Cystatin-C and mortality in elderly persons with heart failure.
OBJECTIVE
We sought to evaluate cystatin-C, a novel measure of renal function, as a predictor of mortality in elderly persons with heart failure (HF) and to compare it with creatinine.


BACKGROUND
Renal function is an important prognostic factor in patients with HF, but creatinine levels, which partly reflect muscle mass, may be insensitive for detecting renal insufficiency.


METHODS
A total of 279 Cardiovascular Health Study participants with prevalent HF and measures of serum cystatin-C and creatinine were followed for mortality outcomes over a median of 6.5 years.


RESULTS
Median creatinine and cystatin-C levels were 1.05 mg/dl and 1.26 mg/l. Each standard deviation increase in cystatin-C (0.35 mg/l) was associated with a 31% greater adjusted mortality risk (95% confidence interval [CI] 20% to 43%, p < 0.001), whereas each standard deviation increase in creatinine (0.39 mg/dl) was associated with a 17% greater adjusted mortality risk (95% CI 1% to 36%, p = 0.04). When both measures were combined in a single adjusted model, cystatin-C remained associated with elevated mortality risk (hazard ratio 1.60, 95% CI 1.32 to 1.94), whereas creatinine levels appeared associated with lower risk (hazard ratio 0.73, 95% CI 0.57 to 0.95).


CONCLUSIONS
Cystatin-C is a stronger predictor of mortality than creatinine in elderly persons with HF. If confirmed in future studies, this new marker of renal function could improve risk stratification in patients with HF.
Shlipak
Michael G
MG
General Internal Medicine Section, Veterans Affairs Medical Center, 4150 Clement Street, University of California-San Francisco, San Francisco, CA 94121, USA. shlip@itsa.ucsf.edu
Katz
Ronit
R
Fried
Linda F
LF
Jenny
Nancy Swords
NS
Stehman-Breen
Catherine  O
C
Newman
Anne B
AB
Siscovick
David
D
Psaty
Bruce M
BM
Sarnak
Mark J
MJ
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D003404:Creatinine / Q000097:blood; D055316:Cystatin C; D015891:Cystatins / Q000097:blood*; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006333:Heart Failure / Q000097:blood* / Q000401:mortality*; D006801:Humans; D008297:Male; D010865:Pilot Projects; D011237:Predictive Value of Tests; D018570:Risk Assessment; D016019:Survival Analysis
C525030:CST3 protein, human; D055316:Cystatin C; D015891:Cystatins; D003404:Creatinine