Se Yong Jang1,2,3, Dong Heon Yang4,5,6, Hyeon Jeong Kim2, Bo Eun Park2, Yoon Jung Park2, Hong Nyun Kim2, Nam Kyun Kim3, Myung Hwan Bae1,2, Jang Hoon Lee1,2, Hun Sik Park1,2, Yongkeun Cho1,2, Shung Chull Chae1,2. 1. Department of Internal Medicine, School of medicine, Kyungpook National University, Daegu, Republic of Korea. 2. Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Republic of Korea. 3. Cardiology Center, Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea. 4. Department of Internal Medicine, School of medicine, Kyungpook National University, Daegu, Republic of Korea, ddhyang@knu.ac.kr. 5. Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Republic of Korea, ddhyang@knu.ac.kr. 6. Cardiology Center, Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea, ddhyang@knu.ac.kr.
Abstract
BACKGROUND: Renal function is closely related to cardiac function and an important prognostic marker in heart failure. OBJECTIVE: We aimed to test the prognostic value of cystatin C (cysC)-derived estimated glomerular filtration rates (eGFR) in comparison with eGFRs from creatinine solely based equations in patients with acute heart failure (AHF). METHODS: This study included 262 patients (65.8 ± 14.9 years old, 126 male) with AHF. Prognostic value of the eGFRs, from cysC-based equations chronic kidney disease epidemiology collaboration (CKD-EPI-cysC and CKD-EPI-creatinine [cr]-cysC equations) were compared with eGFRs calculated from serum creatinine levels only (Modification of Diet in Renal Disease [MDRD]-4 and CKD-EPI-cr equations). Prognosis was evaluated with the composite of all-cause mortality and hospitalization for heart failure within 1 year. RESULTS: During the follow-up period (mean follow-up period, 264.0 ± 136.1 days), 67 (25.6%) events occurred. Estimated GFR using CKD-EPI-cysC was the best for predicting 1-year outcome using receiver operating characteristic curve analysis (area under curve 0.585, 0.607, 0.669, and 0.652 for eGFRs from MDRD-4, CKD-EPI-cr, CKD-EPI-cysC, and CKD-EPI-cr-cysC respectively). The Kaplan-Meier survival curve analysis showed that only the eGFRs classification from the equations based on cysC significantly predicted 1-year outcome in patients with AHF. CONCLUSIONS: Estimated GFRs calculated with cysC predicted the prognosis more accurately in patients with AHF than the eGFRs from creatinine only equations.
BACKGROUND: Renal function is closely related to cardiac function and an important prognostic marker in heart failure. OBJECTIVE: We aimed to test the prognostic value of cystatin C (cysC)-derived estimated glomerular filtration rates (eGFR) in comparison with eGFRs from creatinine solely based equations in patients with acute heart failure (AHF). METHODS: This study included 262 patients (65.8 ± 14.9 years old, 126 male) with AHF. Prognostic value of the eGFRs, from cysC-based equations chronic kidney disease epidemiology collaboration (CKD-EPI-cysC and CKD-EPI-creatinine [cr]-cysC equations) were compared with eGFRs calculated from serum creatinine levels only (Modification of Diet in Renal Disease [MDRD]-4 and CKD-EPI-cr equations). Prognosis was evaluated with the composite of all-cause mortality and hospitalization for heart failure within 1 year. RESULTS: During the follow-up period (mean follow-up period, 264.0 ± 136.1 days), 67 (25.6%) events occurred. Estimated GFR using CKD-EPI-cysC was the best for predicting 1-year outcome using receiver operating characteristic curve analysis (area under curve 0.585, 0.607, 0.669, and 0.652 for eGFRs from MDRD-4, CKD-EPI-cr, CKD-EPI-cysC, and CKD-EPI-cr-cysC respectively). The Kaplan-Meier survival curve analysis showed that only the eGFRs classification from the equations based on cysC significantly predicted 1-year outcome in patients with AHF. CONCLUSIONS: Estimated GFRs calculated with cysC predicted the prognosis more accurately in patients with AHF than the eGFRs from creatinine only equations.