Bahrmann Philipp, Bertsch Thomas, Giannitsis Evangelos, Christ Michael, Hofner Benjamin, Christenson Robert, Lindahl Bertil, Mueller Christian
Clin Lab. 2017 Sep 1;63(9):1457-1466. doi: 10.7754/Clin.Lab.2017.170326.
Increases in the novel serum marker cystatin C are detectable much earlier in the course of chronic kidney disease (CKD) even when levels of serum creatinine are still in the normal range. A major factor causing a decrease in serum creatinine is increasing age. Patients with CKD are more likely to develop cardiovascular disease (CVD) than a healthy population and to suffer premature deaths from CVD related to CKD. The aim of this study was to investigate whether cystatin C, serum creatinine, and estimated glomerular filtration rate (eGFR) predict cardiovascular mortality in patients admitted to the emergency department (ED) with suspected acute coronary syndromes (ACS).
In 1,282 patients (mean age 62 ± 15 years, 477 women, 805 men) with suspected ACS, baseline cystatin C concentrations, serum creatinine, and estimated glomerular filtration rate (eGFR) were measured at the ED. Clinical assessment and serial high sensitivity cardiac troponin T (hs-cTnT) measurements were used for the diagnosis of ACS. Seventeen cardiovascular deaths were registered during a median follow-up of 365 days.
HRs from univariate Cox regression models for each of the potential biomarkers were 12.02 (95% CI 5.10 - 28.34) for cystatin C, 4.53 (1.75 - 11.70) for serum creatinine, and 0.97 (0.96 - 0.99) for eGFR. All three biomarkers showed a significant association with cardiovascular mortality in univariate analyses. The HRs from a model with all three potential biomarkers were 59.21 (95% CI 9.69 - 361.76) for cystatin C, 0.08 (0.01 - 0.58) for serum creatinine, and 0.98 (0.96 - 1.01) for eGFR. The risk association was significant for ln (cystatin C) and ln (serum creatinine).
Results of this prospective study show that the quantification of renal function using cystatin C is useful for predicting cardiovascular mortality in patients with suspected ACS at the ED.
即使血清肌酐水平仍在正常范围内，新型血清标志物胱抑素C在慢性肾脏病（CKD）病程中升高也能被更早检测到。导致血清肌酐降低的一个主要因素是年龄增长。CKD患者比健康人群更易发生心血管疾病（CVD），并因与CKD相关的CVD过早死亡。本研究的目的是调查胱抑素C、血清肌酐和估计肾小球滤过率（eGFR）是否能预测因疑似急性冠状动脉综合征（ACS）而入住急诊科（ED）的患者的心血管死亡率。
在1282例疑似ACS患者（平均年龄62±15岁，477例女性，805例男性）中，于急诊科测量基线胱抑素C浓度、血清肌酐和估计肾小球滤过率（eGFR）。临床评估和连续高敏心肌肌钙蛋白T（hs-cTnT）测量用于ACS的诊断。在中位随访365天期间记录了17例心血管死亡病例。
各潜在生物标志物的单变量Cox回归模型的风险比（HR）分别为：胱抑素C为12.02（95%置信区间5.10 - 28.34），血清肌酐为4.53（1.75 - 11.70），eGFR为0.97（0.96 - 0.99）。在单变量分析中，所有这三种生物标志物均与心血管死亡率显著相关。包含所有三种潜在生物标志物的模型的HR分别为：胱抑素C为59.21（95%置信区间9.69 - 361.76），血清肌酐为0.08（0.01 - 0.58），eGFR为0.98（0.96 - 1.01）。ln（胱抑素C）和ln（血清肌酐）的风险关联具有显著性。
这项前瞻性研究的结果表明，使用胱抑素C对肾功能进行量化有助于预测急诊科疑似ACS患者的心血管死亡率。
