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Journal Article Epublish 5 citations

PubMed: 36359231 DOI: 10.3390/biomedicines10112708

Differential Bias for Creatinine- and Cystatin C- Derived Estimated Glomerular Filtration Rate in Critical COVID-19.

Biomedicines 10(11)

Authors: Anders O Larsson, Michael Hultström, Robert Frithiof, Ulf Nyman, Miklos Lipcsey, Mats B Eriksson

Affiliations

  • Department of Medical Sciences, Section of Clinical Chemistry, Uppsala University, 751 85 Uppsala, Sweden.
  • Department of Surgical Sciences, Anaesthesiology and Intensive Care Medicine, Uppsala University, 751 85 Uppsala, Sweden.
  • Department of Medical Cell Biology, Integrative Physiology, Uppsala University, 751 23 Uppsala, Sweden.
  • Department of Epidemiology, McGill University, Montréal, QC H3A 0G4, Canada.
  • Lady Davis Institute of Medical Research, Jewish General Hospital, Montréal, QC H3T 1E2, Canada.
  • Department of Translational Medicine, Division of Medical Radiology, Lund University, 221 85 Malmö, Sweden.
  • Hedenstierna Laboratory, Department of Surgical Sciences, Uppsala University, 751 85 Uppsala, Sweden.
  • NOVA Medical School, New University of Lisbon, 1099-085 Lisbon, Portugal.

Abstract

COVID-19 is a systemic disease, frequently affecting kidney function. Dexamethasone is standard treatment in severe COVID-19 cases, and is considered to increase plasma levels of cystatin C. However, this has not been studied in COVID-19. Glomerular filtration rate (GFR) is a clinically important indicator of renal function, but often estimated using equations (eGFR) based on filtered metabolites. This study focuses on sources of bias for eGFRs (mL/min) using a creatinine-based equation (eGFR) and a cystatin C-based equation (eGFR) in intensive-care-treated patients with COVID-19. This study was performed on 351 patients aged 18 years old or above with severe COVID-19 infections, admitted to the intensive care unit (ICU) in Uppsala University Hospital, a tertiary care hospital in Uppsala, Sweden, between 14 March 2020 and 10 March 2021. Dexamethasone treatment (6 mg for up to 10 days) was introduced 22 June 2020 (n = 232). Values are presented as medians (IQR). eGFR in dexamethasone-treated patients was 69 (37), and 74 (46) in patients not given dexamethasone ( = 0.01). eGFR was not affected by dexamethasone. eGFR in females was 94 (20), and 75 (38) in males ( = 0.00001). Age and maximal CRP correlated negatively to eGFR and eGFR, whereas both eGFR equations correlated positively to BMI. In ICU patients with COVID-19, dexamethasone treatment was associated with reduced eGFR. This finding may be explained by corticosteroid-induced increases in plasma cystatin C. This observation is important from a clinical perspective since adequate interpretation of laboratory results is crucial.

MeSH

Bias, Creatinine, Glomerular Filtration Rate, Dexamethasone, Adrenal Cortex Hormones, Kidney, Biomarkers, Covid-19, Therapeutics, Intensive Care Units, Cystatin C, Plasma, Cystatins

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