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Cystatin C-based CKD-EPI equations and N-terminal pro-B-type natriuretic peptide for predicting outcomes in acutely
Pedro J Flores-Blanco1, Sergio Manzano-Fernández, Juan I Pérez-Calvo
1Division of Cardiology, University Hospital Virgen de la Arrixaca, School of Medicine, University of Murcia, Murcia, Spain.
Insights
Combining N-terminal pro-B-type natriuretic peptide (NT-proBNP) and cystatin C-based estimated glomerular filtration rate (eGFR) improves prediction of adverse outcomes in acute decompensated heart failure (ADHF) patients. This dual approach offers enhanced prognostic information beyond individual markers.
Area of Science:
- Cardiology
- Nephrology
- Biomarker Research
Background:
- Acute decompensated heart failure (ADHF) patients face adverse outcomes predicted by natriuretic peptides and renal impairment.
- Evaluating complementary prognostic roles of NT-proBNP and cystatin C (CysC)-based CKD-EPI equations is crucial for ADHF management.
Purpose of the Study:
- To assess the combined prognostic value of NT-proBNP and CysC-based CKD-EPI equations for estimating GFR in ADHF patients.
- To determine if this combination improves prediction of adverse outcomes compared to individual markers.
Main Methods:
- 613 consecutive ADHF patients were enrolled.
- Plasma NT-proBNP and CysC levels were measured at admission.
- GFR was estimated using CysC-based CKD-EPI equations; primary endpoint was all-cause death or heart failure readmission.
Main Results:
- An eGFR <60 mL/min/1.73 m² and NT-proBNP >3251 pg/mL independently predicted adverse outcomes after multivariate adjustment.
- The combination of low eGFR and high NT-proBNP identified patients with the highest risk.
- Integrating NT-proBNP and CysC-based eGFR improved prediction accuracy for adverse outcomes.
Conclusions:
- The combination of NT-proBNP and CysC-based eGFR offers superior prediction of outcomes in ADHF patients compared to either marker alone.
- This combined approach provides valuable complementary prognostic information to existing risk factors.
Background:
In patients with acute decompensated heart failure (ADHF), both natriuretic peptides and renal impairment predict adverse outcomes. Our aim was to evaluate the complementary prognosis role of N-terminal pro-B-type natriuretic peptide (NT-proBNP) and the newly developed Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations based on cystatin C (CysC) for glomerular filtration rate (GFR) estimation in ADHF patients.
Hypothesis:
Renal impairment assessed by CysC-based CKD-EPI equations and natriuretic peptides have complementary prognostic value in ADHF patients.
Methods:
The study included 613 consecutive patients presenting with ADHF. At admission, plasma levels of NT-proBNP and CysC were determined. The GFR was estimated using CysC-based CKD-EPI equations. The primary endpoint was death from any cause and heart failure readmission.
Results:
During the median follow-up of 365 days (interquartile range, 227-441 days), 323 patients (0.65 %patient-year) died or were readmitted for heart failure. After multivariate adjustment, estimated GFR <60 mL/min/1.73 m(2) and NT-proBNP >3251 pg/mL were independent predictors of adverse outcomes (P < 0.01). The combination of GFR <60 mL/min/1.73 m(2) and NT-proBNP >3251 pg/mL was associated with the highest risk of adverse outcomes. Furthermore, reclassification analyses demonstrated that use of both NT-proBNP and CysC-based CKD-EPI equations resulted in improving the accuracy for adverse outcomes prediction.
Conclusions:
In patients with ADHF, the combination of NT-proBNP with estimated GFR using CysC-based CKD-EPI equations better predicts outcomes than either parameter alone and adds valuable complementary prognosis information to other established risk factors.
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