Copyright
©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
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
ARTICLE HIGHLIGHTS
Research background
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.
Research motivation
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.
Research objectives
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.
Research methods
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.
Research results
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.
Research conclusions
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.
Research perspectives
sCys C could be a marker of mortality in severe and critically ill COVID-19 patients.
