Diagnostic accuracy of cystatin C compared to serum creatinine for the estimation of renal dysfunction in adults and children--a meta-analysis

Clin Biochem. 2007 Mar;40(5-6):383-91. doi: 10.1016/j.clinbiochem.2006.10.026. Epub 2007 Jan 5.


Objectives: To perform a systematic review comparing the diagnostic accuracy of CysC with SCr.

Methods: MEDLINE and EMBASE (January 1984-February 2006) were searched. Studies included i) evaluated CysC against a recognised 'gold standard' method for determining GFR using a receiver operating characteristics (ROC) curve analysis and ii) included data that could be extracted into a 2x2 table.

Results: The search identified 27 population groups in 24 studies (n=2007) that compared the diagnostic accuracy of CysC with SCr. The diagnostic odds ratios (DORs) (95% CI) of predicting renal dysfunction derived from a Moses-Littenberg linear regression model were 3.99 (3.41-4.57) for CysC and 2.79 (2.12-3.46) for SCr.

Conclusion: The diagnostic accuracy for impaired renal function favours CysC. However, the confidence intervals for the pooled DORs for the biomarkers overlap. The ability of CysC (cut-off values between 0.9 and 1.4 mg/L) to rule in renal impairment (as measured by inulin-determined GFR of 60-79 mL/min/1.73 m2) in persons in whom this is suspected is large and conclusive.

Publication types

  • Meta-Analysis
  • Review
  • Systematic Review

MeSH terms

  • Child
  • Creatinine / blood*
  • Cystatin C
  • Cystatins / blood*
  • Glomerular Filtration Rate
  • Humans
  • Kidney Diseases / blood
  • Kidney Diseases / diagnosis*
  • Kidney Diseases / physiopathology
  • Kidney Function Tests
  • Middle Aged
  • Sensitivity and Specificity


  • CST3 protein, human
  • Cystatin C
  • Cystatins
  • Creatinine