The role of cystatin C in evaluating the severity and predicting the hospital mortality of patients with community-acquired pneumonia_West China Medical Journal

Authors：

YANG Ting ^1,2 , ZENG Zijian ³ , SHEN Yongchun ^1,2 , WANG Hao ^1,2 , WAN Chun ^1,2 ,  WEN Fuqiang ^1,2

1. Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
2. Division of Pulmonary Diseases, State Key Laboratory of Biotherapy of China, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
3. West China School of Medicine, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

WEN Fuqiang, Email: wenfuqiang.scu@gmail.com

Keywords：

Cystatin C; C-reactive protein; Community-acquired pneumonia; Severity; Prognosis

DOI：

10.7507/1002-0179.201710027

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Objective To determine the role of serum cystatin C in evaluating the severity and predicting in-hospital mortality in patients with community-acquired pneumonia (CAP). Methods The clinical data of 176 patients with CAP treated between January 2015 and October 2016 were collected in a retrospective way. The CURB-65 score was used to assess the severity. The serum levels of cystatin C and C-reactive protein (CRP) on admission were measured. The correlations between cystatin C and CURB-65 score and between cystatin C and CRP were calculated. Receiver operating characteristic curve was used to determine the ability of cystatin C in predicting in-hospital mortality. Results The serum level of cystatin C increased with the increasing CURB-65 score (P<0.001). The serum level of cystatin C was correlated positively with CRP level (r_s=0.190, P<0.011). There were 22 patients died in hospital, the mean serum cystatin C level of non-survivor was significantly higher than that of survivors [(1.51±0.56)vs. (1.02±0.29) mg/L, P<0.001]. At a cut-off 1.18 mg/L, the sensitivity and specificity of cystatin C in predicting in-hospital mortality were 68.18% and 81.17%, respectively. The area under the receiver operating characteristic curve was 0.793. The combination of cystatin C and CRP increased the predictive accuracy for in-hospital mortality. Conclusion Cystatin C level increases with the increaseing severity of CAP, and it may be a clinical biomarker to evaluate the severity and prognosis of patients with CAP.

Citation： YANG Ting, ZENG Zijian, SHEN Yongchun, WANG Hao, WAN Chun, WEN Fuqiang. The role of cystatin C in evaluating the severity and predicting the hospital mortality of patients with community-acquired pneumonia. West China Medical Journal, 2018, 33(1): 28-31. doi: 10.7507/1002-0179.201710027 Copy

1.	刘凯雄, 林其昌. 社区获得性肺炎诊治若干进展. 中华医学杂志, 2016, 96(44): 3614-3616.
2.	Bender MT, Niederman MS. Improving outcomes in community-acquired pneumonia. Curr Opin Pulm Med, 2016, 22(3): 235-242.
3.	Jain S, Self WH, Wunderink RG, et al. Community-acquired pneumonia requiring hospitalization among U.S. adults. N Engl J Med, 2015, 373(5): 415-427.
4.	Restrepo MI, Mortensen EM, Rello J, et al. Late admission to the ICU in patients with community-acquired pneumonia is associated with higher mortality. Chest, 2010, 137(3): 552-557.
5.	万晓华, 刘向祎, 文江平, 等. 表观健康人群血清胱抑素 C 参考区间的初步调查. 中国医药导报, 2016, 13(25): 138-141.
6.	Xu Y, Ding Y, Li X, et al. Cystatin C is a disease-associated protein subject to multiple regulation. Immunol Cell Biol, 2015, 93(5): 442-451.
7.	周玉森, 方朝晖, 李新杰, 等. 糖尿病患者胱抑素 C 和视黄醇结合蛋白与肺部感染相关性研究. 中华医院感染学杂志, 2016, 26(16): 3705-3707.
8.	中华医学会呼吸病学分会. 社区获得性肺炎诊断和治疗指南. 中国临床医生, 2001, 29(1): 20-22.
9.	姜轶飞, 杨猛, 莫伟强. PCT 及 hs-CRP 在评估老年社区获得性肺炎严重程度中的应用价值. 中国医药导报, 2017, 14(2): 110-113.
10.	刘润幸. 使用 SPSS 作多变量观察值的 ROC 曲线分析. 中国公共卫生, 2003, 19(9), 1151-1152.
11.	Magister S, Kos J. Cystatins in immune system. J Cancer, 2013, 4(1): 45-56.
12.	Hartmann S, Schönemeyer A, Sonnenburg B, et al. Cystatins of filarial nematodes up-regulate the nitric oxide production of interferon-gamma-activated murine macrophages. Parasite Immunol, 2002, 24(5): 253-262.
13.	Gren ST, Janciauskiene S, Sandeep S, et al. The protease inhibitor cystatin C down-regulates the release of IL-β and TNF-α in lipopolysaccharide activated monocytes. J Leukoc Biol, 2016, 100(4): 811-822.
14.	Zhang M, Li YL, Yang X, et al. Serum cystatin C as an inflammatory marker in exacerbated and convalescent COPD patients. Inflammation, 2016, 39(2): 625-631.
15.	Hu GP, Wu YK, Zhou YM, et al. Cystatin C as a predictor of in-hospital mortality after exacerbation of COPD. Respir Care, 2016, 61(7): 950-957.
16.	Lee YT, Chen SC, Shyu LY, et al. Significant elevation of plasma cathepsin B and cystatin C in patients with community-acquired pneumonia. Clin Chim Acta, 2012, 413(5/6): 630-635.
17.	杨涛, 徐丽, 周敏, 等. 监测血清胱抑素 C 在老年社区获得性肺炎治疗中的临床价值. 老年医学与保健, 2016, 22(6): 375-377, 400.
18.	Mbata GC, Chukwuka CJ, Onyedum CC. The CURB-65 scoring system in severity assessment of Eastern Nigerian patients with community-acquired pneumonia: a prospective observational study. Prim Care Respir J, 2013, 22(2): 175-180.
19.	张帅, 张虹霞, 李晓辉, 等. C 反应蛋白在社区获得性肺炎严重度及预后评估中的作用. 中国综合临床, 2012, 28(2): 119-121.

1. 刘凯雄, 林其昌. 社区获得性肺炎诊治若干进展. 中华医学杂志, 2016, 96(44): 3614-3616.
2. Bender MT, Niederman MS. Improving outcomes in community-acquired pneumonia. Curr Opin Pulm Med, 2016, 22(3): 235-242.
3. Jain S, Self WH, Wunderink RG, et al. Community-acquired pneumonia requiring hospitalization among U.S. adults. N Engl J Med, 2015, 373(5): 415-427.
4. Restrepo MI, Mortensen EM, Rello J, et al. Late admission to the ICU in patients with community-acquired pneumonia is associated with higher mortality. Chest, 2010, 137(3): 552-557.
5. 万晓华, 刘向祎, 文江平, 等. 表观健康人群血清胱抑素 C 参考区间的初步调查. 中国医药导报, 2016, 13(25): 138-141.
6. Xu Y, Ding Y, Li X, et al. Cystatin C is a disease-associated protein subject to multiple regulation. Immunol Cell Biol, 2015, 93(5): 442-451.
7. 周玉森, 方朝晖, 李新杰, 等. 糖尿病患者胱抑素 C 和视黄醇结合蛋白与肺部感染相关性研究. 中华医院感染学杂志, 2016, 26(16): 3705-3707.
8. 中华医学会呼吸病学分会. 社区获得性肺炎诊断和治疗指南. 中国临床医生, 2001, 29(1): 20-22.
9. 姜轶飞, 杨猛, 莫伟强. PCT 及 hs-CRP 在评估老年社区获得性肺炎严重程度中的应用价值. 中国医药导报, 2017, 14(2): 110-113.
10. 刘润幸. 使用 SPSS 作多变量观察值的 ROC 曲线分析. 中国公共卫生, 2003, 19(9), 1151-1152.
11. Magister S, Kos J. Cystatins in immune system. J Cancer, 2013, 4(1): 45-56.
12. Hartmann S, Schönemeyer A, Sonnenburg B, et al. Cystatins of filarial nematodes up-regulate the nitric oxide production of interferon-gamma-activated murine macrophages. Parasite Immunol, 2002, 24(5): 253-262.
13. Gren ST, Janciauskiene S, Sandeep S, et al. The protease inhibitor cystatin C down-regulates the release of IL-β and TNF-α in lipopolysaccharide activated monocytes. J Leukoc Biol, 2016, 100(4): 811-822.
14. Zhang M, Li YL, Yang X, et al. Serum cystatin C as an inflammatory marker in exacerbated and convalescent COPD patients. Inflammation, 2016, 39(2): 625-631.
15. Hu GP, Wu YK, Zhou YM, et al. Cystatin C as a predictor of in-hospital mortality after exacerbation of COPD. Respir Care, 2016, 61(7): 950-957.
16. Lee YT, Chen SC, Shyu LY, et al. Significant elevation of plasma cathepsin B and cystatin C in patients with community-acquired pneumonia. Clin Chim Acta, 2012, 413(5/6): 630-635.
17. 杨涛, 徐丽, 周敏, 等. 监测血清胱抑素 C 在老年社区获得性肺炎治疗中的临床价值. 老年医学与保健, 2016, 22(6): 375-377, 400.
18. Mbata GC, Chukwuka CJ, Onyedum CC. The CURB-65 scoring system in severity assessment of Eastern Nigerian patients with community-acquired pneumonia: a prospective observational study. Prim Care Respir J, 2013, 22(2): 175-180.
19. 张帅, 张虹霞, 李晓辉, 等. C 反应蛋白在社区获得性肺炎严重度及预后评估中的作用. 中国综合临床, 2012, 28(2): 119-121.

West China Medical Journal

The role of cystatin C in evaluating the severity and predicting the hospital mortality of patients with community-acquired pneumonia

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