Role Of Cystatin C In Prediction Acute Kidney Injury Among Patients With Chronic Obstructive Pulmonary Disease

Abstract

Background: complicated chronic obstructive pulmonary disease patients who had acute exacerbation been in a great risk for developing acute kidney injury (AKI). it ranges between 1.9% and 21.3%. It has been submitted that serum protein cystatin C (Cys C) can be used as a indicator for the initial detection of AKI. Objective: This study aimed to assess the role of cystatin C in prediction of acute kidney injury in patients with chronic obstructive pulmonary disease (COPD). Materials: The study was conducted on 150 subjects distributed into three groups: Group (1) comprised fifty patients with an AECOPD, group (2) involved fifty patients with stable COPD without exacerbation and group (3) encompassed fifty subjects as control subjects who were employed from the general population and harmonized for age and sex. All participants were exposed to full history taking, clinical assessment and laboratory investigations. Serum creatinine at admission and after 48 hours was assessed. Pulmonary function test (PFT) was implemented using a spirometry. Serum Cys C levels was measured for all subjects. Results: There was a high statistically significant (p-value < 0.001) increase of Cys C level in AECOPD group (median = 0.95, IQR = 0.86 – 1) when compared to stable COPD group (median = 0.7, IQR = 0.64 – 0.79) and control group (median = 0.6, IQR = 0.58– 0.61). Serum Cys C can be used to discriminate between AECOPD group and stable COPD group at a cutoff level of > 0.79, with 96% sensitivity, 88% specificity, 88.9% PPV and 95.7% NPV (AUC = 0.97 & p- value < 0.001). Conclusion: Patients with acute exacerbation chronic obstructive pulmonary disease (AECOPD) who had serum cystatin C level more than 0.79 are supposed to have a higher risk of developing HA-AKI. Serum Cystatin C level is negatively correlated with FEV1 and FEV1/FVC. We recommend using of serum Cystatin C for prediction of AKI among COPD patients.