Diagnostic accuracy of cystatin C compared to serum creatinine for the estimation of renal dysfunction in adults and children--a meta-analysis.
OBJECTIVE
To perform a systematic review comparing the diagnostic accuracy of CysC with SCr.


METHODS
MEDLINE and EMBASE (January 1984-February 2006) were searched. Studies included i) evaluated CysC against a recognised 'gold standard' method for determining GFR using a receiver operating characteristics (ROC) curve analysis and ii) included data that could be extracted into a 2x2 table.


RESULTS
The search identified 27 population groups in 24 studies (n=2007) that compared the diagnostic accuracy of CysC with SCr. The diagnostic odds ratios (DORs) (95% CI) of predicting renal dysfunction derived from a Moses-Littenberg linear regression model were 3.99 (3.41-4.57) for CysC and 2.79 (2.12-3.46) for SCr.


CONCLUSIONS
The diagnostic accuracy for impaired renal function favours CysC. However, the confidence intervals for the pooled DORs for the biomarkers overlap. The ability of CysC (cut-off values between 0.9 and 1.4 mg/L) to rule in renal impairment (as measured by inulin-determined GFR of 60-79 mL/min/1.73 m2) in persons in whom this is suspected is large and conclusive.
Roos
Juliana F
JF
School of Pharmacy, University of Queensland, Brisbane, QLD 4072, Australia. jroos@pharmacy.uq.edu.au
Doust
Jenny
J
Tett
Susan E
SE
Kirkpatrick
Carl M J
CM
D002648:Child; D003404:Creatinine / Q000097:blood*; D055316:Cystatin C; D015891:Cystatins / Q000097:blood*; D005919:Glomerular Filtration Rate; D006801:Humans; D007674:Kidney Diseases / Q000097:blood / Q000175:diagnosis* / Q000503:physiopathology; D007677:Kidney Function Tests; D008875:Middle Aged; D012680:Sensitivity and Specificity
C525030:CST3 protein, human; D055316:Cystatin C; D015891:Cystatins; D003404:Creatinine