Abstract
Abstract Cystatin C is used as a marker of renal function and has been shown to be promising for evaluating the prognosis of acute coronary syndromes (ACSs). To evaluate the prognostic value of cystatin C in patients with ACSs. The articles were searched using PubMed, Web of Science and Scielo databases. Observational cohort studies that evaluated the association between increased cystatin C and the development of cardiovascular events and mortality in patients with ACSs were included. Only studies that evaluated similar outcomes, studies that compared the highest with the lowest quartiles of cystatin C, and studies that performed multivariate analysis that included glomerular filtration rate or serum creatinine, were included in the meta-analysis. Methodological quality of the articles was assessed using the Newcastle-Ottawa Scale questionnaire for cohort studies. After applying the eligibility criteria, 17 studies were included in the systematic review. All included studies reported a significant association between higher levels of cystatin C and outcomes. The meta-analysis demonstrated that elevated levels of cystatin C are associated with increased risk of cardiovascular mortality or non-fatal myocardial infarction in patients with ACSs, and such association is independent of renal function [OR = 1.65 (1.464 - 1.861), p < 0.001]. Among the studies included, 4 have good quality and 13 have excellent methodological quality.The systematic review and meta-analysis demonstrated that there is a significant association between increased cystatin C levels and the development of cardiovascular events and mortality in patients with ACSs.
Highlights
Cystatin C is a protein belonging to cystatin superfamily of human cysteine protease inhibitors, which is composed of 12 proteins.[1]
A possible mechanism is based on the fact that cystatin C is a more sensitive marker for kidney dysfunction, capable to detect small reductions in glomerular filtration rate (GFR),[4] and a pre-clinical status of kidney dysfunction, which cannot be detected by serum creatinine or creatinine-based GFR.[29]
A lack of standardization of the methods may affect the results reported in different studies, the fact that most studies used immunonephelometry and immunoturbidimetry may indicate high reliability of the results
Summary
Cystatin C is a protein belonging to cystatin superfamily of human cysteine protease inhibitors, which is composed of 12 proteins.[1]. Some studies have demonstrated that increased levels of cystatin C in patients with acute coronary syndrome (ACS) are associated with increased risk for cardiovascular events, cardiovascular death and overall mortality, indicating that cystatin C is a promising prognostic marker of ACSs.[5,6,7] due to lack of scientific evidence of its prognostic value, cystatin C has not been used in clinical practice
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