2 years (p < 0.001) but not in children aged <2 years (p = 0.42). The repeater-operator curve analysis of Cre/CysC to predict bedridden status showed good performance (the area under the curve was 0.82 (95% CI, 0.75-0.89)) and the cut-off value 0.44 had good accuracy (sensitivity 0.87, specificity 0.61).

CONCLUSIONS

The Cre/CysC ratio was a significant marker of impaired physical performance, and a Cre/CysC ratio <0.44 accurately predicted bedridden status in children aged >2 years.

Prognostic Value of Myosteatosis and Creatinine-to-Cystatin C Ratio in Patients with Pancreatic Cancer Who Underwent Radical Surgery

BACKGROUND

Myosteatosis is correlated with poor prognosis in some malignancies. The creatinine-to-cystatin ratio (CCR) is revealed to predict gastric cancer prognosis. However, the prognostic abilities of CCR and the combination of CCR and myosteatosis in patients with pancreatic cancer (PC) who underwent radical surgery remains unclear.

METHODS

The retrospective cohort study included 215 patients with PC who underwent radical surgery (January 2016-October 2021). Clinicopathological and serological data were collected on admission. Myosteatosis and other body composition indices were assessed by using computed tomography. The cutoff value of CCR was determined by using the Youden index. Risk factors responsible for poor overall survival (OS) and disease-free survival (DFS) were determined by the Cox proportional hazards model.

RESULTS

The myosteatosis group included 104 patients (average age, 61.3 ± 9.1 years). The best cutoff value for CCR was 1.09. CCR ≤ 1.09 was an independent predictive biomarker inversely corelated with OS (P = 0.036). Myosteatosis was an independent risk factor associated with OS and DFS (P = 0.032 and P = 0.004, respectively). Patients with concomitant myosteatosis and CCR ≤ 1.09 had the worst OS (P = 0.016).

CONCLUSIONS

Myosteatosis and CCR are prognostic biomarkers for survival in PC patients who underwent radical surgery. Patients with the coexistence of myosteatosis and CCR ≤ 1.09 deserve more attention.

Creatinine-cystatin C ratio and death with a functioning graft in kidney transplant recipients

Death with a functioning graft is important cause of graft loss after kidney transplantation. However, little is known about factors predicting death with a functioning graft among kidney transplant recipients. In this study, we evaluated the association between post-transplant creatinine-cystatin C ratio and death with a functioning graft in 1592 kidney transplant recipients. We divided the patients into tertiles based on sex-specific creatinine-cystatin C ratio. Among the 1592 recipients, 39.5% were female, and 86.1% underwent living-donor kidney transplantation. The cut-off value for the lowest creatinine-cystatin C ratio tertile was 0.86 in males and 0.73 in females. The lowest tertile had a significantly lower 5-year patient survival rate and was independently associated with death with a functioning graft (adjusted hazard ratio 2.574, 95% confidence interval 1.339-4.950, P < 0.001). Infection was the most common cause of death in the lowest tertile group, accounting for 62% of deaths. A low creatinine-cystatin C ratio was significantly associated with an increased risk of death with a functioning graft after kidney transplantation.

Sarcopenia and myosteatosis diagnostic tool for gastrointestinal cancer: creatinine to cystatin C ratio as evaluation marker

OBJECTIVE

This study aimed to develop a simplified diagnostic tool for assessing sarcopenia and myosteatosis in gastrointestinal cancer patients, focusing on the creatinine to cystatin C ratio (CCR) as an evaluation marker.

METHODS

955 patients were split into training (n = 671) and validation (n = 284) cohorts. Using logistic regression, risk factors for sarcopenia and myosteatosis were identified. The predictive capacity of the developed model was examined. The association between CCR and muscle imaging parameters, along with its impact on clinical outcomes, was analyzed.

RESULTS

No significant differences were observed in baseline traits between cohorts. CCR emerged as a significant risk factor for both sarcopenia and myosteatosis. Nomograms for diagnosing these conditions demonstrated strong predictive ability, with AUC values indicating high accuracy (sarcopenia AUC: 0.865-0.872; myosteatosis AUC: 0.848-0.849). The clinical utility of the nomograms was confirmed through decision curve analysis. CCR showed significant association with muscle imaging parameters and was a reliable indicator for assessing the risk of sarcopenia, myosteatosis, and cachexia. Moreover, CCR was able to differentiate between patient survival and disease progression rates.

CONCLUSION

A diagnostic tool for sarcopenia and myosteatosis in gastrointestinal cancer patients was developed, with CCR being a pivotal biomarker for disease diagnosis and prognosis prediction.

An Electrochemical Sensor Based on Cu-MOF-199@MWCNTs Laden with CuNPs for the Sensitive Detection of Creatinine

In this study, the synthesis of Cu-MOF-199@multiwalled carbon nanotubes (Cu-MOF-199@MWCNTs) composites was achieved and utilized to create an advanced electrochemical sensor for creatinine (Cre) detection. The composites were modified on a glassy carbon electrode surface through direct drip coating, followed by the deposition of copper nanoparticles (CuNPs) via constant potential deposition. Characterized by various techniques and electrochemical analyses, the Cu-MOF-199@MWCNTs composite increased the CuNPs load, improving the detection sensitivity for Cre. Under optimal conditions, the modified electrode exhibited good linearity across a broad range of Cre concentrations (0.05-40.0 μM) with a low detection limit of 11.3 nM. The developed sensor demonstrated remarkable stability, reproducibility, and selectivity, showing promise in sensitive and accurate Cre detection in serum samples.

The Association between Serum Creatinine/Cystatin C Ratio and Cardiovascular Morbidity and Mortality: Insights from NHANES

Background

The Serum creatinine/cystatin C ratio (Cr/CysC ratio) is an emerging alternative index for muscle mass loss, a risk factor for cardiovascular diseases (CVDs). However, the association between the Cr/CysC ratio and CVD morbidity and mortality remains unknown.

Methods

A total of 11,150 participants of the National Health and Nutrition Examination Survey (NHANES) were included in this study. Univariable and multivariable logistic regression models were employed to assess the association between the Cr/CysC ratio and self-reported CVD morbidity. Cox proportional hazard models were used to estimate the hazard ratio (HR) and 95% confidence interval (CI) of the Cr/CysC ratio for CVD mortality.

Results

At baseline, 1181 (7.90%) participants had self-reported CVDs. Lower Cr/CysC ratios were found in participants with CVDs (1.18 ± 0.30 vs. 1.05 ± 0.23, p < 0.001). In the multivariable logistic regression model, the Cr/CysC ratio was inversely linked to CVD morbidity (odds ratio: 0.65, 95% CI: 0.52-0.81, p < 0.001, per standard deviation [SD] increase). 997 (8.94%) CVD deaths were documented during a median follow-up of 16.9 years. A higher Cr/CysC ratio was associated with a decreasing risk of CVD mortality (adjusted HR: 0.54, 95% CI: 0.46-0.65, p < 0.001, per SD increase).

Conclusions

In NHANES participants, the Cr/CysC ratio had an inverse correlation with CVD morbidity and mortality.