Author + information
- Sonia Hamdi1,
- Wiem Selmi1,
- Mohamed Mosrati2,
- Slim Fendri3,
- Walid Jomaa1,
- Khaldoun Ben Hamda1 and
- Faouzi Maatouk1
Frequency and gravity of heart failure (HF) led to the need for precise risk stratification. The association with renal failure worsens the prognosis. Cystatin C, an accurate glomerular filtration rate (GFR) marker, may have a prognostic value in heart failure patients.
To evaluate the mortality predictive value of Cystatin C in patients with HF.
We prospectively included patients admitted to our department for acute HF or exacerbation of chronic HF between December 2010 and May 2011. We excluded patients over 80 years old, those with severe renal failure (GFR < 50ml/min/1.73 m2) or severe worsening of renal function during hospitalization and patients having dysthyroidism or under immunosuppressive therapy. A dosage of plasmatic cystatin C concentration was done using particule-enhanced turbidimetric immunoassay method. The main endpoint was death at a 120 days follow up.
Sixty four patients were enrolled, aged 62.2 ± 11.4 years, with a sex ratio of 1.56. Patients were at NYHA class III or IV at admission in 87% of cases, with an ischemic etiology in 55% of cases. LVEF was 51.7 ± 13.8% and GFR was 76 ± 19.8 ml/min. Mean cystatin C was 1.42 ± 0.37 mg/l. During follow-up, 10 (15.6%) patients died. Higher levels of Cystatin C (third tertile) were associated with a significant increase in mortality rate with an RR of 8 when moving from the first to the third tertile and a RR of 3 when moving from the second to the third (p=0.033). Prognostic value is uncertain for milder elevations between the first and second tertiles (p=0.45).
A high level of Cystatin C at admission is a strong predictor of 120-days mortality among patients with HF. Discriminative value falls for milder elevations.
- 2013 American College of Cardiology Foundation