CLINICAL RESEARCH: HEART FAILURE
Cystatin-C and mortality in elderly persons with heart failure
Michael G. Shlipak, MD, MPH*,*,
Mark J. Sarnak, MD ,
Ronit Katz, PhD ,
Linda Fried, MD, MPH ,
Stephen Seliger, MD||,
Anne Newman, MD, MPH¶,
David Siscovick, MD, MPH# and
Catherine Stehman-Breen, MD, MS**
* General Internal Medicine Section, Veterans Affairs Medical Center, and Departments of Medicine, Epidemiology, and Biostatistics, University of California, San Francisco, California
Division of Nephrology, Department of Medicine, Tufts-New England Medical Center, Boston, Massachusetts
Collaborative Health Studies Coordinating Center, Seattle, Washington
Renal Section, Medical Service, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
|| Nephrology Division, University of Washington School of Medicine, Seattle, Washington
¶ Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, and Division of Geriatric Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
# Departments of Medicine, Epidemiology and Health Services, University of Washington, Seattle, Washington
** Amgen Inc., Thousand Oaks, California
Manuscript received July 26, 2004;
revised manuscript received September 14, 2004,
accepted September 28, 2004.
* Reprint requests and correspondence: Dr. Michael G. Shlipak, General Internal Medicine Section (111A-1), Veterans Affairs Medical Center, 4150 Clement Street, San Francisco, California 94121
(Email: shlip{at}itsa.ucsf.edu).
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.
|
Abbreviations and Acronyms
| | CHS = Cardiovascular Health Study | | CI = confidence interval | | GFR = glomerular filtration rate | | HF = heart failure | | HR = hazard ratio | | MI = myocardial infarction |
|
This article has been cited by other articles:
|
|
|
|
 
N. Taglieri, W. Koenig, and J. C. Kaski
Cystatin C and Cardiovascular Risk
Clin. Chem.,
November 1, 2009;
55(11):
1932 - 1943.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
P. C. Patel, C. R. Ayers, S. A. Murphy, R. Peshock, A. Khera, J. A. de Lemos, J. A. Balko, S. Gupta, P. P.A. Mammen, M. H. Drazner, et al.
Association of Cystatin C With Left Ventricular Structure and Function: The Dallas Heart Study
Circ Heart Fail,
March 1, 2009;
2(2):
98 - 104.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. J. Shah, T. Thenappan, S. Rich, L. Tian, S. L. Archer, and M. Gomberg-Maitland
Association of Serum Creatinine With Abnormal Hemodynamics and Mortality in Pulmonary Arterial Hypertension
Circulation,
May 13, 2008;
117(19):
2475 - 2483.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. L. Carter, S. E. O'Riordan, G. L. Eaglestone, M. P. Delaney, and E. J. Lamb
Chronic kidney disease prevalence in a UK residential care home population
Nephrol. Dial. Transplant.,
April 1, 2008;
23(4):
1257 - 1264.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. S. MacGregor
How common is early chronic kidney disease?: A Background Paper prepared for the UK Consensus Conference on Early Chronic Kidney Disease
Nephrol. Dial. Transplant.,
September 1, 2007;
22(suppl_9):
ix8 - ix18.
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. Lassus, V.-P. Harjola, R. Sund, K. Siirila-Waris, J. Melin, K. Peuhkurinen, K. Pulkki, M. S. Nieminen, and for the FINN-AKVA Study group
Prognostic value of cystatin C in acute heart failure in relation to other markers of renal function and NT-proBNP
Eur. Heart J.,
August 1, 2007;
28(15):
1841 - 1847.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
L. Pucci, S. Triscornia, D. Lucchesi, C. Fotino, G. Pellegrini, E. Pardini, R. Miccoli, S. Del Prato, and G. Penno
Cystatin C and Estimates of Renal Function: Searching for a Better Measure of Kidney Function in Diabetic Patients
Clin. Chem.,
March 1, 2007;
53(3):
480 - 488.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. G. Shlipak, R. Katz, M. J. Sarnak, L. F. Fried, A. B. Newman, C. Stehman-Breen, S. L. Seliger, B. Kestenbaum, B. Psaty, R. P. Tracy, et al.
Cystatin C and Prognosis for Cardiovascular and Kidney Outcomes in Elderly Persons without Chronic Kidney Disease
Ann Intern Med,
August 15, 2006;
145(4):
237 - 246.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. S. Jaffe, L. Babuin, and F. S. Apple
Biomarkers in Acute Cardiac Disease: The Present and the Future
J. Am. Coll. Cardiol.,
July 4, 2006;
48(1):
1 - 11.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
G. L. Smith, J. H. Lichtman, M. B. Bracken, M. G. Shlipak, C. O. Phillips, P. DiCapua, and H. M. Krumholz
Renal Impairment and Outcomes in Heart Failure: Systematic Review and Meta-Analysis
J. Am. Coll. Cardiol.,
May 16, 2006;
47(10):
1987 - 1996.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. M. O'Hare, A. B. Newman, R. Katz, L. F. Fried, C. O. Stehman-Breen, S. L. Seliger, D. S. Siscovick, and M. G. Shlipak
Cystatin C and Incident Peripheral Arterial Disease Events in the Elderly: Results From the Cardiovascular Health Study
Arch Intern Med,
December 12, 2005;
165(22):
2666 - 2670.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
