title: Early Acute Kidney Injury based on Serum Creatinine or Cystatin C in Intensive Care Unit after Major Trauma.
abstract: BACKGROUND
  Acute kidney injury (AKI) is a common problem in critically ill patients and is independently associated with increased morbidity and mortality. Recently, serum cystatin C has been shown to be superior to creatinine in early detection of renal function impairment. We compared estimated GFR based on serum cystatin C with estimated GFR based on serum creatinine for early detection of renal dysfunction according to the RIFLE criteria.
  
  
  METHODS
  During 9 months, three hundred post trauma patients that were referred to the intensive care unit of a referral trauma hospital were recruited. Serum creatinine and serum cystatin C were measured and the estimated GFR within 24 hours of ICU admission was calculated. The primary outcome was the incidence of AKI according to the RIFLE criteria within 2(nd) to 7(th) day of admission.
  
  
  RESULTS
  During the first week of ICU admission, 21% of patients experienced AKI. After adjusting for major confounders, only the patients with first day's serum cystatin level higher than 0.78 mg/l were at higher risk of first week AKI (OR=6.14, 95% CI: 2.5-14.7, P<0.001). First day's serum cystatin C and injury severity score were the major risk factors for ICU mortality (OR=3.54, 95% CI: 1.7-7.4, P=0.001) and (OR=4.6, 95% CI: 1.5-14, P=0.007), respectively.
  
  
  CONCLUSIONS
  Within 24 hours after admission in ICU due to multiple trauma, high serum cystatin C level may have prognostic value in predicting early AKI and mortality during ICU admission. However, such correlation was not seen neither with creatinine nor cystatin C based GFR.
authors.affiliation: Shiraz Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
authors.forename: Farid
authors.initials: F
authors.lastname: Zand
authors.affiliation: Trauma Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
authors.forename: Golnar
authors.initials: G
authors.lastname: Sabetian
authors.affiliation: Department of Anesthesia, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
authors.forename: Ghasem
authors.initials: G
authors.lastname: Abbasi
authors.affiliation: Department of Epidemiology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
authors.forename: Abbas
authors.initials: A
authors.lastname: Rezaianzadeh
authors.affiliation: Research Center in Traditional Medicine and History of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
authors.forename: Alireza
authors.initials: A
authors.lastname: Salehi
authors.affiliation: Trauma Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
authors.forename: Abbas
authors.initials: A
authors.lastname: Khosravi
authors.affiliation: Shiraz Transplant Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
authors.forename: Bita
authors.initials: B
authors.lastname: Geramizadeh
authors.affiliation: Trauma Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
authors.forename: Shuja Ulhaq
authors.initials: SU
authors.lastname: Taregh
authors.affiliation: Department of Critical Care Nursing, Jahrom University of Medical Sciences, Shiraz, Iran.
authors.forename: Shohreh
authors.initials: S
authors.lastname: Javadpour
keywords: Acute kidney injury; Creatinine; Cystatin C; Glomerular filtration rate; Trauma