Cystatin C for predicting all-cause mortality and rehospitalization in patients with heart failure: a meta-analysis.

Shenghua Chen,Xueyin Zhou,Yangzhang Tang

doi:10.1042/bsr20181761

Shenghua Chen, Xueyin Zhou + Show 1 more

Open Access

https://doi.org/10.1042/bsr20181761

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Journal: Bioscience reports	Publication Date: Feb 5, 2019
Citations: 16	License type: CC BY 4.0

Affiliation: Huaibei Normal University

Abstract

Circulating cystatin C (cys-C/CYC) has been identified as an independent predictor of all-cause mortality in patients with coronary artery disease and the general population. This meta-analysis aimed to systematically evaluate the association between elevated cys-C level and all-cause mortality and rehospitalization risk amongst patients with heart failure (HF). PubMed and Embase databases were searched until December 2017. All prospective observational studies that reported a multivariate-adjusted risk estimate of all-cause mortality and/or rehospitalization for the highest compared with lowest cys-C level in HF patients were included. Ten prospective studies involving 3155 HF patients were included. Meta-analysis indicated that the highest compared with lowest cys-C level was associated with an increased risk of all-cause mortality (hazard ratio (HR): 2.33; 95% confidence intervals (CI): 1.67–3.27; I2 = 75.0%, P<0.001) and combination of mortality/rehospitalization (HR: 2.06; 95%CI: 1.58–2.69; I2 = 41.6%, P=0.181). Results of stratified analysis indicated that the all-cause mortality risk was consistently found in the follow-up duration, cys-C cut-off value or type of HF subgroup. Elevated cys-C level is possibly associated with an increased risk of all-cause mortality and rehospitalization in HF patients. This increased risk is probably independent of creatinine or estimated glomerular filtration rate (eGFR).

Highlights

Heart failure (HF) is a global healthcare burden with unacceptable risk of morbidity, rehospitalization, and mortality [1,2]
HF with preserved EF (HFpEF) patients had a higher incidence of non-HF hospitalizations, while HF with reduced EF (HFrEF) patients had a higher incidence of HF hospitalizations [7]
Sensitivity analyses indicated that removal of any one study did not significantly change the conclusion (Supplementary Table S2). This meta-analysis suggested that elevated Cystatin C (cys-C) level was possibly associated with an increased risk of all-cause mortality and rehospitalization in patients with HF

Summary

Introduction

Heart failure (HF) is a global healthcare burden with unacceptable risk of morbidity, rehospitalization, and mortality [1,2]. According to the different pathophysiological mechanisms, patients are commonly classified into HF with preserved ejection fraction (EF) (HFpEF) or HF with reduced EF (HFrEF). HFpEF is associated with poor clinical outcomes and severe cardiovascular dysfunction [3,4]. Frequent hospitalization and prolonged hospital stay were the typical features of patients with HF [5,6]. HFpEF patients had a higher incidence of non-HF hospitalizations, while HFrEF patients had a higher incidence of HF hospitalizations [7]. Early prognostic stratification of HF patients at high risk of mortality and rehospitalization is in urgent need

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