European Heart Journal Advance Access originally published online on July 7, 2007
European Heart Journal 2007 28(15):1848-1853; doi:10.1093/eurheartj/ehm270
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Cystatin C blood level as a risk factor for death after heart surgery
1 Intensive Care Unit, Liège University Hospital, Sart Tilman Bat B35, B-4000 Liège, Belgium
2 Intensive Care Unit, Institut Jacques Cartier, Massy, France
3 Department of Clinical Chemistry, Liège University Hospital, Sart Tilman Bat B35, B-4000 Liège, Belgium
Received 21 December 2006; revised 10 May 2007; accepted 31 May 2007; online publish-ahead-of-print 7 July 2007.
* Corresponding author. Tel: +32 4366 7494; fax: +32 4366 8898. E-mail address: dledoux{at}chu.ulg.ac.be
Aims: Pre-operative renal dysfunction is a known risk factor for mortality and morbidity after heart surgery. Despite limited accuracy, serum creatinine is widely used to estimate glomerular filtration rate (GFR). Cystatin C is more accurate for assessing GFR. The aim of the present study was to assess associations between GFR estimated from serum cystatin C levels before heart surgery and hospital mortality, hospital morbidity, and 1 year mortality.
Methods and results: In a prospective single-centre observational study, clinical risk factors for morbidity and mortality were recorded and serum creatinine and cystatin C levels were measured in patients admitted for heart surgery. Hospital mortality and morbidity and 1 year mortality were recorded. Over an 8 month period, 499 patients were screened, among whom 376 (74.5%) were included in the study. Hospital mortality was 5.6% (21 patients) and 1 year mortality was 10.2%. Hospital morbidity, defined by a length of stay above the 75th percentile, was 22.1% (83 patients). In the multivariable analysis, GFR estimated from serum cystatin C, but not GFR estimated from serum creatinine, was an independent risk factor for hospital morbidity/mortality (odds ratio per 10 mL/min of GFR decrease, 1.20 (1.07–1.34), P = 0.001) and for 1 year mortality (hazards ratio per 10 mL/min of GFR decrease, 1.26 (1.09–1.46), P = 0.002).
Conclusion: Pre-operative GFR estimation from serum cystatin C may provide a better risk assessment than pre-operative GFR estimation from serum creatinine in patients scheduled for heart surgery.
Key Words: Cystatin • Creatinine • Renal insufficiency • Glomerular filtration rate • Cardiac surgery • Risk stratification
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  M. Bell, F. Granath, J. Martensson, E. Lofberg, A. Ekbom, C.-R. Martling, and of KING (Karolinska Intensive care Nephrology Grou Cystatin C is correlated with mortality in patients with and without acute kidney injury Nephrol. Dial. Transplant., April 25, 2009; (2009) gfp196v1. [Abstract] [Full Text] [PDF]
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 B. Lambermont and V. D'Orio Cystatin C blood level as a risk factor for death after heart surgery Eur. Heart J., November 2, 2007; 28(22): 2818 - 2818. [Full Text] [PDF]
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D. Ledoux, M. Monchi, J.-P. Chapelle, and P. Damas Cystatin C blood level as a risk factor for death after heart surgery: reply Eur. Heart J., November 2, 2007; 28(22): 2818 - 2819. [Full Text] [PDF]
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