Department of Cardiology, University Medical Center Groningen, Hanzeplein 1, P.O. Box 30001, 9700 RB Groningen, The Netherlands.
Heart. 2012 Feb;98(4):319-24. doi: 10.1136/heartjnl-2011-300692. Epub 2011 Oct 29.
Estimates of glomerular filtration rate (GFR), including creatinine and creatinine based formulae, are inaccurate in extremes of GFR and substantially biased in patients with chronic heart failure (CHF).
To investigate whether serum cystatin C levels would be a better, more accurate and simple alternative for estimation of GFR and prognosis in CHF.
Cohort study.
Chronic heart failure. PATIENTS, INTERVENTIONS AND MAIN OUTCOME MEASURE: In 102 CHF patients, the correlation between GFR as estimated by (125)I-iothalamate clearance (GFR(IOTH)), the modification of diet in renal disease formula (GFR(MDRD)) and cystatin C was investigated. The combined endpoint consisted of the first occurrence of all cause mortality, heart transplantation or admission for CHF within 24 months.
Mean age was 58±12 years; 77% were male. Mean left ventricular ejection fraction was 28±9%. Mean GFR(IOTH) was 75±27 ml/min/1.73 m(2), while median cystatin C levels were 0.80 (0.69-1.02) mg/l. GFR(IOTH) was strongly correlated with all renal function estimates, including 1/cystatin C (r=0.867, p<0.001). GFR(IOTH) was better predicted by 1/cystatin C compared to 1/serum creatinine (z=3.12, p=0.002), but equally predicted compared to GFR(MDRD) (z=0.92, p=0.356). Serum 1/cystatin C was a strong independent predictor of prognosis (HR: 2.27 per SD increase, 95% CI 1.12 to 4.63), comparable to GFR(MDRD).
Cystatin C is an accurate and easy estimate of renal function with prognostic properties superior to serum creatinine and similar to creatinine based formulae in patients with CHF.
肾小球滤过率（GFR）的估计值，包括肌酐和基于肌酐的公式，在 GFR 的极端情况下不准确，并且在慢性心力衰竭（CHF）患者中存在很大的偏差。
研究血清胱抑素 C 水平是否可作为更准确、更简单的替代方法，用于估计 CHF 中的 GFR 和预后。
队列研究。
慢性心力衰竭。
患者、干预措施和主要观察指标：在 102 例 CHF 患者中，研究了 GFR （通过 125）I-碘酞酸盐清除率（GFR（IOTH））、肾脏病饮食改良公式（GFR（MDRD））和胱抑素 C 之间的相关性。联合终点包括所有原因死亡率、心脏移植或 24 个月内因 CHF 入院的首次发生。
平均年龄为 58±12 岁；77%为男性。平均左心室射血分数为 28±9%。平均 GFR（IOTH）为 75±27 ml/min/1.73 m2，而中位胱抑素 C 水平为 0.80（0.69-1.02）mg/l。GFR（IOTH）与所有肾功能估计值密切相关，包括 1/胱抑素 C（r=0.867，p<0.001）。1/胱抑素 C 比 1/血清肌酐（z=3.12，p=0.002）更好地预测 GFR（IOTH），但与 GFR（MDRD）（z=0.92，p=0.356）预测结果相当。血清 1/胱抑素 C 是预后的独立强预测因子（HR：每增加一个标准差增加 2.27，95%CI 为 1.12 至 4.63），与 GFR（MDRD）相似。
胱抑素 C 是肾功能的准确、简便估计值，在 CHF 患者中具有优于血清肌酐的预后价值，与基于肌酐的公式相似。
