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Serum cystatin C for risk stratification of prediabetes and diabetes populations

Kun Xiong1, Shiran Zhang1, Pingting Zhong1

  • 1State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, 510000, Guangdong Province, China; Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, 510000, Guangdong Province, China; Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, 510000, Guangdong Province, China.

Diabetes & Metabolic Syndrome
|October 28, 2023
PubMed

Insights

Serum cystatin C levels predict higher risks of mortality and vascular issues in individuals with diabetes and prediabetes. This biomarker improves risk assessment for these conditions.

Area of Science:

  • Endocrinology
  • Nephrology
  • Cardiology
  • Ophthalmology

Background:

  • The link between serum cystatin C and vascular outcomes in diabetes is not fully understood, and it remains unclear in prediabetes.
  • This study aimed to determine if serum cystatin C levels can predict the future risk of mortality and vascular complications in individuals with prediabetes and diabetes.

Purpose of the Study:

  • To investigate the predictive value of serum cystatin C levels for mortality and vascular outcomes in prediabetes and diabetes.
  • To assess the impact of cystatin C on retinal microvascular changes and neural layer degeneration in diabetes.

Main Methods:

  • Utilized UK Biobank data from 85,371 participants with prediabetes/diabetes and baseline cystatin C levels, with a 14-year follow-up.
  • Employed Cox hazards models to analyze associations between cystatin C, mortality (all-cause, cause-specific), and vascular outcomes (MI, stroke, ESRD, DR).
  • Incorporated data from 1136 diabetes subjects in the Guangzhou Diabetic Eye Study (GDES) using SS-OCT and OCTA to examine in vivo retinal changes.

Main Results:

  • The highest quartile of cystatin C was associated with significantly increased risks for all-cause, cardiovascular, cancer, and other-cause mortality.
  • Elevated cystatin C levels correlated with higher risks of myocardial infarction, stroke, end-stage renal disease, and diabetic retinopathy.
  • Adding cystatin C to conventional models significantly improved risk prediction (C-statistic) for various mortality and vascular outcomes. GDES analysis showed increased cystatin C linked to retinal neural layer thinning and microvascular rarefaction.

Conclusions:

  • Serum cystatin C serves as a valuable biomarker for refining risk stratification in patients with prediabetes or diabetes.
  • Elevated cystatin C levels are associated with increased mortality and a spectrum of vascular complications, including specific ocular changes.
Abstract

Keywords:
Cystatin CDiabetesMortalityPrediabetesVascular outcomes

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