The value of NT-proBNP paired with Cys-C in early diagnosis of the type 1 cardiorenal syndrome

Abstract

Objective To study the value of plasma amino-terminal pro-B-type natriuretic peptide precursor (NT-proBNP) along with cystatin C (Cys-C) used together in early diagnosis of the type 1 cardio-renal syndrome (CRS) in patients with acute heart failure. Methods From January 2011 to January 2014, the data of 395 acute heart failure patients in Wenzhou People's Hospital were retrospectively analyzed. Plasma concentrations of NT-proBNP and Cys-C of 395 patients with acute heart failure were measured by using PETIA and ECLIA methods at about 24 hours after admission. And the incidence of type 1 CRS syndrome was analyzed by statistics. ROC analyses were performed to evaluate the early diagnosing value of plasma NT-proBNP along with Cys-C in determining type 1 CRS and in discerning the optimal cut-off point for early diagnosing type 1 CRS patients. Results A total of 395 patients with acute heart failure aged from 29 -96 years with (74.3 ±13.0) years in mean, and 61.3% male were enrolled in this study. Of them, 82 patients were suffered from CRS syndrome. Logistic regression analysis showed diabetes, chronic heart failure, Cys-C and NT-proBNP were independent risk factors for predicting type 1 CRS, and serum Cys-C level was the most important predictor. ROC analysis showed the areas under the curve (AUC) of plasma NT-proBNP and Cys-C for early diagnosing CRS were 0.835 (95% CI: 0.785 -0.886, P <0.01) and 0.885 (95% CI: 0.825 -0.944, P <0.01) , respectively. The value of plasma NT-proBNP alone in early diagnosing the type 1 CRS was limited with Youden index up to 0.483. When the NT-proBNP paired with Cys-C, the diagnostic reliability has been greatly improved, especially specificity with Youden index up to 0.717. Therefore, NT-proBNP doupled with Cys-C has great reference value in early diagnosing the type 1 CRS. Conclusion Plasma NT-proBNP level coupled with Cys-C level is a valuable biomarker for early diagnosing type 1 cardio-renal syndrome in patients with acute heart failure. If the levels of plasma NT-proBNP and Cys-C are detected simultaneously, the diagnostic reliability of CRS will be greatly improved, especially in the diagnostic specificity. Key words: Cystatin C; Amino-terminal pro-B-type natriuretic peptide precursor; Type 1 cardiorenal syndrome; Early diagnosis