Creatinine-cystatin C ratio and mortality in cancer patients: a retrospective cohort study

J Cachexia Sarcopenia Muscle. 2022 Aug;13(4):2064-2072. doi: 10.1002/jcsm.13006. Epub 2022 Apr 27.


Background: Muscle wasting is prevalent in cancer patients, and early recognition of this phenomenon is important for risk stratification. Recent studies have suggested that the creatinine-cystatin C ratio may correlate with muscle mass in several patient populations. The association between creatinine-cystatin C ratio and survival was assessed in cancer patients.

Methods: A total of 3060 patients who were evaluated for serum creatinine and cystatin C levels at the time of cancer diagnosis were included. The primary outcome was 6-month mortality. The 1-year mortality, and length of intensive care unit (ICU) and hospital stay were also evaluated.

Results: The mean age was 61.6 ± 13.5 years, and 1409 patients (46.0%) were female. The median creatinine and cystatin C levels were 0.9 (interquartile range [IQR], 0.6-1.3) mg/dL and 1.0 (IQR, 0.8-1.5) mg/L, respectively, with a creatinine-cystatin C ratio range of 0.12-12.54. In the Cox proportional hazards analysis, an increase in the creatinine-cystatin C ratio was associated with a significant decrease in the 6-month mortality (per 1 creatinine-cystatin C ratio, hazard ratio [HR] 0.35; 95% confidence interval [CI], 0.28-0.44). When stratified into quartiles, the risk of 6-month mortality was significantly lower in the highest quartile (HR 0.30; 95% CI, 0.24-0.37) than in the lowest quartile. Analysis of 1-year mortality outcomes revealed similar findings. These associations were independent of confounding factors. The highest quartile was also associated with shorter lengths of ICU and hospital stay (both P < 0.001).

Conclusions: The creatinine-cystatin C ratio at the time of cancer diagnosis significantly associates with survival and hospitalization in cancer patients.

Keywords: Cancer; Creatinine; Cystatin C; Mortality; Muscle mass; Sarcopenia.

MeSH terms

  • Aged
  • Creatinine* / blood
  • Cystatin C* / blood
  • Female
  • Humans
  • Male
  • Middle Aged
  • Neoplasms* / complications
  • Neoplasms* / mortality
  • Proportional Hazards Models
  • Retrospective Studies


  • Cystatin C
  • Creatinine