Heart Failure Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.
PLoS One. 2012;7(12):e51234. doi: 10.1371/journal.pone.0051234. Epub 2012 Dec 11.
To compare the prognostic value of estimated glomerular filtration rate, cystatin-C, an alternative renal biomarker, and their combination, in an outpatient population with heart failure. Estimated glomerular filtration rate is routinely used to assess renal function in heart failure patients. We recently demonstrated that the Cockroft-Gault formula is the best among the most commonly used estimated glomerular filtration rate formulas for predicting heart failure prognosis.
METHODOLOGY/PRINCIPAL FINDINGS: A total of 879 consecutive patients (72% men, age 70.4 years [P(25-75) 60.5-77.2]) were studied. The etiology of heart failure was mainly ischemic heart disease (52.7%). The left ventricular ejection fraction was 34% (P(25-75) 26-43%). Most patients were New York Heart Association class II (65.8%) or III (25.9%). During a median follow-up of 3.46 years (P(25-75) 1.85-5.05), 312 deaths were recorded. In an adjusted model, estimated glomerular filtration rate and cystatin-C showed similar prognostic value according to the area under the curve (0.763 and 0.765, respectively). In Cox regression, the multivariable analysis hazard ratios were 0.99 (95% CI: 0.98-1, P = 0.006) and 1.14 (95% CI: 1.02-1.28, P = 0.02) for estimated glomerular filtration rate and cystatin-C, respectively. Reclassification, assessed by the integration discrimination improvement and the net reclassification improvement indices, was poorer with cystatin-C (-0.5 [-1.0;-0.1], P = 0.024 and -4.9 [-8.8;-1.0], P = 0.013, respectively). The value of cystatin-C over estimated glomerular filtration rate for risk-stratification only emerged in patients with moderate renal dysfunction (eGFR 30-60 ml/min/1.73 m(2), chi-square 12.9, P<0.001).
CONCLUSIONS/SIGNIFICANCE: Taken together, the results indicate that estimated glomerular filtration rate and cystatin-C have similar long-term predictive values in a real-life ambulatory heart failure population. Cystatin-C seems to offer improved prognostication in heart failure patients with moderate renal dysfunction.
比较估算肾小球滤过率、胱抑素 C（一种替代的肾生物标志物）及其组合在门诊心力衰竭患者中的预后价值。估算肾小球滤过率常用于评估心力衰竭患者的肾功能。我们最近证明，在预测心力衰竭预后方面，Cockroft-Gault 公式是最常用的估算肾小球滤过率公式中最好的。
方法/主要发现：共研究了 879 例连续患者（72%为男性，年龄 70.4 岁[P（25-75）60.5-77.2]）。心力衰竭的病因主要为缺血性心脏病（52.7%）。左心室射血分数为 34%（P（25-75）26-43%）。大多数患者为纽约心脏协会心功能分级 II 级（65.8%）或 III 级（25.9%）。在中位随访 3.46 年（P（25-75）1.85-5.05）期间，记录了 312 例死亡。在调整后的模型中，根据曲线下面积（分别为 0.763 和 0.765），估算肾小球滤过率和胱抑素 C 显示出相似的预后价值。在 Cox 回归中，多变量分析的风险比分别为 0.99（95%CI：0.98-1，P=0.006）和 1.14（95%CI：1.02-1.28，P=0.02）。评估再分类的整合判别改善和净再分类改善指数显示，胱抑素 C 较差（-0.5[-1.0;-0.1]，P=0.024 和-4.9[-8.8;-1.0]，P=0.013）。仅在肾功能中度障碍（eGFR 30-60ml/min/1.73m（2），卡方值 12.9，P<0.001）患者中，胱抑素 C 对风险分层的价值优于估算肾小球滤过率。
结论/意义：综上所述，结果表明，在真实生活中的门诊心力衰竭患者中，估算肾小球滤过率和胱抑素 C 具有相似的长期预测价值。在肾功能中度障碍的心力衰竭患者中，胱抑素 C 似乎能提供更好的预后判断。
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