Multicenter Evaluation of Cystatin C Measurement after Assay Standardization

Clin Chem. 2017 Apr;63(4):833-841. doi: 10.1373/clinchem.2016.264325. Epub 2017 Feb 10.


Background: Since 2010, a certified reference material ERM-DA471/IFCC has been available for cystatin C (CysC). This study aimed to assess the sources of uncertainty in results for clinical samples measured using standardized assays.

Methods: This evaluation was performed in 2015 and involved 7 clinical laboratories located in France and Belgium. CysC was measured in a panel of 4 serum pools using 8 automated assays and a candidate isotope dilution mass spectrometry reference measurement procedure. Sources of uncertainty (imprecision and bias) were evaluated to calculate the relative expanded combined uncertainty for each CysC assay. Uncertainty was judged against the performance specifications derived from the biological variation model.

Results: Only Siemens reagents on the Siemens systems and, to a lesser extent, DiaSys reagents on the Cobas system, provided results that met the minimum performance criterion calculated according to the intraindividual and interindividual biological variations. Although the imprecision was acceptable for almost all assays, an increase in the bias with concentration was observed for Gentian reagents, and unacceptably high biases were observed for Abbott and Roche reagents on their own systems.

Conclusions: This comprehensive picture of the market situation since the release of ERM-DA471/IFCC shows that bias remains the major component of the combined uncertainty because of possible problems associated with the implementation of traceability. Although some manufacturers have clearly improved their calibration protocols relative to ERM-DA471, most of them failed to meet the criteria for acceptable CysC measurements.

Publication types

  • Evaluation Study
  • Multicenter Study

MeSH terms

  • Automation / standards*
  • Blood Chemical Analysis / standards*
  • Cystatin C / blood*
  • Cystatin C / standards
  • Humans
  • Mass Spectrometry / standards
  • Reference Standards


  • Cystatin C