Abstract | OBJECTIVES: We sought to evaluate cystatin-C, a novel measure of renal function, as a predictor of mortality in elderly persons with heart failure (HF) and to compare it with creatinine. BACKGROUND: Renal function is an important prognostic factor in patients with HF, but creatinine levels, which partly reflect muscle mass, may be insensitive for detecting renal insufficiency. METHODS: A total of 279 Cardiovascular Health Study participants with prevalent HF and measures of serum cystatin-C and creatinine were followed for mortality outcomes over a median of 6.5 years. RESULTS: Median creatinine and cystatin-C levels were 1.05 mg/dl and 1.26 mg/l. Each standard deviation increase in cystatin-C (0.35 mg/l) was associated with a 31% greater adjusted mortality risk (95% confidence interval [CI] 20% to 43%, p < 0.001), whereas each standard deviation increase in creatinine (0.39 mg/dl) was associated with a 17% greater adjusted mortality risk (95% CI 1% to 36%, p = 0.04). When both measures were combined in a single adjusted model, cystatin-C remained associated with elevated mortality risk (hazard ratio 1.60, 95% CI 1.32 to 1.94), whereas creatinine levels appeared associated with lower risk (hazard ratio 0.73, 95% CI 0.57 to 0.95). CONCLUSIONS:
Cystatin-C is a stronger predictor of mortality than creatinine in elderly persons with HF. If confirmed in future studies, this new marker of renal function could improve risk stratification in patients with HF.
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Authors | Michael G Shlipak, Ronit Katz, Linda F Fried, Nancy Swords Jenny, Catherine O Stehman-Breen, Anne B Newman, David Siscovick, Bruce M Psaty, Mark J Sarnak |
Journal | Journal of the American College of Cardiology
(J Am Coll Cardiol)
Vol. 45
Issue 2
Pg. 268-71
(Jan 18 2005)
ISSN: 0735-1097 [Print] United States |
PMID | 15653026
(Publication Type: Comparative Study, Journal Article, Research Support, Non-U.S. Gov't, Research Support, U.S. Gov't, P.H.S.)
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Chemical References |
- CST3 protein, human
- Cystatin C
- Cystatins
- Creatinine
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Topics |
- Age Factors
- Aged
- Aged, 80 and over
- Creatinine
(blood)
- Cystatin C
- Cystatins
(blood)
- Female
- Follow-Up Studies
- Glomerular Filtration Rate
- Heart Failure
(blood, mortality)
- Humans
- Male
- Pilot Projects
- Predictive Value of Tests
- Risk Assessment
- Survival Analysis
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