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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 29, No 5, September/October 2018
AFRICA
305
The impact of admission cystatin C levels on in-hospital
and three-year mortality rates in acute decompensated
heart failure
Hatice Selcuk, Mehmet Timur Selcuk, Orhan Maden, Kevser Gülcihan Balci, Mustafa Mücahit Balci,
Sebahat Tekeli, Elif Hande Çetin, Ahmet Temizhan, Mustafa Balci, Nihal Karabiber
Abstract
Background:
Although tremendous advances have been made
in preventative and therapeutic approaches in heart failure
(HF), the hospitalisation and mortality rates for patients with
HF is high. The aim of this study was to investigate the asso-
ciation between cystatin C and N-terminal pro-B-type natriu-
retic peptide (NT-proBNP) levels and in- and out-of-hospital
mortality rates in acute decompensated HF (ADHF).
Methods:
Between February 2008 and November 2011, 57
consecutive patients who were admitted with ADHF were
included in this prospective study. These patients were clinically
followed up every three months by means of visits or telephone
interviews. The primary clinical endpoint of this study was any
death from heart failure rehospitalisation and/or other causes.
Results:
The subjects who died during the in-hospital follow up
were younger than the survivors (47.4
±
17.5 vs 60.8
±
15.8,
p
=
0.043). There was a notable correlation between plasma cystatin
C and NT-proBNP levels (
r
=
0.324,
p
=
0.014) and glomerular
filtration rate (GFR) (
r
=
–0.638,
p
<
0.001). Multivariate logis-
tic regression analysis revealed that only cystatin C level [odds
ratio (OR): 12.311, 95% confidence interval (CI): 1.616–93.764,
p
=
0.015] and age [OR: 0.925, 95% CI: 0.866–0.990,
p
=
0.023]
were linked to in-hospital mortality rate. In the multivariate
Cox proportional hazard model, only admission sodium level
appeared as a significant independent predictor of death
during the 36-month follow up [hazard ratio: 0.937, 95% CI:
0.880–0.996,
p
=
0.037].
Conclusion:
Evaluation of admission cystatin C levels may
provide a reliable prediction of in-hospital mortality, compared
to estimated GFR or NT-proBNP levels among patients with
ADHF. However, in this trial, during long-term follow up,
only admission sodium level significantly predicted death.
Keywords:
cystatin C, heart failure, in-hospital mortality
Submitted 5/5/17, accepted 20/6/18
Published online 13/7/18
Cardiovasc J Afr
2018;
29
: 305–309
www.cvja.co.zaDOI: 10.5830/CVJA-2018-035
Worldwide, chronic heart failure (HF) syndrome is increasing
in prevalence. Despite advances in preventative and therapeutic
approaches, mortality and hospitalisation rates in this population
remain high. Impaired renal function often accompanies HF,
and co-existence of these diseases is correlated with an increased
rate of cardiovascular risk and death.
1
The exact mechanism underlying the complex interaction
between HF and renal disease remains unclear. Recently, cystatin
C, an inhibitor of cysteine proteases of the cathepsin family has
gained valuable recognition, being a more reliable measure of
renal function than serum creatinine-based calculations.
Cystatin C is created by all nucleated cells and is simply
drained at the glomerulus and not secreted from the tubules.
Unlike creatinine, it does not seem to be affected by gender, race
or muscle volume, which makes it a more definite marker of
glomerular capacity.
2,3
Increased levels of cystatin C are related
to impaired renal function and correlated with a decline in
estimated glomerular filtration rate (eGFR).
4
In both acute and
chronic stages of HF, cystatin C level is a better predictor of
mortality and unfavourable cardiovascular outcome, compared
to serum creatinine-based assessments.
5-7
HF causes volume overload, which results in myocardial
stretch and excretion of cardiac peptides such as N-terminal
pro-B-type natriuretic peptide (NT-proBNP).
8
NT-proBNP is
not only useful for diagnostic purposes, but also provides
relevant information about clinical responses to HF regimens
and prognosis of the HF.
9,10
In a previous report, a combination
of cystatin C and NT-proBNP level was used as a predictor of
unfavourable results in subjects with acute decompensated HF
(ADHF).
11
The authors reported that combination of the two parameters
was useful in predicting patients who had the highest risk for
worse outcomes. However, in the literature, there are no data
about the relationship between hospital admission cystatin C
levels and mortality on an annual basis. We intended to assess the
association between in-hospital mortality rate among patients
with ADHF and both cystatin C and NT-proBNP levels.
Another aim was to evaluate whether out-of-hospital mortality
rate was associated with in-hospital levels of cystatin C during
regular follow up (36 months).
Department of Cardiology, Turkiye Yuksek Ihtisas Research
and Education Hospital, Ankara, Turkey
Hatice Selcuk, MD
Mehmet Timur Selcuk, MD
Orhan Maden, MD
Kevser Gülcihan Balci, MD,
kevs84@gmail.comMustafa Mücahit Balci, MD
Sebahat Tekeli, MD
Elif Hande Çetin, MD
Ahmet Temizhan, MD
Department of Immunology, Turkiye Yuksek Ihtisas
Research and Education Hospital, Ankara, Turkey
Mustafa Balci, MD
Department of Microbiology, Turkiye Yuksek Ihtisas
Research and Education Hospital, Ankara, Turkey
Nihal Karabiber, MD