title: Beta-trace protein and cystatin c as predictors of major bleeding in non-ST-segment elevation acute coronary syndrome.
abstract: BACKGROUND
  Beta-trace protein (BTP) and cystatin C (CysC) are novel biomarkers of renal function. We assessed the ability of both to predict major bleeding (MB) in patients with non-ST-segment elevation acute coronary syndromes (NSTE-ACS), compared to other renal function parameters and clinical risk scores.
  
  
  RESULTS
  We included 273 patients. Blood samples were obtained within 24h of admission. The endpoint was MB. During a follow-up of 760 days (411-1,098 days), 25 patients (9.2%) had MB. Patients with MB had higher concentrations of BTP (0.98 mg/L; 0.71-1.16 mg/L vs. 0.72 mg/L, 0.60-0.91 mg/L, P=0.002), CysC (1.05 mg/L; 0.91-1.30 mg/L vs. 0.90 mg/L, 0.75-1.08 mg/L, P=0.003), higher CRUSADE score (39 ± 16 points vs. 29 ± 15 points, P=0.002) and lower estimated glomerular filtration rate (eGFR; 66 ± 27 vs. 80 ± 30 ml·min(-1)·1.73 m(-2), P=0.02) than patients without MB; there was no difference in creatinine level between the groups (P=0.14). After multivariable adjustment, both were predictors of MB, while eGFR and creatinine did not achieve statistical significance. Among subjects with eGFR >60 ml·min(-1)·1.73 m(-2), those with elevated concentrations of both biomarkers had a significantly higher risk for MB. Net reclassification indexes from the addition of BTP and CysC to CRUSADE risk score were 38% and 21% respectively, while the relative integrated discrimination indexes were 12.5% and 3.8%.
  
  
  CONCLUSIONS
  Among NSTE-ACS patients, BTP and CysC were superior to conventional renal parameters for predicting MB, and improved clinical stratification for hemorrhagic risk.
authors.affiliation: Division of Cardiology, University Hospital Virgen de la Arrixaca, Murcia, Spain.
authors.forename: Ángel
authors.initials: Á
authors.lastname: López-Cuenca
authors.forename: Sergio
authors.initials: S
authors.lastname: Manzano-Fernández
authors.forename: Francisco
authors.initials: F
authors.lastname: Marín
authors.forename: Soledad
authors.initials: S
authors.lastname: Parra-Pallares
authors.forename: Marina
authors.initials: M
authors.lastname: Navarro-Peñalver
authors.forename: Salvador
authors.initials: S
authors.lastname: Montalban-Larrea
authors.forename: Jose M
authors.initials: JM
authors.lastname: Andreu-Cayuelas
authors.forename: Ana I
authors.initials: AI
authors.lastname: Romero-Aniorte
authors.forename: Francisco
authors.initials: F
authors.lastname: Avilés-Plaza
authors.forename: Mariano
authors.initials: M
authors.lastname: Valdés-Chavarri
authors.forename: James L
authors.initials: JL
authors.lastname: Januzzi
mesh_terms: D054058:Acute Coronary Syndrome / Q000097:blood* / Q000150:complications / Q000503:physiopathology; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D003404:Creatinine / Q000097:blood; D055316:Cystatin C / Q000097:blood*; D005260:Female; D005500:Follow-Up Studies; D006470:Hemorrhage / Q000097:blood* / Q000209:etiology / Q000503:physiopathology; D006801:Humans; D019746:Intramolecular Oxidoreductases / Q000097:blood*; D007677:Kidney Function Tests; D054834:Lipocalins / Q000097:blood*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors
chemical_list: D015415:Biomarkers; C525030:CST3 protein, human; D055316:Cystatin C; D054834:Lipocalins; D003404:Creatinine; D019746:Intramolecular Oxidoreductases; C022466:prostaglandin R2 D-isomerase