title: Prognostic significance of changes in cystatin C during treatment of acute cardiac decompensation.
abstract: BACKGROUND
  The long-term prognostic significance of in-hospital worsening renal function (WRF) during treatment of acute cardiac decompensation (ACD) remains controversial.
  
  
  METHODS
  We analyzed data from 100 patients (mean age=75 years; 53% men) presenting with ACD, in whom the serum cystatin C (Cys-C) concentration was measured upon admission to the hospital and 4 days later. We examined the relationship between changes in Cys-C and primary study endpoint of risk of death and re-hospitalization for management of ACD, up to 180 days, searched for predictors by multiple variable analysis and calculated the hazard ratios (HR) and 95% confidence intervals (CI).
  
  
  RESULTS
  A median (25th to 75th percentile) increase in Cys-C from 1.29 (0.88-1.66)mg/l on day 1 to 1.31 (1.00-1.84)mg/l on day 4, observed in 66% of all patients, was associated with a significant decrease (p=0.040) in the 180-day incidence of primary study endpoint. By multiple variable regression analysis, an increase in Cys-C was an independent predictor of death and re-hospitalization for management of ACD (HR 0.415; 95% CI 0.193-0.885; p=0.023).
  
  
  CONCLUSIONS
  An increase in serum Cys-C concentration after hospitalization for management of ACD was associated with a decreased, long-term incidence of primary study endpoint.
authors.affiliation: Department of Cardiovascular Medicine, Hyogo Prefectural Amagasaki Hospital, Amagasaki, Hyogo, Japan. Electronic address: i_hide_aki@yahoo.co.jp.
authors.forename: Hideaki
authors.initials: H
authors.lastname: Inazumi
authors.affiliation: Department of Cardiovascular Medicine, Hyogo Prefectural Amagasaki Hospital, Amagasaki, Hyogo, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Koyama
authors.affiliation: Department of Cardiovascular Medicine, Hyogo Prefectural Amagasaki Hospital, Amagasaki, Hyogo, Japan.
authors.forename: Yohei
authors.initials: Y
authors.lastname: Tanada
authors.affiliation: Department of Cardiovascular Medicine, Hyogo Prefectural Amagasaki Hospital, Amagasaki, Hyogo, Japan.
authors.forename: Hisayoshi
authors.initials: H
authors.lastname: Fujiwara
authors.affiliation: Department of Cardiovascular Medicine, Hyogo Prefectural Amagasaki Hospital, Amagasaki, Hyogo, Japan.
authors.forename: Yoshiki
authors.initials: Y
authors.lastname: Takatsu
authors.affiliation: Department of Cardiovascular Medicine, Hyogo Prefectural Amagasaki Hospital, Amagasaki, Hyogo, Japan.
authors.forename: Yukihito
authors.initials: Y
authors.lastname: Sato
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D055316:Cystatin C / Q000097:blood*; D005260:Female; D006333:Heart Failure / Q000097:blood* / Q000401:mortality*; D017052:Hospital Mortality; D006760:Hospitalization; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D010359:Patient Readmission; D011379:Prognosis
chemical_list: D015415:Biomarkers; D055316:Cystatin C
keywords: Cardiac decompensation; Cystatin C; Heart failure; Worsening renal function