Abstract: SA-PO0929
Differences Between Cystatin C- and Creatinine-Based eGFR and the Risk of Postoperative Complications and Mortality
Session Information
- Pathology: Updates and Insights
November 08, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Pathology and Lab Medicine
- 1800 Pathology and Lab Medicine
Authors
- Pu, Wei-yi, Department of Nephrology, The Affiliated Wuxi People’s Hospital of Nanjing Medical University, Wuxi, Jiangsu, China
- Wang, Yiwei, Department of Anesthesiology, The Affiliated Wuxi People’s Hospital of Nanjing Medical University, Wuxi, Jiangsu, China
- Larson, Nicholas B., Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, United States
- Lieske, John C., Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, Minnesota, United States
- Zhou, Leting, Department of Nephrology, The Affiliated Wuxi People’s Hospital of Nanjing Medical University, Wuxi, Jiangsu, China
Background
Cystatin C-based eGFR (eGFR_cys) and creatinine-based eGFR (eGFR_cr) often yield discordant results. The difference between them (eGFR_diff = eGFR_cys - eGFR_cr) has been proposed to predict adverse clinical outcomes, but its association with postoperative complications and mortality remains unclear.
Methods
The primary analysis focused on 26,065 individuals from UK Biobank who underwent surgery within one year of enrolment. Participants were classified into lower (< -15 mL min-1 1.73 m-2) and higher eGFR_diff (≥ -15 mL min-1 1.73 m-2) groups. The primary outcomes were 30-day major postoperative complications and 90-day all-cause mortality. Associations were assessed via restricted cubic spline (RCS) analyses, multivariable logistic regression models, and subgroup analyses. We also conducted extended analyses with a median follow-up of 13.7 years, involving 241,006 participants.
Results
In the primary analysis, RCS modelling revealed a nonlinear association, with a threshold near −15 mL min-1 1.73 m-2(Figure 1). Compared with the higher group, lower eGFR_diff was associated with increased risks of complications (OR=1.69, 95% CI: 1.38–2.08, P<0.001) and mortality (OR=2.29, 95% CI:1.59–3.32, P<0.001) in the unadjusted models. These associations remained significant after full adjustment (complications: OR=1.53, 95% CI:1.17–1.99, P=0.001; mortality: OR=1.80, 95% CI: 1.10–2.95, P=0.018) and were consistent in extended analyses (complications: OR=1.30, 95% CI:1.19–1.34, P<0.001; mortality: OR=1.42, 95% CI:1.30–1.56, P<0.001)(Table 1). A significant interaction was observed only in BMI-stratified subgroups (P=0.008).
Conclusion
Lower eGFR_diff was independently associated with increased risks of postoperative complications and mortality, even during long-term follow-up.
Table 1. Association between eGFR_diff and postoperative complications and mortality within one year of recruitment
| eGFR_diff group | Number of cases | OR (95%CI), P value | |
| 30-day complications | Higher (reference) | 166 (2.0%) | Unadjusted: 1.69 (1.38–2.08), P <0.001 Model 1: 1.68 (1.37–2.06), P <0.001 Model 2: 1.59 (1.22–2.06), P <0.001 Model 3: 1.53 (1.17–1.99), P= 0.001 |
| Lower | 218 (1.2%) | ||
| 90-day mortality | Higher (reference) | 58 (0.7%) | Unadjusted: 2.29 (1.59–3.32), P <0.001 Model 1: 2.09 (1.44–3.03), P <0.001 Model 2: 2.18 (1.36–3.49), P =0.001 Model 3: 1.80 (1.10–2.95), P = 0.018 |
| Lower | 56 (0.3%) |
Figure 1
Funding
- NIDDK Support