Complementary Prognostic Value of Cystatin C, N-Terminal Pro-B-Type Natriuretic Peptide and Cardiac Troponin T in Patients With Acute Heart Failure
Complementary Prognostic Value of Cystatin C, N-Terminal Pro-B-Type Natriuretic Peptide and Cardiac Troponin T in Patients With Acute Heart Failure
复制标题
DOI：
10.1016/j.amjcard.2009.02.029
复制
发表时间：
2009-06-15
影响因子：
2.8
通讯作者：
Andres Pascual-Figal, Domingo
中科院分区：
文献类型：
--
作者：
Manzano-Fernandez, Sergio;Boronat-Garcia, Miguel;Andres Pascual-Figal, Domingo
本研究的目的是比较胱抑素C相对于肌酐和肾脏疾病饮食改良（MDRD）方程的预后价值，并评估其是否为急性心力衰竭患者队列风险分层中的心脏生物标志物提供补充信息。前瞻性研究了确诊为急性心力衰竭的连续住院患者。在到达医院时采集血液样本，以测定胱抑素C、心肌肌钙蛋白T和N-末端脑钠肽前体。获得临床随访，并登记死亡和/或心力衰竭再入院的发生率。研究了138例患者（中位年龄74岁，四分位数范围67 - 80; 54%为男性）。在261天的中位随访期间（四分位距161 - 449），60例患者（43.5%）出现不良事件。多变量校正后，胱抑素C、N末端脑钠肽前体、心肌肌钙蛋白T、纽约心脏协会心功能III或IV级和糖尿病被确定为死亡率和/或心力衰竭再入院的独立预测因子。与肌酐和MDRD方程相反，最高胱抑素C三分位数（> 1.50 mg/L）是不良事件的显著独立风险因素（风险比3.08，95%置信区间1.54至6.14，p = 0.004）。联合使用心肌肌钙蛋白T、N末端脑钠肽前体和半胱氨酸蛋白酶抑制剂C的多标志物方法进一步改善了风险分层，表明2（风险比2.37，95%置信区间1.10 - 5.71）或3（风险比3.64，95%置信区间1.55至8.56）生物标志物升高的患者发生不良事件的风险高于生物标志物未升高的患者（趋势p = 0.015）。总之，在这一队列研究中，胱抑素C是一个比传统的肾功能指标更强的不良事件预测因子。此外，胱抑素C为心脏生物标志物提供了补充的预后信息，可以帮助临床医生对急性心力衰竭患者进行更准确的风险分层。(C)2009 Elsevier Inc. (Am J Cardiol 2009;103：1753-1759）
The aims of this study were to compare the prognostic value of cystatin C over creatinine and the Modification of Diet in Renal Disease (MDRD) equation and to evaluate whether it provides complementary information to cardiac biomarkers in the risk stratification of an unselected cohort of patients with acute heart failure. Consecutive hospitalized patients with established diagnoses of acute heart failure were prospectively studied. Blood samples were collected on hospital arrival to determine cystatin C, cardiac troponin T, and N-terminal-pro-brain natriuretic peptide. Clinical follow-up was obtained, and the occurrence of mortality and/or heart failure readmission was registered. One hundred thirty-eight patients (median age 74 years, interquartile range 67 to 80; 54% men) were studied. During a median follow-up period of 261 days (interquartile range 161 to 449), 60 patients (43.5%) presented with adverse events. After multivariate adjustment, cystatin C, N-terminal-pro-brain natriuretic peptide, cardiac troponin T, New York Heart Association functional class III or IV, and diabetes mellitus were identified as independent predictors of mortality and/or heart failure readmission. In contrast to creatinine and the MDRD equation, the highest cystatin C tertile (> 1.50 mg/L) was a significant independent risk factor for adverse events (hazard ratio 3.08, 95% confidence interval 1.54 to 6.14, p = 0.004). A multimarker approach combining cardiac troponin T, N-terminal-pro-brain natriuretic peptide, and cystatin C improved risk stratification further, showing that patients with 2 (hazard ratio 2.37, 95% confidence interval 1.10 to 5.71) or 3 (hazard ratio 3.64, 95% confidence interval 1.55 to 8.56) elevated biomarkers had a higher risk for adverse events than patients with no elevated biomarkers (p for trend = 0.015). In conclusion, in this unselected cohort, cystatin C was a stronger predictor of adverse events than conventional measures of kidney function. In addition, cystatin C offered complementary prognostic information to cardiac biomarkers and could help clinicians perform more accurate risk stratification of patients with acute heart failure. (C) 2009 Elsevier Inc. (Am J Cardiol 2009;103:1753-1759)