Cystatin C and eGFR_CKD-EPI-CysC: novel biomarkers for renal impairment diagnosis and two-year progression-free survival in multiple myeloma

Abstract

To evaluate cystatin C (CysC) and estimation of glomerular filtration rate (GFR) calculated using the formula, CKD-EPI-CysC (eGFR_CKD-EPI-CysC) for renal impairment diagnosis and predicting the prognosis of patients with multiple myeloma (MM). One hundred-fourteen patients with MM and 38 healthy individuals were recruited for the study. Data on clinical characteristics and renal function-related biochemical indicators were collected and analyzed. Patients with MM had increased levels of CysC (1.25 (0.97–2.31) vs. 0.84 (0.80–0.92), respectively, p < 0.001) and decreased levels of eGFR_CKD-EPI-CysC (53.0 (24.4–81.1) vs. 97.2 (87.0–104.5), respectively, p < 0.001), compared with healthy individuals. There were significantly more patients with elevated CysC levels than with elevated sCr levels (64.9% vs. 41.2%, respectively, p < 0.001). The CKD-EPI-CysC formula detected more patients with eGFR < 60 ml/(min × 1.73 m²) than the CKD-EPI-sCr formula (52.63% vs. 37.72%, respectively, p < 0.001). Correlation analysis found that only CysC, eGFR_CKD-EPI-CysC, and eGFR_{CKD-EPI-sCr-CysC} strongly correlated with β₂-microglobulin in group ISS-I. Logistic regression analysis was used to screen CysC (OR = 1.495, 95% CI = 1.097–2.038, p = 0.011) and eGFR_CKD-EPI-CysC (OR = 0.980, 95% CI = 0.967–0.993, p = 0.003) as independent prognostic indicators for 2-year-progression-free survival (PFS) of patients with MM. Receiver operating characteristic curve analysis found that CysC values >1.70 mg/L had 67.6% sensitivity and 65.2% specificity and eGFR_CKD-EPI-CysC values <38.62 ml/(min × 1.73 m²) had 65.2% sensitivity and 67.6% specificity for 2-year PFS of patients with MM. In summary, CysC and eGFR_CKD-EPI-CysC were more sensitive than sCr and eGFR_CKD-EPI-sCr for predicting renal impairment in patients newly diagnosed with MM. Increased CysC and decreased eGFR_CKD-EPI-CysC levels were effective predictors of 2-year PFS of patients with MM.

Keywords:

• Multiple myeloma
• cystatin C
• glomerular filtration rate
• renal impairment
• prognosis

Author contributions

JN prepared the manuscript. JN and DZ edited the manuscript. JS, HH, JY and JN collected the data. JN, DZ and JQ reviewed the manuscript and supervised this study. All the authors have read and approved the final version of the manuscript.

Disclosure statement

The authors declare no competing interests.

Additional information

Funding

This work was supported by Foundation of Engineering Research Center of Drug Technology for Diagnosis and Treatment of Blood and Vascular Diseases, Ministry of Education [GCZ202001].