130 - Value of serum Cystatin C measurement in the assessment of kidney function in pediatric patients with sepsis.
Friday, April 25, 2025
5:30pm – 7:45pm HST
Publication Number: 130.7011
Ahmed Mafraj, McGovern Medical School at the University of Texas Health Science Center at Houston, Sugarland, TX, United States; Konstantinos Boukas, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX, United States; Chinyere O’Connor, UTHealth Houston, Houston, TX, United States; Samhar Al-Akash, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX, United States; Kaleigh Riggs-Harpur, University of Texas Medical Branch School of Medicine, Spring, TX, United States; Bibek Bista, UT Health, Houston, TX, United States
Pediatric Critical Care Medicine Fellow McGovern Medical School at the University of Texas Health Science Center at Houston Sugarland, Texas, United States
Background: Acute kidney injury (AKI) occurs in more than 20% of pediatric patients with sepsis. Serum Creatinine (SCr) is the most widely used biomarker for assessing kidney function. However, SCr levels may vary with age, muscle mass, medications, hydration status and immobility. Serum Cystatin C (SCys-C) is a low molecular weight protein that is freely filtered by the glomerulus; its production is a stable process that is not influenced by age, gender, or muscle mass. The role of SCys-C as a biomarker of kidney function in pediatric patients with sepsis has not been well established. Objective: The aim of this observational, prospective study is to compare the incidence of AKI and the estimated Glomerular Filtration Rate (eGFR) based on SCr, SCys-C and SCr & SCys-C in pediatric patients with sepsis in a tertiary Pediatric Intensive Care Unit (PICU). Design/Methods: The eGFR based on SCr (Schwartz equation), eGFR based on SCys-C (2012 Cys-C eGFR equation) and eGFR based on combined SCr & SCys-C (U25 CKiD equation), volume of intravenous fluid given during resuscitation, urine output, and nephrotoxic medication exposure were serially measured in pediatric patients with sepsis. Sepsis was diagnosed based on the Phoenix Sepsis Criteria. AKI was diagnosed based upon p-RIFLE criteria. Composite and subset analyses were conducted using Fischer exact T-test, chi-square test, and ANOVA. Results: There were 46 patients with sepsis requiring resuscitation admitted in the PICU. On presentation, the incidence of AKI was (56.7%) by SCr, (32.4%) by SCys-C and (48.6%) by combined SCr & SCys-C based eGFR. On day 1, mean eGFR based on SCys-C was higher than mean eGFR based on SCr (mean difference 18.8, p-value 0.042) and combined SCr & SCys-C-based eGFR (mean difference 20.7, p-value 0.022). The mean eGFR values based on SCr and combined SCr & SCys-C on day 1 were lower than day 3 of the diagnosis of sepsis (mean difference -35.7, p-value 0.005 and -20.5, p-value 0.020 respectively); while serum Cys-C based mean eGFR values were not significantly different on day 1 and day 3 of the diagnosis of sepsis (mean difference –0.6, p-value 0.984).
Conclusion(s): Our results indicate that early in pediatric sepsis, the incidence of AKI measured by eGFR based on SCys-C is significantly lower compared to SCr and combined SCr & SCys-C based eGFR estimations. Furthermore, eGFR based on SCys-C has less fluctuations over time as compared to other biomarkers suggesting clinical utility of SCys-C to monitor longitudinal trend of kidney function in pediatric patients with sepsis.
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