| BackgroundWith the application of new techniques and new drugs,anesthetic safety has been improved significantly.However,there was still a mortality of 0.56-4%,and the incidences of cardiovascular complications,cerebrovascular accidents and acute renal injury were 2-11%,0.6-5.1% and 2-30% respectively.Therefore,how to predict and prevent postoperative complications is an important issue in the field of anesthesiology and surgery.Cystatin C is a cysteine protease inhibitor containing 120 amino acids produced by nearly all human cells.It is a low molecular mass protein(13.4 kDa)that is freely filtered by the glomerulus and then reabsorbed and fully catabolized,but not secreted,by proximal renal tubules.In the past few years,cystatin C has been proposed as a more reliable and sensitive marker of renal function than serum creatinine.In addition,cystatin C is an important inhibitor of cathepsin B and other cysteine proteases,playing an important role in regulating the process of cell survival and death.Thus,it's closely related to many diseases.Plenty of evidences have suggested that high concentration of serum cystatin C is closely related to cardiovascular events.Studies about cystatin C in the central nervous system has attracted interests.Cystatin C is related to Alzheimer's disease,Parkinson's disease,stroke,etc.Moreover,our previous studies have shown that cystatin C may have neuroprotective effects.Therefore,people have tried to use cystatin C to predict the prognosis of diseases,such as the prognosis of cardiovascular disease,and to study the correlation between cystatin C and coronary heart disease prognosis,but these studies were mostly done in elderly patients with renal dysfunction.Can cystatin C predict the outcome of patients undergoing cardiac surgery? There is no report yet.Therefore,we have designed this retrospective study to analyze and evaluate the correlation between serum cystatin C level and postoperative outcomes in patients undergoing cadiac surgery.ObjectiveTo investigate the correlation between serum cystatin C level and outcomes after cardiac surgery.MethodsThe medical records of patients undergoing cardiac surgery in our hospital between January 1,2011 and October 1,2015 were reviewed and screened according to the inclusion and exclusion criteria.The preoperative and postoperative cystatin C levels,postoperative nosocomial complications and death were recorded.A total of 5170 cases were involved.ResultsPostoperative cystatin C value was positively correlated with incidences of SIRS,respiratory complications,renalrenal failure,neurological complications,cardiac complications at 24 h after surgery,MODS score and duration of ICU stay after cardiac surgery.And the correlations were most significant between cystatin C and MODS score(r = 0.473),renal failure(r = 0.372),and duration of ICU stay(r = 0.409)(P < 0.001).The area under the curve for the receiver-operating characterwastic of cystatin C to predict renal failure after cardiac surgery was 0.749,the cut-off value of cystatin C to predict renal failure was > 1.455 mg/L,with sensitivity and specificity of 0.513 and 0.838 respectively.The area under the curve for the receiver-operating characterwastic of cystatin C to predict neurological complications after cardiac surgery was 0.717,the cut-off value of cystatin C to predict neurological complications was > 1.415 mg/L,with sensitivity and specificity of 0.610 and 0.754,respectively.Change of cystatin C to the baseline was positively correlated with the incidence of respiratory complications,neurological complications,renal failure,MODS score and ICU stay time(P < 0.001),particularly with renal failure(r = 0.198),MODS score(r = 0.243)and ICU stay time(r = 0.217).ConclusionElevated serum cystatin C concentration can predict the incidence of complications after cardiac surgery,including renal failure,MODS and neurological complications,etc.It helps to predict the postoperative complications and facilitate intervention promptly. |
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