The diagnostic value of serum creatinine and cystatin c in evaluating glomerular filtration rate in patients with chronic kidney disease: a systematic literature review and meta-analysis

// Xilian Qiu 1, * , Chunyong Liu 2, * , Yuqiu Ye 3, * , Huiqun Li 3 , Yanbing Chen 4 , Yongmei Fu 3 , Zhenjie Liu 2 , Xianzhang Huang 2 , Yunqiang Zhang 5 , Xueyuan Liao 5 , Hongyong Liu 5, * , Wenbo Zhao 3 and Xun Liu 5, 3 1 Department of Laboratory Medicine, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China 2 Department of Laboratory Medicine, The Second Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou, China 3 Department of Nephrology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China 4 Medical genetic center, Guangdong Women And Children Hospital, Guangzhou, Guangdong, China 5 Division of Nephrology, The 3rd Affiliated Hospital of Sun Yat-sen University, Yuedong Hospital, Meizhou, China * These authors contributed equally to this work Correspondence to: Xun Liu, email: naturestyle@163.com Wenbo Zhao, email: bobo800101@foxmail.com Hongyong Liu, email: 13823850589@139.com Keywords: creatinine, cystatin C, glomerular filtration rate, meta-analysis Received: June 07, 2017      Accepted: July 30, 2017      Published: August 16, 2017 ABSTRACT Background: Serum biomarkers, such as serum creatinine (SCr) and serum cystatin C (SCysC), have been widely used to evaluate renal function in patients who have chronic kidney disease (CKD). Objective: This article aims to assess the value of determining SCr and SCysC levels in patients that have long-term kidney disease. Approaches: MEDLINE, EmBase, the Cochrane Library and other databases were searched using both MeSH terms and text words to collect research that assessed the diagnostic value of using SCr and SCysC to evaluate Glomerular Filtration Rate (GFR) in patients with CKD. Data were converted into fourfold tables. Summary Receiver Operating Characteristic Curves and meta-analyses were accomplished via Meta-Disc version 1.4. Results: In total, 21 relevant articles involving 3112 study subjects were included in our review. Results showed that the collective sensitivity for SCr and SCysC was 0.77 (95% CI: 0.69–0.84) and 0.87 (95% CI: 0.82–0.91), respectively. The pooled specificity for SCr and SCysC was 0.91 (95% CI: 0.86–0.94) and 0.87 (95% CI: 0.82–0.91), respectively. Subgroup analyses demonstrated that when GFR cut-off values are set to 60 (ml/min/1.73 m 2 ), the pooled sensitivity is 0.94 (95% CI: 0.90–0.96) for SCysC and 0.75 (95% CI: 0.68–0.82) for SCr. Conclusions: The diagnostical accuracy for impaired kidney function favors SCysC. Confidence intervals for the pooled sensitivity and specificity for SCr and SCysC overlap. However, SCysC is more sensitive for estimating GFR than SCr when GFR cut-off values are set to 60 (ml/min/1.73 m 2 ).