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J Am Coll Cardiol, 2005; 45:268-271, doi:10.1016/j.jacc.2004.09.061 © 2005 by the American College of Cardiology Foundation |
* 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.
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