Dataset Information

Prognostic value of creatinine-to-cystatin c ratio in patients with type 2 diabetes mellitus: a cohort study.

ABSTRACT:

Background

The serum creatinine-to-cystatin C ratio (Scr/Scys) has been suggested as a surrogate marker of muscle mass and a predictor of adverse outcomes in many diseases. However, the prognostic value of Scr/Scys in patients with type 2 diabetes mellitus (T2DM) is unknown. The aim of this study is to assess the prognostic value of Scr/Scys in patients with T2DM.

Methods

In this retrospective observational study, we enrolled 3668 T2DM patients undergoing coronary angiography (CAG). Serum creatinine (Scr) and serum cystatin C (Scys) levels were measured at admission. The study population was separated into low muscle mass (low-MM) and normal muscle mass (normal-MM) groups by Scr/Scys cut-off point. The association between muscle mass and long-term all-cause mortality was examined using Cox regression analysis.

Results

During a median follow-up of 4.9 (3.0-7.1) years, a total of 352 (9.6%) patients died. The mortality was higher in patients with low-MM as compared with patients with normal-MM (11.1% vs. 7.3%; p < 0.001). Low muscle mass was associated with increased risk for long-term all-cause mortality, regardless of whether Scr/Scys were used as a continuous variable (adjusted hazard ratio: 1.08 [95% confidence interval (CI) 1.03 to 1.13]; p = 0.009) or a categorial variable (adjusted hazard ratio: 1.36 [95% CI 1.03 to 1.75]; p = 0.021).

Conclusion

Low muscle mass assessed by Scr/Scys was associated with increased risk of long-term all-cause mortality in diabetic patients.

SUBMITTER: Wei W

PROVIDER: S-EPMC9686100 | biostudies-literature | 2022 Nov

REPOSITORIES: biostudies-literature

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Publications

Prognostic value of creatinine-to-cystatin c ratio in patients with type 2 diabetes mellitus: a cohort study.

Wei Wen W Li Shanggang S Liu Jin J Liu Yong Y Chen Kaihong K Chen Shiqun S Tu Mei M Chen Hong H

Diabetology & metabolic syndrome 20221123 1

<h4>Background</h4>The serum creatinine-to-cystatin C ratio (Scr/Scys) has been suggested as a surrogate marker of muscle mass and a predictor of adverse outcomes in many diseases. However, the prognostic value of Scr/Scys in patients with type 2 diabetes mellitus (T2DM) is unknown. The aim of this study is to assess the prognostic value of Scr/Scys in patients with T2DM.<h4>Methods</h4>In this retrospective observational study, we enrolled 3668 T2DM patients undergoing coronary angiography (CAG ...[more]

PMID: 36419088

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Project description:BackgroundIdentifying patients with low muscle mass is crucial for the diagnosis of sarcopenia. Although the Creatinine/Cystatin C (Cr/CysC) is recommended as a simplified indicator to identify patients with low muscle mass, its ability to assess muscle mass and predict a poor prognosis has not been validated. We aimed to determine the diagnosis value of Cr/CysC for low muscle mass and examine the association of Cr/CysC with mortality.MethodsIn this cohort study we analyzed data from the National Health and Nutrition Examination Survey from 1999 to 2002. Follow-up was conducted up to December, 2015. Appendicular skeletal mass was calculated based on dual-energy X-ray absorptiometry (DXA) scans. Low muscle mass was defined referring to five international diagnostic criteria. The diagnostic value of Cr/CysC as a replacement indicator of muscle mass was measured using area under the curve, positive percent agreement, negative percent agreement and kappa. Cox proportional hazards regression models were developed to examine the association between Cr/CysC and risk of mortality.ResultsThis cohort study of 3,741 adults comprised 1,823 females (48.73%), with a weighted mean (SE) age of 44.46 (0.43) years. The positive percent agreement of Cr/CysC for the diagnosis of low muscle mass was poor (40.23-58.74%), except for Foundation of the National Institute of Health (FNIH) criteria (80.90-58.97%). But the negative percent agreement of Cr/CysC for the diagnosis of low muscle mass was high (males: 62.15-88.17%; females: 55.26-82.30%). Moreover, the risk of death was reduced by 2% per 0.01 unit increase in Cr/CysC (aHR, 0.98; 95% CI, 0.98-0.99, P < 0.001).ConclusionsCr/CysC performed well not only in identifying non-sarcopenia cases, especially when based on FNIH diagnostic criteria, but also in revealing a positive association with higher risk of mortality. The optimal cut-off values for Cr/CysC were <1.0 in males and <0.8 in females. Expanding the use of Cr/CysC would allow for early and targeted treatment of sarcopenia.

Project description:Background & aimsSarcopenia is associated with poor clinical outcomes of patients who underwent esophagectomy. The current diagnostic criteria for sarcopenia are complex and laborious. We aimed to employ the simple and economic indicator sarcopenia index (SI = creatinine/cystatin C ×100) to screen for sarcopenia and to evaluate its prognostic value in patients with esophageal cancer (EC).MethodsOlder participants in the National health and nutrition examination survey (NHANES) database (1999-2002) were divided into three groups according to tertiles of the SI value to explore the feasibility of SI in the diagnosis of sarcopenia. Restricted cubic spline (RCS) was utilized to show the non-linear relationship between all-cause mortality and SI. Patients with EC admitted to Jinling Hospital were enrolled to validate the efficacy and prognostic value of SI. Cut-off values of SI were determined using receiver operating characteristic curves. Multivariable logistic analyses and Cox analyses were used to identify the independent factors of postoperative complications and long-term survival, respectively.ResultsA total of 989 participants were identified from the NHANES database. SI showed the diagnostic value of sarcopenia (tertile 1 vs. tertile 3: odds ratio [OR]=3.67, 95% confidence interval [CI]: 1.52-8.87, p=0.004; tertile 2 vs. tertile 3: OR=1.79, 95% CI: 0.75-4.28, p=0.191) adjusted for race, gender, and body mass index (BMI). Individuals with SI ≤ 68 had a poorer overall survival (OS) (hazard ratio [HR]=2.14, 95% CI: 1.71-2.68, p<0.001), and the RCS plot showed that the all-cause mortality risk gradually decreased with the increase in SI. Then, 203 patients with EC were enrolled, of which 76 patients were diagnosed with sarcopenia. There was a linear correlation between SI and skeletal muscle index and prealbumin, indicating that SI was reliable for diagnosing sarcopenia. Patients in the high sarcopenia risk group (Male: SI < 62; Female: SI < 55) showed a higher incidence of complications (OR=3.50, 95% CI: 1.85-6.61, p<0.001) and poorer long-term survival (HR=2.62, 95% CI: 1.02-6.77, p=0.046).ConclusionSI could be used to identify sarcopenia in patients with EC, and it is a useful prognostic factor of postoperative complications and long-term survival.

Project description:BackgroundSarcopenia, characterized by loss of muscle mass and strength, has been linked to various health outcomes, including diabetes mellitus. This study aims to investigate the association of sarcopenia index, based on serum creatinine and cystatin C levels, with incident diabetes mellitus in middle-aged and older adults in China.MethodsThis study extracted data from 2015 to 2020 China Health and Retirement Longitudinal Study (CHARLS), including age ≥ 45-year adults without diabetes mellitus at baseline. Sarcopenia index was calculated based on serum creatinine and cystatin C levels, and incident diabetes mellitus was assessed through follow-up surveys. Cox proportional hazards regression models were used to analyze the association between sarcopenia index and incident diabetes mellitus, adjusting for potential confounders, with hazard ratio (HR) with 95% confidence interval (95% CI) reported.ResultsDuring a mean follow-up period of 5.0 years, a total of 501 new cases of diabetes were recorded. A total of 7718 participants were included in the analysis. The median age was 60 years, and 46.2% were male. During a mean follow-up period of 5.0 years, 501 cases of incident diabetes mellitus were identified. After adjusting for covariates, Compared with participants in the lowest quartile, the corresponding diabetes HRs (95% CIs) for participants in the second, third, and fourth quartiles were 0.930 (95% CI 0.724-1.193; P = 0.567); 0.892 (95% CI 0.685-1.162; P = 0.398), 0.869 (95% CI 0.657-1.150; P = 0.327). Restricted cubic spline curves revealed that incident rate decreased with increase in sarcopenia index.ConclusionsThis study provides national longitudinal evidence in China on the association of sarcopenia index, based on serum creatinine and cystatin C levels, with incident diabetes mellitus in middle-aged and older adults. Our findings suggest that sarcopenia index may be a useful biomarker for predicting the risk of diabetes mellitus in this population.

Dataset Information

Prognostic value of creatinine-to-cystatin c ratio in patients with type 2 diabetes mellitus: a cohort study.

Background

Methods

Results

Conclusion

Publications

Prognostic value of creatinine-to-cystatin c ratio in patients with type 2 diabetes mellitus: a cohort study.

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