机构：[1]Division of Nephrology, National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Nanfang Hospital, Southern Medical University, Guangzhou, China[2]Children's Hospital of Fudan University, Shanghai, China[3]Institute of Nephrology, Zhongda Hospital, Southeast University School of Medicine, Nanjing, China[4]Department of Endocrinology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China[5]Department of Critical Care Medicine, Maoming People's Hospital, Maoming, China[6]Key Laboratory of Prevention and Management of Chronic Kidney Disease of Zhanjiang City, Institute of Nephrology, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China[7]Department of Nephrology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China中山大学附属第二医院[8]Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China[9]Department of Nephrology, the First People's Hospital of Foshan, Foshan, Guangdong, China[10]Renal Department and Institute of Nephrology, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Sichuan Clinical Research Center for Kidney Diseases, Chengdu, China四川省人民医院[11]The Second People’s Hospital of Shenzhen, Shenzhen University, Shenzhen, China[12]Guizhou Provincial People’s Hospital, Guizhou University, Guiyang, China[13]The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China[14]Division of Nephrology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China华中科技大学同济医学院附属同济医院[15]Huizhou Municipal Central Hospital, Sun Yat-Sen University, Huizhou, China[16]Department of Nephrology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China首都医科大学附属天坛医院[17]Department of Nephrology, Guangdong Provincial Hospital of Chinese Medicine, The Second Affiliated Hospital, The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, China大德路总院肾内科大德路总院肾内科广东省中医院[18]The Third Affiliated Hospital of Southern Medical University, Guangzhou, China
Background Serum creatinine is not a sensitive biomarker for AKI in neonates. A better biomarker-based criterion for neonatal AKI is needed. Methods In this large multicenter cohort study, we estimated the upper normal limit (UNL) and reference change value (RCV) of serum cystatin C (Cys-C) in neonates and proposed cystatin C-based criteria (CyNA) for detecting neonatal AKI using these values as the cutoffs. We assessed the association of CyNA-detected AKI with the risk of in-hospital death and compared CyNA performance versus performance of modified Kidney Disease Improving Global Outcomes (KDIGO) creatinine criteria. Results In this study of 52,333 hospitalized neonates in China, Cys-C level did not vary with gestational age and birth weight and remained relatively stable during the neonatal period. CyNA criteria define AKI by a serum Cys-C of >2.2 mg/L (UNL) or an increase in Cys-C of >25% (RCV) during the neonatal period. Among 45,839 neonates with measurements of both Cys-C and creatinine, 4513 (9.8%) had AKI detected by CyNA only, 373 (0.8%) by KDIGO only, and 381 (0.8%) by both criteria. Compared with neonates without AKI by both criteria, neonates with AKI detected by CyNA alone had an increased risk of in-hospital mortality (hazard ratio [HR], 2.86; 95% confidence interval [95% CI], 2.02 to 4.04). Neonates with AKI detected by both criteria had an even higher risk of in-hospital mortality (HR, 4.86; 95% CI, 2.84 to 8.29). Conclusions Serum Cys-C is a robust and sensitive biomarker for detecting neonatal AKI. Compared with modified KDIGO creatinine criteria, CyNA is 6.5 times more sensitive in identifying neonates at elevated risk of in-hospital mortality.
基金：
This study is supported by grants the National Key R&D Program of China (2021YFC2500200 to XX), the National Natural Science Foundation of China (81970586 to XX), the National Natural Science Foundation of China (Key Program) (82030022 to FFH), the Research Fund Program of Guangdong Provincial Clinical Research Center for Kidney Disease (2020B1111170013), the Research Fund Program of Guangdong Provincial Key Laboratory of Renal Failure Research (2017B030314036 to FFH), Guangdong Key Program of Precision Medicine (202204 to FFH), the National Natural Science Foundation of China (81900626 to SN).
第一作者机构：[1]Division of Nephrology, National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Nanfang Hospital, Southern Medical University, Guangzhou, China[*1]Renal Division, Nanfang Hospital, Southern Medical University, 1838 North Guangzhou Ave, Guangzhou 510515, China
共同第一作者：
通讯作者：
通讯机构：[1]Division of Nephrology, National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Nanfang Hospital, Southern Medical University, Guangzhou, China[*1]Renal Division, Nanfang Hospital, Southern Medical University, 1838 North Guangzhou Ave, Guangzhou 510515, China
推荐引用方式(GB/T 7714)：
Xin Xu,Sheng Nie,Hong Xu,et al.Detecting Neonatal AKI by Serum Cystatin C[J].JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY.2023,34(7):1253-1263.doi:10.1681/ASN.0000000000000125.
APA：
Xin Xu,Sheng Nie,Hong Xu,Bicheng Liu,Jianping Weng...&Fan Fan Hou.(2023).Detecting Neonatal AKI by Serum Cystatin C.JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY,34,(7)
MLA：
Xin Xu,et al."Detecting Neonatal AKI by Serum Cystatin C".JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY 34..7(2023):1253-1263
医学