title: Prognostic value of cystatin C in acute heart failure in relation to other markers of renal function and NT-proBNP.
abstract: OBJECTIVE
  Cystatin C, a novel marker of renal function, has been implicated as a prognostic marker in cardiovascular disease. We investigated the prognostic value of cystatin C in acute heart failure (AHF) in comparison to other markers of renal function and NT-proBNP.
  
  
  RESULTS
  Patients with cystatin C measurements (n = 480) from a prospective multicentre study on AHF were included. All-cause mortality at 12 months was 25.4%. Cystatin C, creatinine, age, gender, and systolic blood pressure on admission were identified as independent prognostic risk factors. Cystatin C above median (1.30 mg/L) was associated with the highest adjusted hazard ratio, 3.2 (95% CI 2.0-5.3), P < 0.0001. Mortality increased significantly with each tertile of cystatin C. Combining tertiles of NT-proBNP and cystatin C improved risk stratification further. Moreover, in patients with normal plasma creatinine, elevated cystatin C was associated with significantly higher mortality at 12 months: 40.4% vs. 12.6% in patients with both markers within normal range, P < 0.0001.
  
  
  CONCLUSIONS
  Cystatin C is a strong and independent predictor of outcome at 12 months in AHF. Furthermore, cystatin C identifies patients with poor prognosis despite normal plasma creatinine. Cystatin C seems to be a promising risk marker in patients hospitalized for AHF.
authors.affiliation: Division of Cardiology, Department of Medicine, Helsinki University Central Hospital, Haartmaninkatu 4, POB 340, 00029 HUS, Helsinki, Finland. johan.lassus@fimnet.fi
authors.forename: Johan
authors.initials: J
authors.lastname: Lassus
authors.forename: Veli-Pekka
authors.initials: VP
authors.lastname: Harjola
authors.forename: Reijo
authors.initials: R
authors.lastname: Sund
authors.forename: Krista
authors.initials: K
authors.lastname: Siirilä-Waris
authors.forename: John
authors.initials: J
authors.lastname: Melin
authors.forename: Keijo
authors.initials: K
authors.lastname: Peuhkurinen
authors.forename: Kari
authors.initials: K
authors.lastname: Pulkki
authors.forename: Markku S
authors.initials: MS
authors.lastname: Nieminen
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers; D055316:Cystatin C; D015891:Cystatins; D005260:Female; D006333:Heart Failure / Q000097:blood* / Q000188:drug therapy / Q000401:mortality; D006801:Humans; D007668:Kidney / Q000502:physiology* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors
chemical_list: D015415:Biomarkers; C525030:CST3 protein, human; D055316:Cystatin C; D015891:Cystatins; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain