Predictive value of Cystatin C combined with SOFA score for 28-day mortality in sepsis patients in emergency department
Zhang Xiangqun
Liu Bo
Zhang Hongbin
Wu Junyuan
Mei Xue
Abstract：Objective To evaluate the predictive performance of Cystatin C combined with the sequential organ failure assessment(SOFA)score for 28-day mortality in septic patients in the emergency department.Methods This retrospective cohort study included 436 adult patients diagnosed with sepsis in the emergency department of Beijing Chao-Yang Hospital,Capital Medical University between 2022 and 2024.Clinical indicators including serum Cystatin C,procalcitonin(PCT),lactate(Lac)levels,and SOFA scores were collected upon admission.The predictive performance of Cystatin C,SOFA score,and their combined model for 28-day mortality was evaluated by using receiver operating characteristic(ROC)curve.Multivariate Logistic regression was performed to identify independent predictors.Kaplan-Meier survival analysis and survival curves were also used to compare the mortality in different levels of Cystatin C and combined risk model groups.Results A total of 436 septic patients were enrolled,with a 28-day mortality rate of 22.7％.Patients in the death group were significantly older than those in the survival group(82 vs.73 years,P＜0.001)and had a higher proportion of bedridden status(11.1％vs.5.6％,P=0.058).Median levels of serum Cystatin C,Lac and SOFA scores were all significantly higher in the death group than those in the survival group(P＜0.001).Cystatin C was positively correlated with AST(r=0.115,P=0.017),ALT(r=0.134,P=0.005),WBC(r=0.141,P=0.003),Lac(r=0.131,P=0.006),PCT(r=0.262,P＜0.001),CRP(r=0.171,P＜0.001),and SOFA score(r=0.333,P＜0.001).Multivariate Logistic regression identified age(OR=1.052,95％CI 1.015-1.090,P=0.012),PCT(OR=1.138,95％CI 1.052-1.231,P=0.001),Lac(OR=1.369,95％CI 1.219-1.537,P＜0.001),Cystatin C(OR=1.785,95％CI 1.141-2.794,P=0.011),and SOFA score(OR=1.346,95％CI 1.232-1.471,P＜0.001)as independent predictors of 28-day mortality.ROC analysis showed that the AUC for Cystatin C,PCT,Lac and SOFA score was 0.748(95％CI 0.693-0.803),0.824(95％CI 0.778-0.870),0.789(95％CI0.732-0.846),and 0.835(95％CI 0.779-0.891),respectively.The combined model of Cystatin C and SOFA score had the highest AUC of 0.848(95％CI 0.794-0.902).Kaplan-Meier analysis showed that the high Cystatin C group had significantly higher in the 28-day mortality than the low Cystatin C group(log-rank P＜0.001),and the survival curve of combination model further displayed high survival stratification ability(log-rank P＜0.001).Conclusions The combination of cystatin C and SOFA score improves the predictive performance for 28-day mortality in septic patients in the emergency department.This model compensates for the limitations of SOFA score in assessing early renal dysfunction and inflammatory burden and provides a valuable tool for early identification of high-risk patients and the optimization of clinical management strategies.
Keywords：SepsisCystatin CSequential organ failure assessment(SOFA)28-day mortalityEmergency department
Publication Date：2025-07-10
Online Publishing Date：2025-08-15(First online date of this platform, not the publication date of the document)
Pages：8( 612-619 )