Cystatin C in Acute Heart Failure Without Advanced Renal Impairment
published online 27 April 2009.
Abstract
Background
The prognostic value of cystatin C relative to glomerular filtration rate (GFR) estimated by the Modification of Diet in Renal Disease Study (MDRD) equation modified for Japan has not been investigated in acute heart failure patients with normal to moderately impaired renal function. More accurate detection of mild renal impairment might improve the risk stratification of heart failure patients, especially patients with normal to moderately impaired renal function.
Methods
Cystatin C and creatinine levels were measured on admission in 328 consecutive patients hospitalized for worsening chronic heart failure with a GFR estimated by MDRD equation modified for Japan ≥30 mL/min/1.73 m2.
Results
During a median follow-up period of 915 days, there were 52 (16%) cardiac deaths. In stepwise Cox regression analyses including cystatin C and GFR estimated by MDRD equation modified for Japan (either as continuous variables or as variables categorized into quartiles), cystatin C (P <.0001), but not GFR estimated by MDRD equation modified for Japan, was independently associated with cardiac mortality. Adjusted relative risk according to the quartiles of these markers and Kaplan-Meier analyses revealed that the cystatin C was a better marker to separate low-risk from high-risk patients. Furthermore, receiver-operating characteristic curve analyses of these markers revealed that cystatin C showed a higher precision in predicting cardiac mortality.
Conclusion
Measurements of cystatin C might improve early risk stratification compared with GFR estimated by MDRD equation modified for Japan in acute heart failure patients with normal to moderately impaired renal function.
aDepartment of Internal Medicine, Fujita Health University School of Medicine, Toyoake, Japan
bDepartment of Joint Research Laboratory of Clinical Medicine, Fujita Health University School of Medicine, Toyoake, Japan
Requests for reprints should be addressed to Junnichi Ishii, MD, Department of Joint Research Laboratory of Clinical Medicine, Fujita Health University School of Medicine, 1-98 Kutsukake-cho, Dengakugakubo, Toyoake 470-1192, Japan
Funding: None.
Conflict of Interest: None.
Authorship: We verify that all authors had access to the data and a role in writing the manuscript.
ABSTRACT
