Diagnostic and prognostic value of cystatin C in acute heart failure

Publication date: Available online 26 July 2017
Source:Clinical Biochemistry
Author(s): Tobias Breidthardt, Zaid Sabti, Ronny Ziller, Frank Rassouli, Raphael Twerenbold, Nikola Kozhuharov, Etienne Gayat, Samyut Shrestha, Sara Barata, Patrick Badertscher, Jasper Boeddinghaus, Thomas Nestelberger, Christian Mueller
BackgroundThe 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.Methods207 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.ResultsAt 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).ConclusionPlasma 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.



from #AlexandrosSfakianakis via Alexandros G.Sfakianakis on Inoreader http://ift.tt/2eOatQl
via IFTTT