Preinterventional Cystatin C: A Highly Prognostic Marker for All-Cause Mortality after Coronarography

Abstract

Purpose. Glomerular filtration rate <60 mL/min/1.73 m2 is associated with increased all-cause mortality. Multiple studies have shown that serum cystatin C is more accurate than serum creatinine for detection of mild to moderate chronic kidney dysfunction. We examined the predictive value of the preinterventional cystatin C for all-cause mortality after contrast media exposition. Methods. The prognostic value of preinterventional cystatin C for all-cause mortality was retrospectively analysed in the prospective single-centre “Dialysis-versus-Diuresis” Trial (January 2001–July 2004). Associations during up to 1316 days of followup for all-cause mortality were assessed. The study population consisted of 373 patients (aged 35–89, mean 67 years, 16.4% female). Results. During followup, 65 deaths occurred. Multivariate cox regression confirmed the preinterventional CyC level to be an independent predictor of all-cause mortality (odds ratio 2.061, 95% confidence interval 1.054–4.031, P=0.035). Hazard rate ratio for all-cause mortality was increased in the third cystatin C quartile (>1.4 mg/L) compared with the lowest quartile (<1.1 mg/L), 4.12, 95% confidence interval 1.747–9.694 (P=0.001), in the fourth cystatin C quartile (>1.6 mg/L) compared with the lowest quartile, 5.38, 95% confidence interval 2.329–12.427 (P<0.001). Conclusions. Cystatin C is significantly associated with all-cause mortality after coronarography, regardless of the age, gender, and glomerular filtration rate.