Presented at e-Poster corner in 29th congress of ESICM @ Mico Milano Congressi , Italy

1. Serum cystatin-c versus creatine phosphokinase
to predict acute kidney injury according to rifle criteria
in adult trauma intensive care units within first 24 hours
H.R. Jamaati , M. Masjedi , F. Zand, S.M.R. Hashemian, G. Sabetian, G. Abbasi, V. Khaloo,
S.H. Tabei , A. Kafilzadeh , H. Haddad Bakhodaei
1
Presented by : Mansoor Masjedi MD
Ass. Prof. of anesthesia & Critical care consultant
Shiraz university of medical sciences ,Iran
Milan , Italy - October , 2016

2. • INTRODUCTION
 AKI is a common clinical problem in critically ill pts which independently
predicts poor outcome.
 Despite significant improvements in therapeutics, its mortality and morbidity
remains high.
 A major reason for this is the lack of early markers for AKI and hence an
unacceptable delay in initiating therapy.
 AKI, as a component of the crush syndrome, is the 2nd cause of death after
direct trauma, although it can be prevented by early and vigorous intravenous
fluid therapy .
 Few studies have evaluated the predictive value of biomarkers for early
diagnosis of AKI in trauma.
2
Serum Cys-c vs CPK to predict AKI according to Rifle criteria
in adult trauma ICUs within first 24 hrs

3. • OBJECTIVES
To evaluate and compare
the predictive value of serum Cys-c with CPK
for early diagnosis of AKI
in adult trauma pts admitted in ICU
3
Serum Cys-c vs CPK to predict AKI according to Rifle criteria
in adult trauma ICUs within first 24 hrs

4. • METHODS
o Retrospective interrogation of prospectively collected data of 300 adult
trauma pts aged≥18 yrs admitted and stayed more than 24 hrs in ICU.
o We measured Cys-c & CPK of previously collected and freezed serum samples
o Impression of AKI was applied according to RIFLE criteria in ICU within first
24hr ( early AKI)
o Association of Cys-c and CPK with different stages of AKI were evaluated &
compared
Your Date Here
Your Footer Here 4
Serum Cys-c vs CPK to predict AKI according to Rifle criteria
in adult trauma ICUs within first 24 hrs

5. • RESULTS
 The median age was 34.8 ( 18 - 80 ) yrs, 90% were male .
 The crude prevalence of AKI was 193 ( 65%) with a maximum RIFLE category of :
• Risk in 121 ( 40.3% )
• Injury in 67 (22.3%)
• Failure 5 (1.7%)
 Younger age and male sex were independently associated with higher risk of AKI in the
first 24 hrs after trauma .
 Mean APACHE IV score between AKI and Non-AKI groups were not statistically different
5
Serum Cys-c vs CPK to predict AKI according to Rifle criteria
in adult trauma ICUs within first 24 hrs

6. • RESULTS (cont'd)
• Considering serum Cys-c ,
• lower frequency of AKI ( 144 , 63.2% ) in pts with Cys-c < 0.78
• higher ( 49 , 71 % ) in pts with Cys-c ≥ 0.78
( p value = 0.001 ).
• According to serum CPK ,
• lowest frequency of AKI ( 87, 56.1 % ) in pts with CPK < 2000
• highest ( 18 , 90% ) in pts with CPK of 5000-10000
( p value = 0.003)
6
Serum Cys-c vs CPK to predict AKI according to Rifle criteria
in adult trauma ICUs within first 24 hrs

7. • RESULTS (cont'd)
Diagnosis of AKI ,
• Cys-c; significant odds ratio of 5.874 ( p value: 0.003 with 95% CI ; 1,79-1 9.23 )
in comparison with
• CPK; no correlation (odds ratio of 1 ).
7
Serum Cys-c vs CPK to predict AKI according to Rifle criteria
in adult trauma ICUs within first 24 hrs

8. RESULTS (cont'd)
Sensitivity and specificity ,
Both Cys-c and CPK of 1st day could not be
considered to have high sensitivity and
specificity (area under the curve 0.565
and 0.61 8 , respectively ) by plotting ROC
curve
8
Serum Cys-c vs CPK to predict AKI according to Rifle criteria
in adult trauma ICUs within first 24 hrs

9. CONCLUSION
In adult trauma victims admitted in ICU,
serum Cys-c but not CPK
could predict development of early AKI
9
Serum Cys-c vs CPK to predict AKI according to Rifle criteria
in adult trauma ICUs within first 24 hrs

10. Hope to see you in
shiraz - Iran
Thanks for your patience &
attention 10