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The Uremic Toxin p-Cresyl Sulfate Is a New Predictor of Major Adverse Cardiovascular Events in Patients with

Laure-Anne Raillon1,2, Thomas Bochaton1,3, Griet Glorieux4

  • 1CarMeN Lab, INSERM U1060, INRAe U1397, Université Claude Bernard Lyon-1, 69500 Bron, France.

Toxins
|January 27, 2026
PubMed

Insights

In ST-elevation myocardial infarction (STEMI) patients, elevated p-cresyl-sulfate (p-CS) independently predicts major adverse cardiovascular events (MACE). P-CS shows greater predictive value than indoxyl sulfate (IS) in this population.

Area of Science:

  • Cardiology
  • Nephrology
  • Toxicology

Background:

  • ST-elevation myocardial infarction (STEMI) poses significant cardiovascular risks.
  • Gut-derived uremic toxins, indoxyl sulfate (IS) and p-cresyl-sulfate (p-CS), are linked to poor outcomes in chronic kidney disease (CKD).
  • IS predicts major adverse cardiovascular events (MACE) post-STEMI, but p-CS data is limited, especially in patients with preserved renal function.

Purpose of the Study:

  • To evaluate the predictive value of plasma IS and p-CS for MACE in STEMI patients with normal kidney function.
  • To compare the independent predictive power of IS and p-CS for MACE in this cohort.

Main Methods:

  • Plasma IS and p-CS levels were measured in 260 STEMI patients undergoing primary coronary angiography.
  • Ultra-performance liquid chromatography with fluorescence detection was used for analysis.
  • MACE prediction was assessed using Youden index for cut-offs, log-rank tests, and Cox regression.

Main Results:

  • Among 234 analyzed patients, 11.5% experienced MACE within one year.
  • Higher IS and p-CS levels were observed in patients with MACE.
  • Elevated p-CS independently predicted MACE (HR 3.79, p < 0.05), while IS lost significance after adjusting for kidney function.

Conclusions:

  • Plasma p-CS is a stronger independent predictor of MACE than IS in STEMI patients with preserved renal function.
  • These findings underscore the potential role of p-CS in the gut-heart axis and cardiovascular risk stratification.

Keywords:
ST-elevation myocardial infarction (STEMI)gut–heart axisindoxyl sulfate (IS)major adverse cardiovascular events (MACE)p-cresyl sulfate (p-CS)predictive biomarkersuremic toxins

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