Accuracy of cystatin C for the detection of abnormal renal function in children undergoing chemotherapy for malignancy: a systematic review using individual patient data

Penny Whiting, Kate Birnie, Jonathan Sterne, Catherine Jameson, Rod Skinner, Bob Phillips, Mark Barnfield, Hester Blufpand, Arend Bokenkamp, Marika Grönroos, Catherine Jameson, Petra Lankisch, Bob Philips, Rod Skinner, Jonathan Sterne, Penny Whiting, The Cystatin C In Childhood Cancer Collaboration Group

Research output: Contribution to journalArticle (Academic Journal)peer-review

3 Citations (Scopus)
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Abstract

Purpose
We conducted a systematic review and individual patient data (IPD) meta-analysis to examine the utility of cystatin C for evaluation of glomerular function in children with cancer.

Methods

Eligible studies evaluated the accuracy of cystatin C for detecting poor renal function in children undergoing chemotherapy. Study quality was assessed using QUADAS-2. Authors of four studies shared IPD. We calculated the correlation between log cystatin C and GFR stratified by study and measure of cystatin C. We dichotomized the reference standard at GFR 80 ml/min/1.73m2 and stratified cystatin C at 1mg/l, to calculate sensitivity and specificity in each study and according to age group (0-4, 5-12 and ≥13 years). We used logistic regression to estimate the association of impaired renal function with log cystatin C and quantified diagnostic accuracy using the Area Under the ROC Curve (AUC).

Results

Six studies, which used different test and reference standard thresholds, suggested that cystatin C has the potential to monitor renal function in children undergoing chemotherapy for malignancy. IPD data (504 samples, 209 children) showed that cystatin C has poor sensitivity (63%) and moderate specificity (89%). The AUC for the combined data set was 0.890 (95% CI 0.826, 0.951). Diagnostic accuracy appeared to decrease with age.

Conclusions

Cystatin C has better diagnostic accuracy than creatinine as a test for glomerular dysfunction in young people undergoing treatment for cancer. Diagnostic accuracy is not sufficient for it to replace current reference standards for predicting clinically relevant impairments that may alter dosing of important nephrotoxic agents.
Original languageEnglish
Pages (from-to)1-10
Number of pages10
JournalSupportive Care in Cancer
Early online date6 Dec 2017
DOIs
Publication statusE-pub ahead of print - 6 Dec 2017

Keywords

  • Chemotherapy
  • Children
  • Cystatin C
  • Diagnostic accuracy
  • Systematic review

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