%0 Journal Article %J J Am Coll Cardiol %D 2005 %T Cystatin-C and mortality in elderly persons with heart failure. %A Shlipak, Michael G %A Katz, Ronit %A Fried, Linda F %A Jenny, Nancy Swords %A Stehman-Breen, Catherine O %A Newman, Anne B %A Siscovick, David %A Psaty, Bruce M %A Sarnak, Mark J %K Age Factors %K Aged %K Aged, 80 and over %K Creatinine %K Cystatin C %K Cystatins %K Female %K Follow-Up Studies %K Glomerular Filtration Rate %K Heart Failure %K Humans %K Male %K Pilot Projects %K Predictive Value of Tests %K Risk Assessment %K Survival Analysis %X

OBJECTIVES: We sought to evaluate cystatin-C, a novel measure of renal function, as a predictor of mortality in elderly persons with heart failure (HF) and to compare it with creatinine.

BACKGROUND: Renal function is an important prognostic factor in patients with HF, but creatinine levels, which partly reflect muscle mass, may be insensitive for detecting renal insufficiency.

METHODS: A total of 279 Cardiovascular Health Study participants with prevalent HF and measures of serum cystatin-C and creatinine were followed for mortality outcomes over a median of 6.5 years.

RESULTS: Median creatinine and cystatin-C levels were 1.05 mg/dl and 1.26 mg/l. Each standard deviation increase in cystatin-C (0.35 mg/l) was associated with a 31% greater adjusted mortality risk (95% confidence interval [CI] 20% to 43%, p < 0.001), whereas each standard deviation increase in creatinine (0.39 mg/dl) was associated with a 17% greater adjusted mortality risk (95% CI 1% to 36%, p = 0.04). When both measures were combined in a single adjusted model, cystatin-C remained associated with elevated mortality risk (hazard ratio 1.60, 95% CI 1.32 to 1.94), whereas creatinine levels appeared associated with lower risk (hazard ratio 0.73, 95% CI 0.57 to 0.95).

CONCLUSIONS: Cystatin-C is a stronger predictor of mortality than creatinine in elderly persons with HF. If confirmed in future studies, this new marker of renal function could improve risk stratification in patients with HF.

%B J Am Coll Cardiol %V 45 %P 268-71 %8 2005 Jan 18 %G eng %N 2 %1 https://www.ncbi.nlm.nih.gov/pubmed/15653026?dopt=Abstract %R 10.1016/j.jacc.2004.09.061