Dataset Information

Serum cystatin C predicts vancomycin trough levels better than serum creatinine in hospitalized patients: a cohort study.

ABSTRACT:

Introduction

Serum cystatin C can improve glomerular filtration rate (GFR) estimation over creatinine alone, but whether this translates into clinically relevant improvements in drug dosing is unclear.

Methods

This prospective cohort study enrolled adults receiving scheduled intravenous vancomycin while hospitalized at the Mayo Clinic in 2012. Vancomycin dosing was based on weight, serum creatinine with the Cockcroft-Gault equation, and clinical judgment. Cystatin C was later assayed from the stored serum used for the creatinine-based dosing. Vancomycin trough prediction models were developed by using factors available at therapy initiation. Residuals from each model were used to predict the proportion of patients who would have achieved the target trough with the model compared with that observed with usual care.

Results

Of 173 patients enrolled, only 35 (20%) had a trough vancomycin level within their target range (10 to 15 mg/L or 15 to 20 mg/L). Cystatin C-inclusive models better predicted vancomycin troughs than models based upon serum creatinine alone, although both were an improvement over usual care. The optimal model used estimated GFR by the Chronic Kidney Disease Epidemiology Collaborative (CKD-EPI) creatinine-cystatin C equation (R(2) = 0.580). This model is expected to yield 54% (95% confidence interval 45% to 61%) target trough attainment (P <0.001 compared with the 20% with usual care).

Conclusions

Vancomycin dosing based on standard care with Cockcroft-Gault creatinine clearance yielded poor trough achievement. The developed dosing model with estimated GFR from CKD-EPIcreatinine-cystatin C could yield a 2.5-fold increase in target trough achievement compared with current clinical practice. Although this study is promising, prospective validation of this or similar cystatin C-inclusive dosing models is warranted.

SUBMITTER: Frazee EN

PROVIDER: S-EPMC4075252 | biostudies-literature | 2014 May

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Serum cystatin C predicts vancomycin trough levels better than serum creatinine in hospitalized patients: a cohort study.

Frazee Erin N EN Rule Andrew D AD Herrmann Sandra M SM Kashani Kianoush B KB Leung Nelson N Virk Abinash A Voskoboev Nikolay N Lieske John C JC

Critical care (London, England) 20140529 3

<h4>Introduction</h4>Serum cystatin C can improve glomerular filtration rate (GFR) estimation over creatinine alone, but whether this translates into clinically relevant improvements in drug dosing is unclear.<h4>Methods</h4>This prospective cohort study enrolled adults receiving scheduled intravenous vancomycin while hospitalized at the Mayo Clinic in 2012. Vancomycin dosing was based on weight, serum creatinine with the Cockcroft-Gault equation, and clinical judgment. Cystatin C was later assa ...[more]

PMID: 24887089

Similar Datasets

Project description:Objective Sarcopenia is a syndrome of decreased muscle mass and deficits in muscle strength and physical function. We aimed to investigate the relationship between creatinine/cystatin C ratio (CCR) and sarcopenia and the prognostic value of CCR in hospitalized patients. Materials and methods We searched for relevant studies in PubMed, EMBASE, and the Cochrane Database up to August 25, 2022. Meta-analyses were performed to evaluate the relationship between CCR and skeletal muscle [computed tomography-assessed skeletal muscle (CTASM), muscle strength, and physical performance], prognosis and important clinical outcomes in hospitalized adults. The pooled correlation coefficient, the area under the receiver operating characteristic (ROC) curves, and hazard ratio (HR) together with their 95% confidence intervals (CIs) were calculated. We also conducted subgroup analyses to explore the sources of heterogeneity. Results A total of 38 studies with 20,362 patients were eligible. These studies were of moderate to high quality. Our results showed that CCR was significant correlations with all CTASM types (Fisher’s Z ranged from 0.35 to 0.5; P values ranged from < 0.01 to 0.01), handgrip strength (Fisher’s Z = 0.39; 95% CI, 0.32–0.45; P < 0.001) and gait speed (Fisher’s Z = 0.25; 95% CI, 0.21–0.30; P < 0.001). The ROC curves suggested that CCR had good diagnostic efficacy (0.689; 95% CI, 0.632–0.746; P < 0.01) for sarcopenia. CCR can reliably predict mortality in hospitalized patients, which was confirmed by regression analysis of CCR as both continuous (HR 0.78; 95% CI, 0.72–0.84; P < 0.01) and categorical variables (HR 2.05; 95% CI, 1.58–2.66; P < 0.0001). In addition, less evidence showed that higher CCR was independently associated with a shorter duration of mechanical ventilation, reduced length of stay in the intensive care unit and hospital, less nutritional risk, and decreased complications in hospitalized patients. Conclusion CCR could be a simple, economical, and effective screening tool for sarcopenia in hospitalized patients, and it is a helpful prognostic factor for mortality and other important clinical outcomes. Systematic review registration https://inplasy.com/inplasy-2022-9-0097/, identifier INPLASY202290097.

Project description:Estimates of glomerular filtration rate (GFR) that are based on serum creatinine are routinely used; however, they are imprecise, potentially leading to the overdiagnosis of chronic kidney disease. Cystatin C is an alternative filtration marker for estimating GFR.Using cross-sectional analyses, we developed estimating equations based on cystatin C alone and in combination with creatinine in diverse populations totaling 5352 participants from 13 studies. These equations were then validated in 1119 participants from 5 different studies in which GFR had been measured. Cystatin and creatinine assays were traceable to primary reference materials.Mean measured GFRs were 68 and 70 ml per minute per 1.73 m(2) of body-surface area in the development and validation data sets, respectively. In the validation data set, the creatinine-cystatin C equation performed better than equations that used creatinine or cystatin C alone. Bias was similar among the three equations, with a median difference between measured and estimated GFR of 3.9 ml per minute per 1.73 m(2) with the combined equation, as compared with 3.7 and 3.4 ml per minute per 1.73 m(2) with the creatinine equation and the cystatin C equation (P=0.07 and P=0.05), respectively. Precision was improved with the combined equation (interquartile range of the difference, 13.4 vs. 15.4 and 16.4 ml per minute per 1.73 m(2), respectively [P=0.001 and P<0.001]), and the results were more accurate (percentage of estimates that were >30% of measured GFR, 8.5 vs. 12.8 and 14.1, respectively [P<0.001 for both comparisons]). In participants whose estimated GFR based on creatinine was 45 to 74 ml per minute per 1.73 m(2), the combined equation improved the classification of measured GFR as either less than 60 ml per minute per 1.73 m(2) or greater than or equal to 60 ml per minute per 1.73 m(2) (net reclassification index, 19.4% [P<0.001]) and correctly reclassified 16.9% of those with an estimated GFR of 45 to 59 ml per minute per 1.73 m(2) as having a GFR of 60 ml or higher per minute per 1.73 m(2).The combined creatinine-cystatin C equation performed better than equations based on either of these markers alone and may be useful as a confirmatory test for chronic kidney disease. (Funded by the National Institute of Diabetes and Digestive and Kidney Diseases.).

Project description:BackgroundThe primary aim of this study was to compare the sensitivity and rapidity of acute kidney injury (AKI) detection by cystatin C level relative to creatinine level after cardiac surgery.Study designProspective cohort study.Settings & participants1,150 high-risk adult cardiac surgery patients in the TRIBE-AKI (Translational Research Investigating Biomarker Endpoints for Acute Kidney Injury) Consortium.PredictorChanges in serum creatinine and cystatin C levels.OutcomePostsurgical incidence of AKI.MeasurementsSerum creatinine and cystatin C were measured at the preoperative visit and daily on postoperative days 1-5. To allow comparisons between changes in creatinine and cystatin C levels, AKI end points were defined by the relative increases in each marker from baseline (25%, 50%, and 100%) and the incidence of AKI was compared based on each marker. Secondary aims were to compare clinical outcomes among patients defined as having AKI by cystatin C and/or creatinine levels.ResultsOverall, serum creatinine level detected more cases of AKI than cystatin C level: 35% developed a ≥25% increase in serum creatinine level, whereas only 23% had a ≥25% increase in cystatin C level (P < 0.001). Creatinine level also had higher proportions meeting the 50% (14% and 8%; P < 0.001) and 100% (4% and 2%; P = 0.005) thresholds for AKI diagnosis. Clinical outcomes generally were not statistically different for AKI cases detected by creatinine or cystatin C level. However, for each AKI threshold, patients with AKI confirmed by both markers had a significantly higher risk of the combined mortality/dialysis outcome compared with patients with AKI detected by creatinine level alone (P = 0.002).LimitationsThere were few adverse clinical outcomes, limiting our ability to detect differences in outcomes between subgroups of patients based on their definitions of AKI.ConclusionsIn this large multicenter study, we found that cystatin C level was less sensitive for AKI detection than creatinine level. However, confirmation by cystatin C level appeared to identify a subset of patients with AKI with a substantially higher risk of adverse outcomes.

Dataset Information

Serum cystatin C predicts vancomycin trough levels better than serum creatinine in hospitalized patients: a cohort study.

Introduction

Methods

Results

Conclusions

Publications

Serum cystatin C predicts vancomycin trough levels better than serum creatinine in hospitalized patients: a cohort study.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets