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Clin Biochem. 2017 Dec;50(18):1007-1013. doi: 10.1016/j.clinbiochem.2017.07.016. Epub 2017 Jul 26.

Diagnostic and prognostic value of cystatin C in acute heart failure.

Author information

1
Department of Internal Medicine, University of Basel, Switzerland; Cardiovascular Research Institute Basel (CRIB), University of Basel, Switzerland. Electronic address: tobias.breidthardt@usb.ch.
2
Cardiovascular Research Institute Basel (CRIB), University of Basel, Switzerland; Department of Cardiology all at the University Hospital Basel, University of Basel, Switzerland.
3
Cardiovascular Research Institute Basel (CRIB), University of Basel, Switzerland; Department of Geriatric Medicine, Spital Interlaken, Switzerland.
4
Medical University Clinic, Kantonsspital, Aarau, Switzerland.
5
Cardiovascular Research Institute Basel (CRIB), University of Basel, Switzerland; Department of Cardiology all at the University Hospital Basel, University of Basel, Switzerland; Department of General and Interventional Cardiology, Hamburg University Heart Center, Hamburg, Germany.
6
Hôpital Lariboisière APHP, University of Paris, France.
7
Department of Internal Medicine, University of Basel, Switzerland; Cardiovascular Research Institute Basel (CRIB), University of Basel, Switzerland; Department of Cardiology all at the University Hospital Basel, University of Basel, Switzerland.

Abstract

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.

KEYWORDS:

Acute heart failure; Acute kidney injury; Cystatin C; Mortality; Prediction

[Indexed for MEDLINE]

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