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European Heart Journal Advance Access originally published online on February 8, 2007
European Heart Journal 2007 28(15):1841-1847; doi:10.1093/eurheartj/ehl507
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© The European Society of Cardiology 2007. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Prognostic value of cystatin C in acute heart failure in relation to other markers of renal function and NT-proBNP

Johan Lassus1,*, Veli-Pekka Harjola2, Reijo Sund3, Krista Siirilä-Waris1, John Melin4, Keijo Peuhkurinen5, Kari Pulkki6, Markku S. Nieminen for the FINN-AKVA Study group1

1 Division of Cardiology, Department of Medicine, Helsinki University Central Hospital, Haartmaninkatu 4, POB 340, 00029 HUS, Helsinki, Finland
2 Division of Emergency Care, Department of Medicine, Helsinki University Central Hospital, Helsinki, Finland
3 National Research and Development Centre for Welfare and Health (STAKES), Helsinki, Finland
4 Department of Medicine, Central Finland Central Hospital, Jyväskylä, Finland
5 Department of Cardiology, Kuopio University Hospital, Kuopio, Finland
6 Department of Clinical Chemistry, Helsinki University, Helsinki, Finland

Received 31 August 2006; revised 13 December 2006; accepted 12 January 2007; online publish-ahead-of-print 8 February 2007.

* Corresponding author. Tel: +358 50 322 4094; fax: +358 9 47174015. E-mail address: johan.lassus{at}fimnet.fi

Aims: 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.

Methods and 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.

Conclusion: 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.

Key Words: Cystatin C • Acute heart failure • Prognosis • Renal function • Biomarkers


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