Comparison of cystatin C and creatinine to determine the incidence of composite adverse outcomes in HIV-infected individuals. Issue 2 (February 2015)

• Record Type: Journal Article
• Authors: Yanagisawa, Naoki; Sasaki, Shugo; Suganuma, Akihiko; Imamura, Akifumi; Ajisawa, Atsushi; Ando, Minoru
• Is Part Of: Journal of infection and chemotherapy. Volume 21:Issue 2(2015:Feb.)
• Page Start: 84
• Page End: 89
• Publication Date: 2015-02
• Subjects: Chemotherapy -- Periodicals; Infection -- Periodicals; Communicable diseases -- Chemotherapy -- Periodicals; 615.5805
• DOI: 10.1016/j.jiac.2014.10.006
• Languages: English
• ISSNs: 1341-321X

Abstract

<abstract xml:lang="en" abstract-type="author" id="abs0010"> <title id="sectitle0010">Abstract</title> <sec> <title id="sectitle0015">Background</title> <p id="abspara0010">Cystatin C is an overall biomarker of pathophysiologic abnormalities that accompany chronic kidney disease (CKD). The utility of cystatin C is not fully understood in an HIV-infected population.</p> </sec> <sec> <title id="sectitle0020">Methods</title> <p id="abspara0015">This prospective study investigated 661 HIV-infected individuals for 4 years to determine the incidence of adverse outcomes, including all-cause mortality, cardiovascular disease, and renal dysfunction. The risk of developing the outcomes was discriminated with a 4 color-coded classification in a 3 × 6 contingency table, that combined 3 grades of dipstick proteinuria with 6 grades of estimated glomerular filtration rate (eGFR) calculated using either serum creatinine (eGFRcr) or cystatin C (eGFRcy): green, low risk; yellow, moderately increased risk; orange, high risk; and red, very high risk. The cumulative incidence of the outcomes was assessed by the Kaplan–Meier method, and the association between color-coded risk and the time to outcome was evaluated using multivariate proportional hazards analysis.</p> </sec> <sec> <title id="sectitle0025">Results</title> <p id="abspara0020">Compared with eGFRcr, the use of eGFRcy reduced the prevalence of risk ≥orange by 0.8%. The adverse outcomes were significantly more likely to occur to the patients with baseline risk category ≥orange than those with ≤yellow, independent of risk categories based on eGFRcr or eGFRcy. However, in multivariate analysis, risk category ≥orange with eGFRcy-based classification was significantly associated with adverse outcomes, but not the one with eGFRcr.</p> </sec> <sec> <title id="sectitle0030">Conclusions</title> <p id="abspara0025">Replacing creatinine by cystatin C in the CKD color-coded risk classification may be appropriate to discriminate HIV-infected patients at increased risk of a poor prognosis.</p> </sec> </abstract>