Cystatin C in Acute Heart Failure Without Advanced Renal Impairment

Hiroyuki Naruse, Junichi Ishii, Tomoko Kawai, Kousuke Hattori, Makoto Ishikawa, Masanori Okumura, Shino Kan, Tadashi Nakano, Shigeru Matsui, Masanori Nomura, Hitoshi Hishida, Yukio Ozaki

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Abstract

Background: The prognostic value of cystatin C relative to glomerular filtration rate (GFR) estimated by the Modification of Diet in Renal Disease Study (MDRD) equation modified for Japan has not been investigated in acute heart failure patients with normal to moderately impaired renal function. More accurate detection of mild renal impairment might improve the risk stratification of heart failure patients, especially patients with normal to moderately impaired renal function. Methods: Cystatin C and creatinine levels were measured on admission in 328 consecutive patients hospitalized for worsening chronic heart failure with a GFR estimated by MDRD equation modified for Japan ≥30 mL/min/1.73 m2. Results: During a median follow-up period of 915 days, there were 52 (16%) cardiac deaths. In stepwise Cox regression analyses including cystatin C and GFR estimated by MDRD equation modified for Japan (either as continuous variables or as variables categorized into quartiles), cystatin C (P <.0001), but not GFR estimated by MDRD equation modified for Japan, was independently associated with cardiac mortality. Adjusted relative risk according to the quartiles of these markers and Kaplan-Meier analyses revealed that the cystatin C was a better marker to separate low-risk from high-risk patients. Furthermore, receiver-operating characteristic curve analyses of these markers revealed that cystatin C showed a higher precision in predicting cardiac mortality. Conclusion: Measurements of cystatin C might improve early risk stratification compared with GFR estimated by MDRD equation modified for Japan in acute heart failure patients with normal to moderately impaired renal function.

Original languageEnglish
Pages (from-to)566-573
Number of pages8
JournalAmerican Journal of Medicine
Volume122
Issue number6
DOIs
Publication statusPublished - 01-06-2009

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Cystatin C
Heart Failure
Diet Therapy
Kidney
Glomerular Filtration Rate
Japan
Mortality
Kaplan-Meier Estimate
ROC Curve
Creatinine
Regression Analysis

All Science Journal Classification (ASJC) codes

  • Medicine(all)

Cite this

Naruse, Hiroyuki ; Ishii, Junichi ; Kawai, Tomoko ; Hattori, Kousuke ; Ishikawa, Makoto ; Okumura, Masanori ; Kan, Shino ; Nakano, Tadashi ; Matsui, Shigeru ; Nomura, Masanori ; Hishida, Hitoshi ; Ozaki, Yukio. / Cystatin C in Acute Heart Failure Without Advanced Renal Impairment. In: American Journal of Medicine. 2009 ; Vol. 122, No. 6. pp. 566-573.
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abstract = "Background: The prognostic value of cystatin C relative to glomerular filtration rate (GFR) estimated by the Modification of Diet in Renal Disease Study (MDRD) equation modified for Japan has not been investigated in acute heart failure patients with normal to moderately impaired renal function. More accurate detection of mild renal impairment might improve the risk stratification of heart failure patients, especially patients with normal to moderately impaired renal function. Methods: Cystatin C and creatinine levels were measured on admission in 328 consecutive patients hospitalized for worsening chronic heart failure with a GFR estimated by MDRD equation modified for Japan ≥30 mL/min/1.73 m2. Results: During a median follow-up period of 915 days, there were 52 (16{\%}) cardiac deaths. In stepwise Cox regression analyses including cystatin C and GFR estimated by MDRD equation modified for Japan (either as continuous variables or as variables categorized into quartiles), cystatin C (P <.0001), but not GFR estimated by MDRD equation modified for Japan, was independently associated with cardiac mortality. Adjusted relative risk according to the quartiles of these markers and Kaplan-Meier analyses revealed that the cystatin C was a better marker to separate low-risk from high-risk patients. Furthermore, receiver-operating characteristic curve analyses of these markers revealed that cystatin C showed a higher precision in predicting cardiac mortality. Conclusion: Measurements of cystatin C might improve early risk stratification compared with GFR estimated by MDRD equation modified for Japan in acute heart failure patients with normal to moderately impaired renal function.",
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Naruse, H, Ishii, J, Kawai, T, Hattori, K, Ishikawa, M, Okumura, M, Kan, S, Nakano, T, Matsui, S, Nomura, M, Hishida, H & Ozaki, Y 2009, 'Cystatin C in Acute Heart Failure Without Advanced Renal Impairment', American Journal of Medicine, vol. 122, no. 6, pp. 566-573. https://doi.org/10.1016/j.amjmed.2008.10.042

Cystatin C in Acute Heart Failure Without Advanced Renal Impairment. / Naruse, Hiroyuki; Ishii, Junichi; Kawai, Tomoko; Hattori, Kousuke; Ishikawa, Makoto; Okumura, Masanori; Kan, Shino; Nakano, Tadashi; Matsui, Shigeru; Nomura, Masanori; Hishida, Hitoshi; Ozaki, Yukio.

In: American Journal of Medicine, Vol. 122, No. 6, 01.06.2009, p. 566-573.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Cystatin C in Acute Heart Failure Without Advanced Renal Impairment

AU - Naruse, Hiroyuki

AU - Ishii, Junichi

AU - Kawai, Tomoko

AU - Hattori, Kousuke

AU - Ishikawa, Makoto

AU - Okumura, Masanori

AU - Kan, Shino

AU - Nakano, Tadashi

AU - Matsui, Shigeru

AU - Nomura, Masanori

AU - Hishida, Hitoshi

AU - Ozaki, Yukio

PY - 2009/6/1

Y1 - 2009/6/1

N2 - Background: The prognostic value of cystatin C relative to glomerular filtration rate (GFR) estimated by the Modification of Diet in Renal Disease Study (MDRD) equation modified for Japan has not been investigated in acute heart failure patients with normal to moderately impaired renal function. More accurate detection of mild renal impairment might improve the risk stratification of heart failure patients, especially patients with normal to moderately impaired renal function. Methods: Cystatin C and creatinine levels were measured on admission in 328 consecutive patients hospitalized for worsening chronic heart failure with a GFR estimated by MDRD equation modified for Japan ≥30 mL/min/1.73 m2. Results: During a median follow-up period of 915 days, there were 52 (16%) cardiac deaths. In stepwise Cox regression analyses including cystatin C and GFR estimated by MDRD equation modified for Japan (either as continuous variables or as variables categorized into quartiles), cystatin C (P <.0001), but not GFR estimated by MDRD equation modified for Japan, was independently associated with cardiac mortality. Adjusted relative risk according to the quartiles of these markers and Kaplan-Meier analyses revealed that the cystatin C was a better marker to separate low-risk from high-risk patients. Furthermore, receiver-operating characteristic curve analyses of these markers revealed that cystatin C showed a higher precision in predicting cardiac mortality. Conclusion: Measurements of cystatin C might improve early risk stratification compared with GFR estimated by MDRD equation modified for Japan in acute heart failure patients with normal to moderately impaired renal function.

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