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Published on: March 6, 2021
Pretransplantation Cystatin C, but not Creatinine, Predicts 30-day Cardiovascular Events and Mortality in Liver
H-M Kwon1, Y-J Moon1, K-W Jung1
1Department of Anesthesiology and Pain Medicine, Laboratory for Cardiovascular Dynamics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Insights
Cystatin C better predicts cardiovascular events and death in liver transplant recipients with normal creatinine than creatinine itself. This finding aids in better risk stratification for these patients.
Area of Science:
- Nephrology
- Cardiology
- Hepatology
- Transplantation Medicine
Background:
- Renal dysfunction is linked to cardiovascular dysfunction.
- Accurate renal assessment is crucial for liver transplant (LT) recipients due to its impact on prognosis.
- Cystatin C is a sensitive biomarker for renal function, outperforming creatinine in detecting mild dysfunction.
Purpose of the Study:
- To compare cystatin C and creatinine in predicting 30-day major cardiovascular events (MACE) and all-cause mortality.
- To evaluate the efficacy of cystatin C versus creatinine for risk stratification in LT recipients with normal pretransplantation serum creatinine levels.
Main Methods:
- 1181 LT recipients with pretransplantation creatinine ≤1.4 mg/dL were analyzed.
- Patients were stratified into tertiles based on cystatin C and creatinine levels.
- 30-day MACE included troponin I elevation, arrhythmia, congestive heart failure, death, and cerebrovascular events.
Main Results:
- Higher cystatin C tertiles correlated with increased risk of 30-day MACE and all-cause mortality after adjustment.
- The highest cystatin C tertile showed a 1.62-fold increased risk for MACE and 1.96-fold increased risk for death.
- Elevated creatinine levels did not significantly predict MACE or mortality in this cohort.
Conclusions:
- Pretransplantation cystatin C is a superior predictor of MACE and mortality in LT recipients with normal creatinine compared to creatinine.
- Cystatin C can improve risk stratification for LT recipients, identifying risks not apparent with creatinine testing.
Background:
The connection between renal dysfunction and cardiovascular dysfunction has been consistently shown. In patients with liver cirrhosis, renal dysfunction shows a tight correlation with prognosis after liver transplantation (LT); therefore, precise renal assessment is mandatory. Cystatin C, a sensitive biomarker for assessing renal function, has shown superiority in detecting mild renal dysfunction compared to classical biomarker creatinine. In this study, we aimed to compare cystatin C and creatinine in predicting 30-day major cardiovascular events (MACE) and all-cause mortality in LT recipients with normal serum creatinine levels.
Patients And Methods:
Between May 2010 and October 2015, 1181 LT recipients (mean Model for End-stage Liver Disease score 12.1) with pretransplantation creatinine level ≤1.4 mg/dL were divided into tertiles according to each renal biomarker. The 30-day MACE was a composite of troponin I >0.2 ng/mL, arrhythmia, congestive heart failure, death, and cerebrovascular events.
Results:
The highest tertile of cystatin C (≥0.95 mg/L) was associated with a higher risk for a 30-day MACE event (odds ratio: 1.62; 95% confidence interval: 1.07 to 2.48) and higher risk of death (hazard ratio: 1.96; 95% confidence interval: 1.04 to 3.67) than the lowest tertile (<0.74 mg/L) after multivariate adjustments. However, the highest tertile of creatinine level showed neither increasing MACE event rate nor worse survival rate compared with the lowest tertile (both insignificant after multivariate adjustment).
Conclusions:
Pretransplantation cystatin C is superior in risk prediction of MACE and all-cause mortality in LT recipients with normal creatinine, compared to creatinine. It would assist further risk stratification which may not be detected with creatinine.
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