J Korean Med Sci.  2020 Sep;35(37):e306. 10.3346/jkms.2020.35.e306.

A Meta-Analysis on the Performance of Cystatin C- versus Creatinine-based eGFR Equations in Predicting Vancomycin Clearance

• Mohd Tahir NA
• Saffian SM
• Islahudin FH
• Abdul Gafor AH
• Makmor-Bakry M

• KMID: 2506561
• DOI: http://doi.org/10.3346/jkms.2020.35.e306

Abstract

Background
The objective of this study was to compare the performance of cystatin C- and creatinine-based estimated glomerular filtration rate (eGFR) equations in predicting the clearance of vancomycin.
Methods
MEDLINE and Embase databases were searched from inception up to September 2019 to identify all studies that compared the predictive performance of cystatin C- and/or creatinine-based eGFR in predicting the clearance of vancomycin. The prediction errors (PEs) (the value of eGFR equations minus vancomycin clearance) were quantified for each equation and were pooled using a random-effects model. The root mean squared errors were also quantified to provide a metric for imprecision.
Results
This meta-analysis included evaluations of seven different cystatin C- and creatinine-based eGFR equations in total from 26 studies and 1,234 patients. The mean PE (MPE) for cystatin C-based eGFR was 4.378 mL min ⁻¹ (95% confidence interval [CI], −29.425, 38.181), while the creatinine-based eGFR provided an MPE of 27.617 mL min ⁻¹ (95% CI, 8.675, 46.560) in predicting clearance of vancomycin. This indicates the presence of unbiased results in vancomycin clearance prediction by the cystatin C-based eGFR equations. Meanwhile, creatinine-based eGFR equations demonstrated a statistically significant positive bias in vancomycin clearance prediction.
Conclusion
Cystatin C-based eGFR equations are better than creatinine-based eGFR equations in predicting the clearance of vancomycin. This suggests that utilising cystatin C-based eGFR equations could result in better accuracy and precision to predict vancomycin pharmacokinetic parameters.

Keyword

Cystatin C; Creatinine; Vancomycin; Clearance; eGFR

Figure

• 

  Fig. 1 Study selection process for the meta-analysis.Cr = creatinine, CysC = cystatin C, eGFR = estimated glomerular filtration rate.

• 

  Fig. 2 Forest plot for the primary analysis. (A) On the performance of pooled cystatin C- and (B) creatinine-based estimated glomerular filtration rate equations in predicting vancomycin clearance.MPE = mean prediction error, CI = confidence interval, CG = Cockcroft-Gault, 24hr-CLcr = 24-hour creatinine clearance, 8hr-CLcr = 8-hour creatinine clearance, df = degrees of freedom.

• 

  Fig. 3 Forest plot for the subgroup analysis among adult patients only. (A) On the performance of pooled cystatin C- and (B) creatinine-based estimated glomerular filtration rate equations in predicting vancomycin clearance.MPE = mean prediction error, CI = confidence interval, CG = Cockcroft-Gault, 24hr-CLcr = 24-hour creatinine clearance, 8hr-CLcr = 8-hour creatinine clearance, df = degrees of freedom.

• 

  Fig. 4 Forest plot for the sensitivity analysis. (A) On the performance of pooled cystatin C- and (B) creatinine-based estimated glomerular filtration rate equations in predicting vancomycin clearance.MPE = mean prediction error, CI = confidence interval, CG = Cockcroft-Gault, 24hr-CLcr = 24-hour creatinine clearance, 8hr-CLcr = 8-hour creatinine clearance, df = degrees of freedom.

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