Diagnostic and prognostic value of cystatin C in acute heart failure
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Diagnostic and prognostic value of cystatin C in acute heart failure. / Breidthardt, Tobias; Sabti, Zaid; Ziller, Ronny; Rassouli, Frank; Twerenbold, Raphael; Kozhuharov, Nikola; Gayat, Etienne; Shrestha, Samyut; Barata, Sara; Badertscher, Patrick; Boeddinghaus, Jasper; Nestelberger, Thomas; Mueller, Christian.
In: CLIN BIOCHEM, Vol. 50, No. 18, 12.2017, p. 1007-1013.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Diagnostic and prognostic value of cystatin C in acute heart failure
AU - Breidthardt, Tobias
AU - Sabti, Zaid
AU - Ziller, Ronny
AU - Rassouli, Frank
AU - Twerenbold, Raphael
AU - Kozhuharov, Nikola
AU - Gayat, Etienne
AU - Shrestha, Samyut
AU - Barata, Sara
AU - Badertscher, Patrick
AU - Boeddinghaus, Jasper
AU - Nestelberger, Thomas
AU - Mueller, Christian
N1 - Copyright © 2017 The Canadian Society of Clinical Chemists. Published by Elsevier Inc. All rights reserved.
PY - 2017/12
Y1 - 2017/12
N2 - BACKGROUND: The accurate early diagnosis of acute kidney injury (AKI) in patients with acute heart failure (AHF) is an unmet clinical need. Cystatin C might improve the early detection of AKI.METHODS: 207 patients presenting to the emergency department with AHF were enrolled. Cystatin C was measured in plasma in a blinded fashion at presentation and serially thereafter. The potential of Cystatin C levels to predict AKI was assessed as the primary endpoint. Long-term mortality was assessed as a secondary endpoint.RESULTS: At presentation, creatinine (140μmol/L [91-203] vs. 97μmol/L [76-132], p<0.01) and Cystatin C (2.00mg/L [1.30-3.08] vs. 1.45mg/L [1.00-1.90], p<0.01) levels were significantly higher in AKI compared to Non-AKI patients. The diagnostic accuracy for AKI quantified by the area under the receiver operating characteristic curve was mediocre and comparable for both markers (creatinine 0.68; 95%CI 0.58-78 vs. Cystatin C 0.67; 95%CI 0.58-0.76). Serial measurements of Cystatin C did not further increase the prognostic accuracy for AKI. Cystatin C levels were significantly higher in decedents than in survivors (1.90mg/L [1.30-2.70] vs. 1.30mg/L [1.0-1.6], p<0.001). The combination of Cystatin C and BNP levels significantly improved the prediction of mortality provided by either parameter alone. In multivariable regression analysis Cystatin C remained independently associated with mortality (HR 1.41; 95%CI 1.02-1.95).CONCLUSION: Plasma Cystatin C levels do not adequately predict AKI in patients with AHF. However, in multivariable regression analysis Cystatin C predicted mortality after the adjustment for baseline renal function, AKI, BNP levels and heart failure risk factors.
AB - BACKGROUND: The accurate early diagnosis of acute kidney injury (AKI) in patients with acute heart failure (AHF) is an unmet clinical need. Cystatin C might improve the early detection of AKI.METHODS: 207 patients presenting to the emergency department with AHF were enrolled. Cystatin C was measured in plasma in a blinded fashion at presentation and serially thereafter. The potential of Cystatin C levels to predict AKI was assessed as the primary endpoint. Long-term mortality was assessed as a secondary endpoint.RESULTS: At presentation, creatinine (140μmol/L [91-203] vs. 97μmol/L [76-132], p<0.01) and Cystatin C (2.00mg/L [1.30-3.08] vs. 1.45mg/L [1.00-1.90], p<0.01) levels were significantly higher in AKI compared to Non-AKI patients. The diagnostic accuracy for AKI quantified by the area under the receiver operating characteristic curve was mediocre and comparable for both markers (creatinine 0.68; 95%CI 0.58-78 vs. Cystatin C 0.67; 95%CI 0.58-0.76). Serial measurements of Cystatin C did not further increase the prognostic accuracy for AKI. Cystatin C levels were significantly higher in decedents than in survivors (1.90mg/L [1.30-2.70] vs. 1.30mg/L [1.0-1.6], p<0.001). The combination of Cystatin C and BNP levels significantly improved the prediction of mortality provided by either parameter alone. In multivariable regression analysis Cystatin C remained independently associated with mortality (HR 1.41; 95%CI 1.02-1.95).CONCLUSION: Plasma Cystatin C levels do not adequately predict AKI in patients with AHF. However, in multivariable regression analysis Cystatin C predicted mortality after the adjustment for baseline renal function, AKI, BNP levels and heart failure risk factors.
KW - Acute Disease
KW - Acute Kidney Injury/blood
KW - Acute-Phase Proteins/analysis
KW - Aged
KW - Biomarkers/blood
KW - Creatinine/blood
KW - Cystatin C/analysis
KW - Early Diagnosis
KW - Female
KW - Heart Failure/complications
KW - Humans
KW - Male
KW - Middle Aged
KW - Mortality
KW - Prognosis
KW - Prospective Studies
KW - ROC Curve
U2 - 10.1016/j.clinbiochem.2017.07.016
DO - 10.1016/j.clinbiochem.2017.07.016
M3 - SCORING: Journal article
C2 - 28756070
VL - 50
SP - 1007
EP - 1013
JO - CLIN BIOCHEM
JF - CLIN BIOCHEM
SN - 0009-9120
IS - 18
ER -
