Cystatin C in Acute Heart Failure Without Advanced Renal Impairment

Naruse, Hiroyuki; Ishii, Junnichi; Kawai, Tomoko; Hattori, Kousuke; Ishikawa, Makoto; Okumura, Masanori; Kan, Shino; Nakano, Tadashi; Matsui, Shigeru; Nomura, Masanori; Hishida, Hitoshi; Ozaki, Yukio

doi:10.1016/j.amjmed.2008.10.042

« Previous Next »The American Journal of Medicine
Volume 122, Issue 6 , Pages 566-573, June 2009

Cystatin C in Acute Heart Failure Without Advanced Renal Impairment

Hiroyuki Naruse, MD
- Department of Internal Medicine, Fujita Health University School of Medicine, Toyoake, Japan
Junnichi Ishii, MD
- Department 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
Tomoko Kawai, MD
- Department of Internal Medicine, Fujita Health University School of Medicine, Toyoake, Japan
Kousuke Hattori, MD
- Department of Internal Medicine, Fujita Health University School of Medicine, Toyoake, Japan
Makoto Ishikawa, MD
- Department of Internal Medicine, Fujita Health University School of Medicine, Toyoake, Japan
Masanori Okumura, MD
- Department of Internal Medicine, Fujita Health University School of Medicine, Toyoake, Japan
Shino Kan, MD
- Department of Internal Medicine, Fujita Health University School of Medicine, Toyoake, Japan
Tadashi Nakano, MD
- Department of Internal Medicine, Fujita Health University School of Medicine, Toyoake, Japan
Shigeru Matsui, MD
- Department of Internal Medicine, Fujita Health University School of Medicine, Toyoake, Japan
Masanori Nomura, MD
- Department of Internal Medicine, Fujita Health University School of Medicine, Toyoake, Japan
Hitoshi Hishida, MD
- Department of Internal Medicine, Fujita Health University School of Medicine, Toyoake, Japan
Yukio Ozaki, MD
- Department of Internal Medicine, Fujita Health University School of Medicine, Toyoake, Japan

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.

Keywords: Acute heart failure, Creatinine, Cystatin C, Glomerular filtration rate, MDRD, Prognosis, Renal impairment