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Published on: January 28, 2020
The predictive value of s-cystatin C for mortality after coronary artery bypass surgery
Alain Dardashti1, Shahab Nozohoor1, Lars Algotsson1
1Department of Cardiothoracic Surgery and Department of Anesthesia and Intensive Care, Lund University, Skane University Hospital, Lund, Sweden.
Insights
Serum cystatin C (s-cystatin C) levels and estimated glomerular filtration rate (eGFR) calculated from s-cystatin C, measured before coronary artery bypass grafting (CABG), are strong predictors of patient mortality. This finding aids in risk stratification for CABG patients.
Area of Science:
- Cardiology
- Nephrology
- Medical Diagnostics
Background:
- Coronary artery bypass grafting (CABG) is a major surgical procedure with associated mortality risks.
- Accurate prediction of mortality risk is crucial for patient management and surgical decision-making.
- Renal function markers are increasingly recognized for their prognostic value in cardiovascular disease.
Purpose of the Study:
- To investigate the predictive capability of serum creatinine (s-creatinine) and serum cystatin C (s-cystatin C) levels, along with estimated glomerular filtration rate (eGFR) at various time points, for mortality in patients undergoing CABG.
- To compare the prognostic performance of s-creatinine versus s-cystatin C in this patient cohort.
Main Methods:
- Prospective study of 1638 patients undergoing elective CABG with a median follow-up of 3.5 years.
- Renal function assessed preoperatively and at the lowest postoperative level using s-creatinine and s-cystatin C.
- eGFR calculated using multiple established formulas (MDRD, CKD-EPI for s-creatinine, CKD-EPI for s-cystatin C, combined CKD-EPI, and c-aPDult for s-cystatin C).
- Cox proportional hazards models and C-statistics employed to identify independent predictors of mortality and assess predictive accuracy.
Main Results:
- 30-day mortality was 0.8%; 5-year survival was 90.0%.
- Preoperative s-cystatin C demonstrated superior predictive power for overall mortality compared to s-creatinine (AUC 0.794 vs 0.653).
- Both preoperative s-cystatin C (HR 1.65) and s-cystatin C-based eGFR (HR 0.96) were independent predictors of mortality.
- Higher preoperative s-cystatin C levels were significantly associated with increased mortality risk.
Conclusions:
- Preoperative serum cystatin C levels are a robust predictor of mortality following elective CABG.
- Estimated glomerular filtration rate derived from serum cystatin C also serves as a significant independent predictor of post-CABG mortality.
- These findings highlight the importance of preoperative renal function assessment using cystatin C for risk stratification in CABG patients.
Objectives:
To evaluate serum creatinine (s-creatinine) and serum cystatin C (s-cystatin C) levels and estimated glomerular filtration rate (eGFR) at different time points as predictors for mortality in patients undergoing coronary artery bypass grafting (CABG).
Methods:
A total of 1638 patients undergoing elective CABG were studied prospectively over a median follow-up of 3.5 years (range, 2.0-5.0 years). Renal function was assessed by a comparison of s-creatinine, s-cystatin C values measured preoperatively and at the lowest postoperative level of renal function. The eGFR was estimated by different formulas: Modification of Diet in Renal Disease, the 2009 Chronic Kidney Disease Epidemiology (CDK-EPI) for s-creatinine, the 2012 CKD-EPI formula for s-cystatin C, the 2012 CKD-EPI formula for s-cystatin C and s-creatinine in combination, and the Caucasian Asian, Pediatric, and Adult subjects formula for s-cystatin C. Cox proportional hazards model analysis and C-statistics were used to evaluate independent predictors of mortality and to assess the predictive ability of the different renal function measures.
Results:
The 30-day mortality was 0.8%. Overall survival was 96.1% ± 0.4% at 2 years and 90.0% ± 1.2% at 5 years. Preoperative s-cystatin C showed greater predictive power than s-creatinine for overall mortality (area under the curve, 0.794 vs 0.653). Preoperative s-cystatin C (hazard ratio [HR], 1.65; 95% confidence interval [CI], 1.36-1.99) and eGFR based on s-cystatin C (HR, 0.96; 95% CI, 0.95-0.98), were both independent predictors of mortality. The unadjusted HR for mortality comparing the lowest preoperative cystatin C quintile (Q1) with Q4-Q5 were as follows: Q1 versus Q5, HR, 2.0; 95% CI, 1.6-2.5 (P < .001); Q1 versus Q4, HR, 1.6; 95% CI, 1.2-2.2 (P = .005).
Conclusions:
The s-cystatin C level and s-cystatin C-based eGFR measured preoperatively are strong predictors for mortality after elective CABG.
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