serum cystatine c vs serum cpk for diagnosis of aki after trauma in adults according to rifle...

1

Serum cystatin-c versus creatine phosphokinase to predict acute kidney injury according to rifle criteria

in adult trauma intensive care units within first 24 hours H.R. Jamaati , M. Masjedi , F. Zand, S.M.R. Hashemian, G. Sabetian, G. Abbasi, V. Khaloo,

S.H. Tabei , A. Kafilzadeh , H. Haddad Bakhodaei

Presented by : Mansoor Masjedi MDAss. Prof. of anesthesia & Critical care consultant

Shiraz university of medical sciences ,IranMilan , Italy - October , 2016

2

• INTRODUCTION AKI is a common clinical problem in critically ill pts which independently

predicts poor outcome. Despite significant improvements in therapeutics, its mortality and morbidity

remains high. A major reason for this is the lack of early markers for AKI and hence an

unacceptable delay in initiating therapy. AKI, as a component of the crush syndrome, is the 2nd cause of death after

direct trauma, although it can be prevented by early and vigorous intravenous fluid therapy .

Few studies have evaluated the predictive value of biomarkers for early diagnosis of AKI in trauma.

Serum Cys-c vs CPK to predict AKI according to Rifle criteria in adult trauma ICUs within first 24 hrs

3

• OBJECTIVES

To evaluate and compare the predictive value of serum Cys-c with CPK

for early diagnosis of AKI in adult trauma pts admitted in ICU


Your Footer Here 4

• METHODSo Retrospective interrogation of prospectively collected data of 300 adult

trauma pts aged≥18 yrs admitted and stayed more than 24 hrs in ICU. o We measured Cys-c & CPK of previously collected and freezed serum samples o Impression of AKI was applied according to RIFLE criteria in ICU within first

24hr ( early AKI) o Association of Cys-c and CPK with different stages of AKI were evaluated &

compared

Your Date Here


5

• RESULTS The median age was 34.8 ( 18 - 80 ) yrs, 90% were male . The crude prevalence of AKI was 193 ( 65%) with a maximum RIFLE category of :

• Risk in 121 ( 40.3% )• Injury in 67 (22.3%)• Failure 5 (1.7%)

Younger age and male sex were independently associated with higher risk of AKI in the first 24 hrs after trauma .

Mean APACHE IV score between AKI and Non-AKI groups were not statistically different


6

• RESULTS (cont'd)• Considering serum Cys-c ,

• lower frequency of AKI ( 144 , 63.2% ) in pts with Cys-c < 0.78 • higher ( 49 , 71 % ) in pts with Cys-c ≥ 0.78 ( p value = 0.001 ).

• According to serum CPK ,• lowest frequency of AKI ( 87, 56.1 % ) in pts with CPK < 2000 • highest ( 18 , 90% ) in pts with CPK of 5000-10000 ( p value = 0.003)


7

• RESULTS (cont'd)Diagnosis of AKI , • Cys-c; significant odds ratio of 5.874 ( p value: 0.003 with 95% CI ; 1,79-1 9.23 )

in comparison with• CPK; no correlation (odds ratio of 1 ).


8

RESULTS (cont'd)

Sensitivity and specificity ,

Both Cys-c and CPK of 1st day could not be considered to have high sensitivity and specificity (area under the curve 0.565 and 0.61 8 , respectively ) by plotting ROC curve


9

CONCLUSION

In adult trauma victims admitted in ICU, serum Cys-c but not CPK

could predict development of early AKI


10Hope to see you in

shiraz - IranThanks for your patience & attention

serum cystatine c vs serum cpk for diagnosis of aki after trauma in adults according to rifle...

Health & Medicine