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Diagnostic and prognostic value of cystatin C in acute heart failure

Tobias Breidthardt1, Zaid Sabti2, Ronny Ziller3

  • 1Department of Internal Medicine, University of Basel, Switzerland; Cardiovascular Research Institute Basel (CRIB), University of Basel, Switzerland.

Clinical Biochemistry
|July 31, 2017
PubMed

Insights

Cystatin C does not reliably predict acute kidney injury (AKI) in acute heart failure (AHF) patients. However, it independently predicts mortality, especially when combined with BNP levels.

Area of Science:

  • Nephrology
  • Cardiology
  • Biomarker Research

Background:

  • Accurate early diagnosis of acute kidney injury (AKI) in acute heart failure (AHF) patients remains a clinical challenge.
  • Cystatin C is being investigated as a potential early biomarker for AKI detection.

Purpose of the Study:

  • To evaluate the diagnostic accuracy of Cystatin C for predicting AKI in AHF patients.
  • To assess Cystatin C's role in predicting long-term mortality in this population.

Main Methods:

  • 207 AHF patients were enrolled, with plasma Cystatin C measured at presentation and serially.
  • Diagnostic accuracy for AKI and prediction of mortality were assessed as primary and secondary endpoints, respectively.
  • Creatinine and Cystatin C levels were compared between AKI and Non-AKI groups.

Main Results:

  • Cystatin C and creatinine levels were significantly higher in AKI patients compared to Non-AKI patients at presentation.
  • The diagnostic accuracy of Cystatin C for AKI was comparable to creatinine but mediocre (AUC 0.67 vs. 0.68).
  • Cystatin C levels were higher in non-survivors and independently predicted mortality, particularly when combined with BNP.

Conclusions:

  • Plasma Cystatin C is not an adequate predictor of AKI in AHF patients.
  • Cystatin C independently predicts mortality in AHF patients, even after adjusting for renal function and other factors.
  • Combining Cystatin C with BNP may improve mortality prediction in AHF.
Abstract

Keywords:
Acute heart failureAcute kidney injuryCystatin CMortalityPrediction

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