Department of Cardiology, University Hospital Virgen de Arrixaca, Murcia, Spain.
J Am Coll Cardiol. 2011 Feb 15;57(7):849-58. doi: 10.1016/j.jacc.2010.08.644.
The purpose of this study was to evaluate the prognostic importance of novel markers of renal dysfunction among patients with acutely destabilized heart failure (ADHF).
β-trace protein (BTP) and cystatin C are newer biomarkers for renal dysfunction; the prognostic importance of these tests, particularly BTP, relative to standard measures of renal function remains unclear.
A total of 220 consecutive hospitalized patients with ADHF were prospectively studied. Blood samples were collected on presentation. In-hospital worsening renal function, as well as mortality and/or heart failure (HF) hospitalization, over a median follow-up period of 500 days was examined as a function of BTP or cystatin C concentrations; results were compared with creatinine, estimated glomerular filtration rate, and blood urea nitrogen.
Neither BTP nor cystatin C was associated with worsening renal function during the index hospitalization. A total of 116 patients (53%) either died or were hospitalized for HF during follow-up. Those with adverse outcomes had higher BTP (1.04 mg/l [range 0.80 to 1.49 mg/l] vs. 0.88 mg/l [range 0.68 to 1.17 mg/l], p = 0.003) and cystatin C (1.29 mg/l [range 1.00 to 1.71 mg/l] vs. 1.03 mg/l [range 0.86 to 1.43 mg/l], p = 0.001). After multivariable adjustment, both BTP (hazard ratio: 1.41, 95% confidence interval: 1.06 to 1.88; p = 0.018) and cystatin C (hazard ratio: 1.50, 95% confidence interval: 1.13 to 2.01; p = 0.006) were significant predictors of death/HF hospitalization, whereas serum creatinine, estimated glomerular filtration rate, and blood urea nitrogen were no longer significant. In patients with an estimated glomerular filtration rate >60 ml/min/1.73 m(2), elevated concentrations of BTP and cystatin C were still associated with significantly higher risk of adverse clinical events (p < 0.05). Net reclassification index analysis suggested cystatin C and BTP deliver comparable information regarding prognosis.
Among patients hospitalized with ADHF, BTP and cystatin C predict risk of death and/or HF hospitalization and are superior to standard measures of renal function for this indication.
本研究旨在评估急性失代偿性心力衰竭（ADHF）患者肾功能新标志物的预后重要性。
β-痕迹蛋白（BTP）和胱抑素 C 是用于肾功能障碍的新型生物标志物；这些检测的预后重要性，尤其是 BTP，相对于标准肾功能检测仍不明确。
对 220 例连续住院的 ADHF 患者进行前瞻性研究。入院时采集血样。中位随访期为 500 天后，检测 BTP 或胱抑素 C 浓度与住院期间肾功能恶化、死亡率和/或心力衰竭（HF）住院之间的关系；结果与肌酐、估计肾小球滤过率和血尿素氮进行比较。
BTP 和胱抑素 C 均与住院期间肾功能恶化无关。随访期间共有 116 例（53%）患者死亡或因 HF 住院。不良预后患者的 BTP 水平更高（1.04mg/L[范围 0.80 至 1.49mg/L]比 0.88mg/L[范围 0.68 至 1.17mg/L]，p=0.003），胱抑素 C 水平也更高（1.29mg/L[范围 1.00 至 1.71mg/L]比 1.03mg/L[范围 0.86 至 1.43mg/L]，p=0.001）。多变量调整后，BTP（危险比：1.41，95%置信区间：1.06 至 1.88；p=0.018）和胱抑素 C（危险比：1.50，95%置信区间：1.13 至 2.01；p=0.006）均为死亡/HF 住院的显著预测因子，而血清肌酐、估计肾小球滤过率和血尿素氮不再显著。在估计肾小球滤过率>60ml/min/1.73m2 的患者中，BTP 和胱抑素 C 浓度升高与不良临床事件的风险显著增加仍相关（p<0.05）。净重新分类指数分析表明，胱抑素 C 和 BTP 提供了关于预后的相似信息。
在住院治疗的 ADHF 患者中，BTP 和胱抑素 C 预测死亡和/或 HF 住院风险，对于该适应证优于标准肾功能检测。
