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Non-linear association of cystatin C and all-cause mortality of heart failure: A secondary analysis based on a
Tao Zheng1, A-Mei Tang1, Yuan-Lei Huang1
1Department of Cardiology, The First Affiliated Hospital of Guizhou University of Traditional Chinese Medicine, Guiyang, Guizhou, China.
Insights
Elevated Cystatin-C (CysC) levels in Chinese heart failure patients signal increased mortality risk. A threshold of 2.5 mg/L indicates a danger zone, with higher CysC significantly raising death risk.
Area of Science:
- Cardiology
- Biomarkers
- Public Health
Background:
- Previous studies link basal Cystatin-C (CysC) to mortality in heart failure (HF).
- Generalizability to Chinese HF patients is uncertain due to prior study limitations and data gaps.
- This study addresses the association in a Chinese cohort.
Purpose of the Study:
- To investigate the association between baseline Cystatin-C (CysC) and all-cause mortality in Chinese patients with heart failure (HF).
- To identify potential thresholds of CysC indicative of increased mortality risk.
Main Methods:
- Secondary analysis of a retrospective cohort of 1966 Chinese HF patients (2016-2019).
- Baseline CysC as the exposure variable, all-cause death at 28 days, 90 days, and 6 months as outcomes.
- Adjusted for demographic data, comorbidities, organ function, and HF severity.
Main Results:
- Mortality rates were 1.83% (28-day), 2.09% (90-day), and 2.85% (6-month).
- Non-linear associations between CysC and all-cause mortality were observed, with an inflection point around 2.5 mg/L.
- Above 2.5 mg/L, each 1 mg/L increase in CysC significantly elevated 28-day (RR 2.07), 90-day (RR 2.51), and 6-month (RR 2.25) mortality risk.
Conclusions:
- Baseline CysC levels around 2.5 mg/L may represent a danger threshold for short-term mortality in Chinese HF patients.
- Exceeding this threshold is associated with a more than doubling of all-cause mortality risk for each 1 mg/L increment.
Background:
Prior reports have revealed that basal Cystatin-C (CysC) is positively associated with all-cause death in patients with heart failure (HF). Yet, this positive association is not necessarily generalizable to Chinese HF patients due to methodological limitations and lack of data from Chinese patients.
Materials And Methods:
We performed secondary data mining based on a retrospective cohort dataset published on the internet. This dataset contains 2008 patients with HF who were admitted to a tertiary hospital in Sichuan Province, China from 2016 to 2019. The exposure variable was baseline CysC and the outcome variable was all-cause death on day 28, day 90, and month 6. Covariates were baseline measurements, including demographic data, drug use, comorbidity score, organ function status (heart, kidney), and severity of heart failure.
Results:
Among 1966 selected participants, the mortality rates at 28 days, 90 days and 6 months were 1.83% (36/1966), 2.09% (41/1966) and 2.85% (56/1966) respectively. After adjustment for confounders, the non-linear associations between CysC and all-cause deaths were observed. We calculated the inflection points were about 2.5 mg/L of CysC. On the right of inflection point, each increase of 1 mg/L in CysC was associated with an increase in the risk of 28-day mortality (Relative risk [RR], 2.07; 95% confidence interval [CI], 1.09 to 3.93; P = 0.0266), 90-day mortality (RR, 2.51; 95% CI, 1.38 to 4.57; P = 0.003), and 6-month mortality (RR,2.25; 95% CI, 1.37 to 3.70; P < 0.001).
Conclusion:
Our findings suggest that values about 2.5 mg/l of cystatin could be a danger threshold for the short-term risk of death in heart failure. Exceeding this threshold, for every 1 mg/L increase in CysC, the risk of all-cause mortality increased by more than one time.
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