Assessment of Serum Cystatin C and Creatinine in Monitoring Pre-eclampsia BC12-BC15
Dr. SMR Usha,
Adarsh Vista, Villa 85, Vignana Nagar Main Road, Vibuthipura, Bengaluru-560037, Karnataka, India.
Introduction: Pre-eclampsia is one of the common pregnancy related hypertensive disorders often accompanied with proteinuria with or without oedema. It is associated with risk of preterm labour, Intrauterine Growth Restriction (IUGR), perinatal and maternal mortality. The development of pre-eclampsia is believed to be multifactorial; however the exact aetiopathogenesis of pre-eclampsia remains debatable. The development of early predictive markers for timely prediction/detection, orderly management and prevention of the disorder can improve overall outcome.
Aim: To determine the diagnostic efficacy of serum cystatin C as a biomarker of renal health in pre-eclampsia and to compare it with conventional renal parameter creatinine.
Materials and Methods: This case-control study was conducted in the Department of Biochemistry, Raja Rajeswari Medical College and Hospital, Bengaluru, Karnataka, India. The study group included 50 pre-eclamptic women aged 18-35 years and 50 age-matched healthy pregnant women. Serum cystatin C was estimated by immunoturbidimetry method and serum creatinine by Isotope Dilution Mass Spectrometry (IDMS) traceable Jaffeâ€™s kinetic method. The data were analysed using unpaired Studentâ€™s t-test, p<0.05 was considered statistically significant. Analysis of variance (ANOVA) was used to compare Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP), cystatin C and creatinine between groups. Pearsonâ€™s correlation coefficient analysis was used to determine the correlation between study parameters. Receiver Operating Characteristic (ROC) curve was used to assess the diagnostic efficacy of study parameters.
Results: In the present study, a significant increase in serum cystatin C levels in pre-eclampsia (p<0.001), compared to creatinine (p=0.126) was observed. ANOVA analysis in mild, severe pre-eclampsia cases and controls showed a significant difference in the level of cystatin C between the groups (p<0.001), whereas no statistically significant difference was observed in the level of creatinine (p=0.06). A positive correlation was observed between SBP (r-value 0.47; p<0.001) and DBP (r-value 0.42; p<0.01) with cystatin C. Creatinine showed a weak positive correlation with SBP (r-value 0.17; p=0.23) and DBP (r-value 0.10; p=0.48). ROC curve analysis revealed that in pre-eclampsia cases, cystatin C exhibited better diagnostic efficacy than creatinine.
Conclusion: In the present study, the diagnostic role of cystatin C in pre-eclampsia was evaluated. The study findings indicate that cystatin C has a better predictive value than currently used creatinine for diagnosing renal damage, even in its early stages. Therefore, cystatin C holds potential for identification of pregnant women at risk of developing renal complications of pre-eclampsia.