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Published on: May 10, 2013
Limited value of cystatin-C over estimated glomerular filtration rate for heart failure risk stratification
Elisabet Zamora1, Josep Lupón, Marta de Antonio
1Heart Failure Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.
Insights
Estimated glomerular filtration rate and cystatin-C show similar prognostic value in heart failure patients. Cystatin-C offers improved risk prediction for those with moderate renal dysfunction.
Area of Science:
- Cardiology
- Nephrology
- Biomarker Research
Background:
- Estimated glomerular filtration rate (eGFR) is standard for renal function assessment in heart failure (HF).
- Previous research identified the Cockcroft-Gault formula as optimal for eGFR in HF prognosis.
Purpose of the Study:
- To compare the prognostic capabilities of eGFR and cystatin-C in an outpatient HF population.
- To evaluate the combined prognostic value of eGFR and cystatin-C.
Main Methods:
- Analysis of 879 consecutive HF outpatients with a median follow-up of 3.46 years.
- Utilized adjusted Cox regression and reclassification indices (IDI, NRI) to assess prognostic value.
- Compared area under the curve (AUC) for eGFR and cystatin-C.
Main Results:
- Both eGFR and cystatin-C demonstrated similar prognostic value (AUC 0.763 vs. 0.765).
- Multivariable analysis showed comparable hazard ratios for eGFR and cystatin-C.
- Cystatin-C provided improved risk reclassification only in patients with moderate renal dysfunction (eGFR 30-60 ml/min/1.73 m²).
Conclusions:
- eGFR and cystatin-C possess similar long-term predictive power in ambulatory HF patients.
- Cystatin-C may enhance prognostication specifically for HF patients with moderate renal impairment.
Background:
To compare the prognostic value of estimated glomerular filtration rate, cystatin-C, an alternative renal biomarker, and their combination, in an outpatient population with heart failure. Estimated glomerular filtration rate is routinely used to assess renal function in heart failure patients. We recently demonstrated that the Cockroft-Gault formula is the best among the most commonly used estimated glomerular filtration rate formulas for predicting heart failure prognosis.
Methodology/Principal Findings:
A total of 879 consecutive patients (72% men, age 70.4 years [P(25-75) 60.5-77.2]) were studied. The etiology of heart failure was mainly ischemic heart disease (52.7%). The left ventricular ejection fraction was 34% (P(25-75) 26-43%). Most patients were New York Heart Association class II (65.8%) or III (25.9%). During a median follow-up of 3.46 years (P(25-75) 1.85-5.05), 312 deaths were recorded. In an adjusted model, estimated glomerular filtration rate and cystatin-C showed similar prognostic value according to the area under the curve (0.763 and 0.765, respectively). In Cox regression, the multivariable analysis hazard ratios were 0.99 (95% CI: 0.98-1, P = 0.006) and 1.14 (95% CI: 1.02-1.28, P = 0.02) for estimated glomerular filtration rate and cystatin-C, respectively. Reclassification, assessed by the integration discrimination improvement and the net reclassification improvement indices, was poorer with cystatin-C (-0.5 [-1.0;-0.1], P = 0.024 and -4.9 [-8.8;-1.0], P = 0.013, respectively). The value of cystatin-C over estimated glomerular filtration rate for risk-stratification only emerged in patients with moderate renal dysfunction (eGFR 30-60 ml/min/1.73 m(2), chi-square 12.9, P<0.001).
Conclusions/Significance:
Taken together, the results indicate that estimated glomerular filtration rate and cystatin-C have similar long-term predictive values in a real-life ambulatory heart failure population. Cystatin-C seems to offer improved prognostication in heart failure patients with moderate renal dysfunction.
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