Abstract 3614: Multi-Biomarker Approach to Risk Stratification in Patients Hospitalized for Worsening Chronic Heart Failure: Simultaneous Assessment of Cystatin C, B-Type Natriuretic Peptide, and Cardiac Troponin T
Background: Cystatin C is a new and better marker of glomerular filtration rate than creatinine. In patients with chronic heart failure (CHF), cystatin C, B-type natriuretic peptide (BNP), and cardiac troponin T (TnT) each predict adverse cardiac events. Little is known, however, about the utility of these biomarkers in combination.
Methods Admission measurements of cystatin C, BNP, and TnT were performed in 256 consecutive patients hospitalized for worsening CHF [mean age of 68.7 years; New York Heart Association (NYHA) functional class III in 109 patients, and class IV in 147 patients].
Results: During a mean follow-up period of 1059 days after admission, there were 54 (21.1%) cardiovascular deaths including 15 in-hospital deaths. On a stepwise Cox regression analysis including these biomarkers, age, sex, ischemic etiology, systolic blood pressure, heart rate, NYHA class, left ventricular ejection fraction on admission, elevation in cystatin C (>median value of 1.17 mg/l; relative risk [RR] 2.7, P=0.006), BNP (>median value of 790 pg/ml; RR 2.4, P=0.01) and TnT (>median value of 0.02 ng/ml; RR 2.7, P=0.008) were independently associated with cardiovascular deaths. When patients were categorized on the basis of the number of elevated biomarkers on admission, adjusted RR for cardiovascular mortality was 1.5 (P=0.6) in patients with one elevated biomarker, 5.7 (P=0.005) in those with two, and 12.4 (P<0.0001) in those with three. The number of elevated biomarkers on admission was correlated with an incremental increase in in-hospital and overall cardiovascular mortality rate (Table⇓).
Conclusions: Cystatin C, BNP, and TnT each provide unique prognostic information in patients hospitalized for worsening CHF. A simple multi-biomarker strategy that categorizes patients based on the number of elevated biomarkers on admission allows risk stratification for cardiovascular mortality in this population.