Feng Wei-Zhong, Zhou Jun-Qing, Yu Guang-Mao, Zeng Yong, Xu Peng
Department of Cardiothoracic Surgery, Shaoxing People's Hospital, Shaoxing Hospital of Zhejiang University, Shaoxing 312000, Zhejiang Province, China.
Oncotarget. 2017 Aug 30;8(60):101103-101111. doi: 10.18632/oncotarget.20593. eCollection 2017 Nov 24.
Increased serum cystatin C levels are related to the prognosis of cardiovascular diseases. This study aims to investigate the effect of admission serum cystatin C levels on short- and long-term mortality in patients with acute type A aortic dissection (ATAAD). From 2010 to 2014, 136 consecutive patients with ATAAD were enrolled and followed up. Clinical data and laboratory assays including were measured. During a median follow-up of 198.7 days, the short-term mortality (30-days) was 20.6%, whereas the long-term death rate was 10.2%. We identified that the expression of cystatin C and high-sensitivity C-reactive protein (hs-CRP) in the dying patients was higher than in the surviving patients ( < 0.01). Hs-CRP (HR = 1.41, 95% CI: 1.03-2.59, = 0.037) was an independent risk factor of short-term death determined by univariate and multivariate Cox analyses. No impact of cystatin C was observed on the short-term mortality. For long-term mortality, cystatin C (HR = 1.49, 95% CI: 1.10-7.36, = 0.013) was identified as an independent predictor at above the cut-off value ≥ 1.10 mg/L. ROC analysis showed the AUC values of cystatin C and hs-CRP were 0.772 (95% CI, 0.692-0.839) and 0.640 (95% CI, 0.574-0.739), respectively, in the prediction of long-term death. The combined AUC value of cystatin C and hs-CRP was 0.883 (95% CI, 0.826-0.935; < 0.01). Taken together, high cystatin C levels (≥ 1.10 mg/L) on admission are independently associated with the long-term mortality in patients with ATAAD.
血清胱抑素C水平升高与心血管疾病的预后相关。本研究旨在探讨入院时血清胱抑素C水平对急性A型主动脉夹层（ATAAD）患者短期和长期死亡率的影响。2010年至2014年，连续纳入136例ATAAD患者并进行随访。测量了临床资料和实验室检测指标。在中位随访198.7天期间，短期死亡率（30天）为20.6%，而长期死亡率为10.2%。我们发现，胱抑素C和高敏C反应蛋白（hs-CRP）在死亡患者中的表达高于存活患者（<0.01）。单因素和多因素Cox分析确定，hs-CRP（HR = 1.41，95%CI：1.03 - 2.59，= 0.037）是短期死亡的独立危险因素。未观察到胱抑素C对短期死亡率有影响。对于长期死亡率，胱抑素C（HR = 1.49，95%CI：1.10 - 7.36，= 0.013）在截断值≥1.10 mg/L以上时被确定为独立预测因子。ROC分析显示，在预测长期死亡方面，胱抑素C和hs-CRP的AUC值分别为0.772（95%CI，0.692 - 0.839）和0.640（95%CI，0.574 - 0.739）。胱抑素C和hs-CRP的联合AUC值为0.883（95%CI，0.826 - 0.935；<0.01）。综上所述，入院时高胱抑素C水平（≥1.10 mg/L）与ATAAD患者的长期死亡率独立相关。
