title: Cystatin C, a novel measure of renal function, is an independent predictor of cardiac events in patients with heart failure.
abstract: BACKGROUND
  Cystatin C, a novel endogenous marker of glomerular filtration rate, has been reported as more sensitive to detect renal insufficiency than creatinine. The purpose of the present study was to examine the clinical significance of serum cystatin C level in patients with mild to moderate heart failure.
  
  
  RESULTS
  Serum levels of cystatin C were measured by an enzyme immunoassay in 140 patients with heart failure and 64 control subjects without heart failure. Patients were prospectively followed during a median follow-up period of 480 days, with the end points of cardiac death and progressive heart failure requiring rehospitalization. Serum levels of cystatin C were higher in patients with heart failure than in control subjects (1.14 +/- 0.60 ng/mL versus 0.72 +/- 0.14 ng/mL, P < .001). The Cox multivariate proportional hazard analysis revealed that a change of 1 standard deviation (SD) in cystatin C level was the one of independent predictor for cardiac events (hazard ratio, 1.94; 95% confidence interval, 1.29-6.64; P < .01). The cardiac event rate was markedly higher in patients with elevated cystatin C level (> or =1.0 ng/mL) than in those with normal level (< or =1.0 ng/mL) (38.7% versus 10.3%, P < 0.001). Furthermore in patients with normal creatinine levels (n = 91), the cardiac event rate was similarly higher in patients with elevated cystatin C than in those with normal levels (29.2% versus 7.5%, P = .002).
  
  
  CONCLUSIONS
  Elevation of serum cystatin C, a new marker of renal function, provides promising prognostic information for clinical outcome in patients with mild to moderate heart failure.
authors.affiliation: From the First Department of Internal Medicine, Yamagata University School of Medicine, Yamagata, Japan.
authors.forename: Takanori
authors.initials: T
authors.lastname: Arimoto
authors.forename: Yasuchika
authors.initials: Y
authors.lastname: Takeishi
authors.forename: Takeshi
authors.initials: T
authors.lastname: Niizeki
authors.forename: Noriaki
authors.initials: N
authors.lastname: Takabatake
authors.forename: Hidenobu
authors.initials: H
authors.lastname: Okuyama
authors.forename: Akio
authors.initials: A
authors.lastname: Fukui
authors.forename: Hidetada
authors.initials: H
authors.lastname: Tachibana
authors.forename: Naoki
authors.initials: N
authors.lastname: Nozaki
authors.forename: Osamu
authors.initials: O
authors.lastname: Hirono
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Tsunoda
authors.forename: Takehiko
authors.initials: T
authors.lastname: Miyashita
authors.forename: Tetsuro
authors.initials: T
authors.lastname: Shishido
authors.forename: Hiroki
authors.initials: H
authors.lastname: Takahashi
authors.forename: Yo
authors.initials: Y
authors.lastname: Koyama
authors.forename: Isao
authors.initials: I
authors.lastname: Kubota
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D003404:Creatinine / Q000378:metabolism; D055316:Cystatin C; D015891:Cystatins / Q000097:blood* / Q000378:metabolism; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006333:Heart Failure / Q000097:blood* / Q000378:metabolism / Q000401:mortality / Q000503:physiopathology*; D006801:Humans; D007668:Kidney / Q000378:metabolism / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010359:Patient Readmission; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012720:Severity of Illness Index; D016019:Survival Analysis
chemical_list: D015415:Biomarkers; C525030:CST3 protein, human; D055316:Cystatin C; D015891:Cystatins; D003404:Creatinine