Intensive Care Medicine

, Volume 37, Issue 3, pp 493-501

First online:

Open Access This content is freely available online to anyone, anywhere at any time.

Serum and urine cystatin C are poor biomarkers for acute kidney injury and renal replacement therapy

  • Annick A. N. M. RoyakkersAffiliated withDepartment of Anesthesiology, Tergooi Hospitals, location Blaricum
  • , Johanna C. KorevaarAffiliated withDepartments of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Center, University of Amsterdam
  • , Jeroen D. E. van SuijlenAffiliated withLaboratory of Clinical Chemistry, Gelre Hospitals, location Lukas
  • , Lieuwe S. HofstraAffiliated withDepartment of Intensive Care, Scheper Hospital
  • , Michael A. KuiperAffiliated withDepartment of Intensive Care, Medical Center LeeuwardenHERMES Critical Care Group
  • , Peter E. SpronkAffiliated withHERMES Critical Care GroupDepartment of Intensive Care, Gelre Hospitals, location Lukas
  • , Marcus J. SchultzAffiliated withDepartment of Intensive Care, Academic Medical Center, University of AmsterdamHERMES Critical Care GroupLaboratory of Experimental Intensive Care and Anesthesiology, Academic Medical Center, University of Amsterdam
  • , Catherine S. C. BoumanAffiliated withDepartment of Intensive Care, Academic Medical Center, University of Amsterdam Email author 



To evaluate whether cystatin C in serum (sCyC) and urine (uCyC) can predict early acute kidney injury (AKI) in a mixed heterogeneous intensive care unit (ICU), and also whether these biomarkers can predict the need for renal replacement therapy (RRT).


Multicenter prospective observational cohort study in patients ≥18 years old and with expected ICU stay ≥72 h. The RIFLE class for AKI was calculated daily, while sCyC and uCyC were determined on days 0, 1, and alternate days until ICU discharge. Test characteristics were calculated to assess the diagnostic performance of CyC.


One hundred fifty-one patients were studied, and three groups were defined: group 0 (N = 60), non-AKI; group 1 (N = 35), AKI after admission; and group 2 (N = 56), AKI at admission. We compared the two days prior to developing AKI from group 1 with the first two study days from group 0. On Day –2, median sCyC was significantly higher (0.93 versus 0.80 mg/L, P = 0.01), but not on Day –1 (0.98 versus 0.86 mg/L, P = 0.08). The diagnostic performance for sCyC was fair on Day –2 [area under the curve (AUC) 0.72] and poor on Day –1 (AUC 0.62). Urinary CyC had no diagnostic value on either of the two days prior to AKI (AUC <0.50). RRT was started in 14 patients with AKI; sCyC and uCyC determined on Day 0 were poor predictors for the need for RRT (AUC ≤0.66).


In this study, sCyC and uCyC were poor biomarkers for prediction of AKI and the need for RRT.


Urine cystatin C Serum cystatin C Acute kidney injury Renal replacement therapy Predictive biomarkers Intensive care unit