Impact of sepsis on levels of plasma cystatin C in AKI and non-AKI patients

Nephrol Dial Transplant. 2012 Feb;27(2):576-81. doi: 10.1093/ndt/gfr358. Epub 2011 Sep 12.


Background: Cystatin C is a marker of acute kidney injury (AKI). However, systemic inflammation associated with sepsis, a common AKI-trigger, may affect cystatin C. We studied the impact of sepsis on cystatin C levels in plasma. Furthermore, we investigated whether the presence of sepsis affects the predictive properties of cystatin C.

Methods: Three hundred and twenty-seven intensive care unit (ICU) patients were categorized as having: neither AKI nor sepsis (n = 151), sepsis without AKI (n = 80), AKI without sepsis (n = 24) or AKI and sepsis (n = 72) during their first week in the ICU. Changes in cystatin C and creatinine over time in patients with and without sepsis or AKI were analysed using repeated measures analysis of variance. The performance of cystatin C on admission to predict sustained AKI, worsened AKI or death was assessed from the area under the receiver-operating characteristic curve (AUC-ROC) in septic and non-septic patients separately.

Results: In non-AKI patients, cystatin C increased and creatinine decreased significantly over the first week. The change in cystatin C or creatinine did not differ significantly between septic and non-septic patients without AKI. Even in AKI patients, the cystatin C change did not differ significantly between septic and non-septic patients. The AUC-ROCs for prediction of the composite outcome were 0.80 and 0.78 in patients with and without sepsis, respectively, and did not differ significantly (P = 0.76).

Conclusion: The inflammatory response induced by sepsis has no impact on the levels of cystatin C in plasma during the first week in the ICU.

Publication types

  • Comparative Study

MeSH terms

  • Acute Kidney Injury / blood*
  • Acute Kidney Injury / diagnosis
  • Acute Kidney Injury / mortality
  • Adolescent
  • Adult
  • Aged
  • Analysis of Variance
  • Area Under Curve
  • Biomarkers / blood
  • Body Weight
  • C-Reactive Protein / metabolism
  • Case-Control Studies
  • Child
  • Cohort Studies
  • Creatinine / blood*
  • Critical Care* / methods
  • Critical Illness / mortality
  • Critical Illness / therapy
  • Cystatin C / blood*
  • Disease Progression
  • Female
  • Humans
  • Intensive Care Units
  • Male
  • Middle Aged
  • Predictive Value of Tests
  • ROC Curve
  • Sensitivity and Specificity
  • Sepsis / blood*
  • Sepsis / diagnosis
  • Sepsis / mortality
  • Survival Rate
  • Young Adult


  • Biomarkers
  • Cystatin C
  • C-Reactive Protein
  • Creatinine