The role of serum cystatin c in the early diagnosis of acute kidney injury and evaluation of the nephroproprotective effect of N-acetylcysteine in severe concomitant trauma

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Abstract

Background. Acute kidney injury (AKI) is an independent predictor of poor outcomes in critically ill patients with multiple injuries, associated with a significant increase in mortality. The inertia of traditional markers of kidney function, particularly serum creatinine (sCr), determines delayed diagnosis and missed opportunities for preventive therapy.

Objective. Evaluation of the predictive value of serum cystatin C (sCyC) as an early biomarker for the development of AKI in patients with severe combined trauma (SCT) and to study the renoprotective potential of N-acetylcysteine (NAC) in this cohort of patients.

Material and methods. A total of 85 patients with SCT (Injury Severity Index (ISS)>16) were included in this randomized study. Patients were randomized to the intervention group (n=43), which received standard therapy plus NAC according to the protocol (loading dose of 150 mg/kg IV, then 50 mg/kg/day by continuous infusion for 72 hours), or the control group (n=42), which received standard therapy. sCyC levels, sCr, estimated glomerular filtration rate (CKD-EPIcr, CKD-EPIcys), markers of tissue damage (creatine phosphokinase, lactate dehydrogenase, myoglobin), and inflammation (C-reactive protein, procalcitonin) were determined at admission (T0), 24 (T1), 48 (T2), and 72 (T3) hours. The primary endpoint was the development of acute kidney injury (AKI) according to KDIGO criteria within 7 days.

Results. AKI developed in 28 (32,9%) patients. An increase in sCyC >1,5 mg/L at T1 demonstrated high predictive value for subsequent manifestation of AKI (sensitivity 92,9%, specificity 89,5%, AUC 0,94; 95% CI 0,88–0.99), while sCr at T1 was non-predictive (AUC 0,62; 95% CI 0,51–0,73). Multivariate regression analysis revealed that the sCyC level at T1 (OR=4,8, 95% CI 2,1–10,9; p<0,001) and the presence of shock on admission (OR=3,2, 95% CI 1,4–7,3; p=0,006) are independent predictors of AKI. The NAC group demonstrated a significant reduction in the incidence of stage 2–3 AKI (9,3% vs 28,6%; p=0,024), the need for renal replacement therapy (RRT) (2,3% vs 14,3%; p=0,045), as well as lower median sCyC values (1,9 mg/L vs 2,8 mg/L; p=0,018) and ICU length of stay (12 days vs 16 days; p=0,038).

Conclusion. sCyC is a highly accurate and early predictor of AKI in patients with SCT, preceding creatinine dynamics by 24–48 hours. Early preventive administration of N-acetylcysteine is associated with a statistically significant reduction in the incidence and severity of acute kidney injury (AKI), the need for RRT, and demonstrates a pronounced nephroprotective effect, justifying its inclusion in complex treatment regimens for polytrauma.

About the authors

Ismail A. Miziev

Kabardino-Balkarian State University named after Kh.M. Berbekov

Author for correspondence.
Email: kfeh@yandex.ru

Dr.Sci. (Med.), Professor, Director of the Medical Academy, Head of the Department of Faculty and Endoscopic Surgery

Russian Federation, Nalchik

Murat Kh. Makhov

Kabardino-Balkarian State University named after Kh.M. Berbekov

Email: mahov_murat@mail.ru

Cand.Sci. (Med.), Urologist, Associate Professor at the Department of Faculty and Endoscopic Surgery

Russian Federation, Nalchik

Alina B. Makhova

Republican Children's Clinical Multidisciplinary Center of the Ministry of Health of the Kabardino-Balkarian Republic

Email: mahov_murat@mail.ru

Nephrologist, Nephrology Department

Russian Federation, Nalchik

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