title: Cystatin C in acute heart failure without advanced renal impairment.
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 >or=30 mL/min/1.73 m(2).
  
  
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Internal Medicine, Fujita Health University School of Medicine, Toyoake, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Naruse
authors.forename: Junnichi
authors.initials: J
authors.lastname: Ishii
authors.forename: Tomoko
authors.initials: T
authors.lastname: Kawai
authors.forename: Kousuke
authors.initials: K
authors.lastname: Hattori
authors.forename: Makoto
authors.initials: M
authors.lastname: Ishikawa
authors.forename: Masanori
authors.initials: M
authors.lastname: Okumura
authors.forename: Shino
authors.initials: S
authors.lastname: Kan
authors.forename: Tadashi
authors.initials: T
authors.lastname: Nakano
authors.forename: Shigeru
authors.initials: S
authors.lastname: Matsui
authors.forename: Masanori
authors.initials: M
authors.lastname: Nomura
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Hishida
authors.forename: Yukio
authors.initials: Y
authors.lastname: Ozaki
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D003404:Creatinine / Q000097:blood; D055316:Cystatin C / Q000097:blood*; D004452:Echocardiography / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006333:Heart Failure / Q000097:blood / Q000175:diagnosis* / Q000401:mortality / Q000503:physiopathology; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D051437:Renal Insufficiency / Q000097:blood / Q000175:diagnosis* / Q000401:mortality / Q000503:physiopathology; D015203:Reproducibility of Results; D018570:Risk Assessment; D016019:Survival Analysis
chemical_list: D015415:Biomarkers; D055316:Cystatin C; D003404:Creatinine