A glomerular filtration rate (GFR) less than 60 mL/min/1.73 m² has always been correlated with increased risk of all-cause mortality. While it is widely acknowledged that serum creatinine is a reasonable tool for estimating renal function, numerous investigations have confirmed that there is superior accuracy in identifying mild or moderate chronic kidney dysfunction with serum cystatin C. Observing that contrast media use with coronarography can further impair renal function with a resultant effect on prognosis, investigators sought to determine if cystatin C would be a predictor for all-cause mortality.
The prognostic value of baseline cystatin C levels was retrospectively evaluated within the setting of a prospective, monocentric “Dialysis-versus-Diuresis” trial, which recruited patients from January 2001 to July 2004. A total of 373 patients aged between 35 and 89 years, with a mean age of 67 years, participated in this study, of whom 16.4% were female. Patients were followed for a period of up to 1316 days to evaluate the association between preprocedural cystatin C levels and all-cause mortality.
Key findings
In a cohort of 373 patients (mean age 67 years; 16.4% female) followed for up to 1316 days, 65 deaths occurred.
Preinterventional cystatin C independently predicted all-cause mortality with an odds ratio of 2.061 (95% CI, 1.054–4.031; P = 0.035).
Compared with the lowest quartile (<1.1 mg/L), the third quartile (>1.4 mg/L) demonstrated a hazard ratio of 4.12 (95% CI, 1.747–9.694; P = 0.001), and the fourth quartile (>1.6 mg/L) showed a hazard ratio of 5.38 (95% CI, 2.329–12.427; P < 0.001).
Preprocedural values of cystatin C were significantly linked to long-term all-cause mortality in patients undergoing coronarography, and the result was independent of age, gender, and glomerular filtration rate. The above findings confirmed the role of cystatin C in the development of new models of risk estimation based on preinterventional values.
Reference:
Lüders, Florian, Malyar, Nasser, Meyborg, Matthias, Reinecke, Holger, Preinterventional Cystatin C: A Highly Prognostic Marker for All-Cause Mortality after Coronarography, Advances in Nephrology, 2014, 510209, 6 pages, 2014. https://doi.org/10.1155/2014/510209
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