Rovella Valentina, Marrone Giulia, Dessì Mariarita, Ferrannini Michele, Toschi Nicola, Pellegrino Antonio, Casasco Maurizio, Di Daniele Nicola, Noce Annalisa
Department of Medicine, Hypertension and Nephrology Unit, University Hospital Tor Vergata, Rome 00133, Italy.
PhD School of Applied Medical-Surgical Sciences, University of Rome Tor Vergata, Rome 00133, Italy.
Aging (Albany NY). 2018 Mar 27;10(3):425-433. doi: 10.18632/aging.101403.
Renal dysfunction is a risk factor for morbidity and mortality in cardiac surgery patients. Serum Cystatin C (sCysC) is a well-recognized marker of early renal dysfunction but few reports evaluate its prognostic cardio-vascular role. The aim of the study is to consider the prognostic value of sCysC for cardiovascular mortality. Four hundred twenty-four cardiac-surgery patients (264 men and 160 women) were enrolled. At admission, all patients were tested for renal function and inflammatory status. Patients were subdivided in subgroups according to the values of the following variables: sCysC, serum Creatinine (sCrea), age, high sensitivity-C Reactive Protein, fibrinogen, surgical procedures and Kaplan-Meier cumulative survival curves were plotted. The primary end-point was cardiovascular mortality. In order to evaluate the simultaneous independent impact of all measured variables on survival we fitted a multivariate Cox-Proportional Hazard Model (CPHM). In Kaplan-Meier analysis 124 patients (29.4%) reached the end-point. In multivariate CPHM, the only significant predictors of mortality were sCysC (p<0.00001, risk ratio: 1.529, CI: 1.29-1.80) and age (p=0.039, risk ratio: 1.019, CI: 1.001-1.037). When replacing sCysC with sCrea, the only significant predictor of mortality was sCrea (p=0.0026; risk ratio 1.20; CI: 1.06-1.36). Increased levels of sCysC can be considered a useful biomarker of cardiovascular mortality in cardiac-surgery patients.
肾功能不全是心脏手术患者发病和死亡的危险因素。血清胱抑素C（sCysC）是早期肾功能不全的一个公认标志物，但很少有报告评估其对心血管疾病的预后作用。本研究的目的是探讨sCysC对心血管疾病死亡率的预后价值。纳入了424例心脏手术患者（264例男性和160例女性）。入院时，对所有患者进行肾功能和炎症状态检测。根据以下变量的值将患者分为亚组：sCysC、血清肌酐（sCrea）、年龄、高敏C反应蛋白、纤维蛋白原、手术方式，并绘制Kaplan-Meier累积生存曲线。主要终点是心血管疾病死亡率。为了评估所有测量变量对生存的同时独立影响，我们拟合了一个多变量Cox比例风险模型（CPHM）。在Kaplan-Meier分析中，124例患者（29.4%）达到终点。在多变量CPHM中，死亡率的唯一显著预测因素是sCysC（p<0.00001，风险比：1.529，CI：1.29-1.80）和年龄（p=0.039，风险比：1.019，CI：1.001-1.037）。当用sCrea替代sCysC时，死亡率的唯一显著预测因素是sCrea（p=0.0026；风险比1.20；CI：1.06-1.36）。sCysC水平升高可被认为是心脏手术患者心血管疾病死亡率的一个有用生物标志物。
