Abstract
Aim: The present study was established to investigate the use of the serum cystatin C/prealbumin (Cys-C/PAB) ratio as a predictive factor for long-term prognosis in patients with chronic heart failure.Methods: We divided our retrospective cohort of 6,311 patients admitted to hospital due to an episode of heart failure (HF) into three groups according to the Cys-C/PAB ratio. The endpoints were cardiovascular and all-cause mortality. Median follow-up time were 3.3 years (2–8 years), during which 2,945 (46.7%) patients died.Results: The Cys-C/PAB ratio was revealed to be an independent predictor of cardiovascular mortality (HR: 1.12, 95% CI: 1.15–1.23, P < 0.01) and all-cause mortality (HR: 1.19, 95% CI: 1.13–1.24, P < 0.01) by multivariable Cox analysis. Integrated discrimination improvement (IDI) showed that the Cys-C/PAB ratio in conjunction with the level of N-terminal pro-B-type natriuretic peptide (NT-proBNP) conferred a significant improvement in predicting individual risks of cardiovascular (P = 0.023) and all-cause (P = 0.028) mortality. For those with a high Cys-C/PAB ratio in combination with a high NT-proBNP level, the long-term cardiovascular mortality risk ratio was 8.6-times higher than for those with low values, and 7.51-times for all-cause mortality. Our study also showed that Cys-C/PAB and NT-proBNP in combination displayed higher value for the prediction of cardiovascular and all-cause in-hospital mortality in patients with HF.Conclusions: The Cys-C/PAB ratio is valuable for predicting cardiovascular and all-cause mortality in patients with HF and offers additional information to that provided by NT-proBNP.
Highlights
It is estimated that about 26 million adults worldwide suffer from heart failure (HF), a number that is expected to increase in the coming decades [1, 2]
The cystatin C (Cys-C)/PAB ratio was revealed to be an independent predictor of cardiovascular mortality (HR: 1.12, 95% confidence interval (CI): 1.15–1.23, P < 0.01) and all-cause mortality (HR: 1.19, 95% CI: 1.13–1.24, P < 0.01) by multivariable Cox analysis
Our study showed that Cys-C/PAB and NT-proBNP in combination displayed higher value for the prediction of cardiovascular and all-cause in-hospital mortality in patients with HF
Summary
It is estimated that about 26 million adults worldwide suffer from heart failure (HF), a number that is expected to increase in the coming decades [1, 2]. In addition to NT-proBNP, several other biomarkers possess prognostic value in patients with HF; cystatin C (Cys-C), and prealbumin (PAB) have been extensively studied. Cys-C is removed from circulation by glomerular filtration and subsequently reabsorbed and catabolized by the proximal convoluted tubules [8]. Given this background, it has been proposed that the level of circulating Cys-C may be an appropriate early biomarker of renal impairment. Several studies have reported that baseline Cys-C levels can play a prognostic role in rehospitalization and all-cause mortality in acute decompensated HF [13,14,15] and chronic heart failure (CHF) [16, 17]
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