Campbell Catherine Y, Clarke William, Park Haeseong, Haq Nowreen, Barone Bethany B, Brotman Daniel J
Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Am J Cardiol. 2009 Aug 1;104(3):389-92. doi: 10.1016/j.amjcard.2009.03.059. Epub 2009 Jun 6.
Cystatin C is a novel marker of renal function that has been found to predict adverse cardiovascular outcomes in ambulatory patients. The aim of this study was to investigate whether this biomarker predicts the length of hospitalization and adverse outcomes in patients hospitalized for heart failure. Two hundred forty consecutive patients aged > or =25 admitted to Johns Hopkins Hospital with exacerbations of heart failure were prospectively enrolled. Cystatin C levels were measured on admission. Patients were followed for 1 year. The primary outcome measure was the length of hospitalization. Secondary outcomes included all-cause mortality and readmission for heart failure. Cystatin C showed no significant association with the length of hospitalization. Patients in the highest quartile (quartile 4) of cystatin C level were at increased risk for death (hazard ratio 2.07 for quartile 4 vs quartiles 1 to 3, p = 0.01) and death or rehospitalization (hazard ratio 1.61 for quartile 4 vs quartiles 1 to 3, p = 0.01). The association between cystatin C and the combined end point of death or rehospitalization during 1-year follow-up remained significant after adjusting for age, race, gender, co-morbidities, and creatinine. Cystatin C was more predictive of these end points than creatinine, and the combination of cystatin C and creatinine was more predictive than either variable alone. In conclusion, cystatin C may be useful in addition to creatinine for predicting outcomes after admission for acute heart failure exacerbations.
胱抑素C是一种新型肾功能标志物，已被发现可预测门诊患者的不良心血管结局。本研究的目的是调查这种生物标志物是否能预测因心力衰竭住院患者的住院时间和不良结局。连续纳入240例年龄≥25岁、因心力衰竭加重入住约翰霍普金斯医院的患者。入院时测定胱抑素C水平。对患者进行1年的随访。主要结局指标是住院时间。次要结局包括全因死亡率和心力衰竭再入院率。胱抑素C与住院时间无显著相关性。胱抑素C水平处于最高四分位数（四分位数4）的患者死亡风险增加（四分位数4与四分位数1至3相比，风险比为2.07，p = 0.01），死亡或再次住院风险增加（四分位数4与四分位数1至3相比，风险比为1.61，p = 0.01）。在调整年龄、种族、性别、合并症和肌酐后，胱抑素C与1年随访期间死亡或再住院的联合终点之间的关联仍然显著。胱抑素C比肌酐更能预测这些终点，胱抑素C和肌酐的联合比单独任何一个变量更具预测性。总之，除肌酐外，胱抑素C可能有助于预测急性心力衰竭加重入院后的结局。
