New predictive biomarkers for screening COVID-19 patients with rhabdomyolysis in combination with cystatin C

Abstract

Abstract Purpose Cystatin C (CysC) has been linked to the prognosis of Corona Virus Disease 2019 (COVID-19). The study aims to investigate a predictor correlated with CysC screening for poor prognosis in COVID-19 patients combined with skeletal muscle (SKM) impairment and rhabdomyolysis (RM). Methods A single-center retrospective cohort analysis was carried out. Demographic information, clinical data, laboratory test results, and clinical outcome data were gathered and analyzed. Results According to the inclusion and exclusion criteria, 382 patients were included in this study. The subjects were divided into three groups based on CysC tertiles. Multivariate analysis revealed that SaO2 (HR 0.946, 95%CI: 0.906-0.987, P = 0.011), CysC (HR 2.124, 95%CI: 1.223-3.689, P = 0.008), AST (HR 1.009, 95%CI. 1.000-1.018, P = 0.041), and hypersensitive CRP (HR 1.005, 95%CI: 1.000-1.010, P = 0.045) were significantly associated with survivals. The area under curve (AUC) in the model characterized by RM incidence was 0.819 (0.698-0.941), as shown by CysC ROC curves. LDH*CysC and AST*CysC had better predictive values than CysC, and the best prediction for RM, with an AUC of 0.880 (0.796,0.964) for LDH*CysC (P<0.05, vs CysC) and 0.925 (0.878,0.972) for AST*CysC (P<0.05, vs CysC). Conclusion CysC is an essential evaluation indicator for COVID-19 patients’ prognosis. AST*CysC and LDH*CysC have superior predictive value to CysC for SKM, RM, and death, and optimal classification for RM.