Value of cystatin C for reviewing prognosis in heart failure patients with preserved left ventricular ejection fraction

XIAO Yong-qiang; JIANG Yi

doi:10.3969/j.1674-4055.2014.06.30

Abstract：Objective To investigate the value of cystatin C (Cys-C) for reviewing prognosis in heart failure patients with preserved left ventricular ejection fraction (LVEF).Methods The patients with acute heart failure (AHF) or acute exacerbated chronic heart failure (n=215, male 107, female 108 and aged from 50 to 91) were chosen from June 2012 to Dec. 2012. The levels of serum creatinine (SCr), blood urea nitrogen (BUN), hemoglobin (Hb), brain natriuretic peptide (BNP) and C-reactive protein (CRP) were detected, and glomerular filtration rate (GFR) was calculated. The incidence of grade I endpoint events and all-cause mortality were recorded during hospitalization period and within 400 d after discharged from hospital. All patients were divided into 4 groups according to Cys-C level, including group A (<1.10 mg/L,n=54), group B (1.10-1.47 mg/L,n=54), group C (1.48-1.88 mg/L,n=54) and group D (>1.88 mg/L,n=53).Results Compared with group A, the percentage of patients with renal insufficiency, BNP, BUN, grade I endpoint events and all-cause mortality increased, and GFR decreased in group C and group D (allP<0.01). Compared with group B, the percentage of patients with renal insufficiency, BNP and BUN increased, and GFR decreased in group C and group D (allP<0.01). As Cys C increased, SCr showed an increasing trend (allP<0.01). Cys C was positively correlated to SCr (r=0.717,P<0.01), negatively correlated to GFR (r=-0.778, P<0.01), positively correlated to BNP (r=0.530,P<0.01), correlated to NYHA grading (r=0.504,P<0.01), and positively correlated to CRP (r=0.303,P<0.01). The analysis on the incidence of grade I endpoint events and all-cause mortality with Kaplan-Meier survival curve in 4 groups showed that as the increase of Cys C, the incidence of grade I endpoint events and all-cause mortality increased gradually (allP<0.01). When the cut-off diagnosis value of Cys C was 1.54 mg/L, the area under ROC curve reached the largest, and sensitivity was 72.97% and specificity was 85.58%. The areas under ROC curve of BNP, BUN, SCr and CRP (0.7186, 0.7143, 0.7489, 0.6138) were smaller than that of Cys C (allP<0.001).Conclusion Cys C has a certain clinical value for predicting the prognosis in heart failure patients with preserved LVEF.