Abstract 18069: Plasma Cystatin C Predicts Risk of All-Cause Mortality and Mortality Related to Cardiovascular, Coronary Artery Disease or Any Malignant Neoplasm Independent of Creatinine Based Assessment of Renal Function Status Among Asymptomatic Adults: The National Health and Nutrition Examination Survey

Abstract

Background: Cystatin C (Cys-C) is known to reflect a more precise renal function status than creatinine based glomerular filtration rate (GFR-C). However, less is known about its predictive value for clinical outcomes among non-institutionalized asymptomatic adults. We studied the predictive value of Cys-C for all-cause mortality and mortality due to cardiovascular (CV), coronary artery disease (CAD), or any malignant neoplasm among asymptomatic adults.

Methods: We analyzed data from the continuous National Health and Nutrition Examination Survey (NHANES) from 1999-2002. Data on all-cause and cause specific mortality was obtained using probabilistic match between NHANES and National Death Index death records available from date of the survey participation through December 31st, 2006. Participants (> 18 years) were divided into 4 groups based on level of Cys-C at baseline: Q1 (< 0.74 mg/L), Q2 (0.74 - 0.82 mg/L), Q3 (0.83 - 0.95 mg/L), and Q4 ( ≥ 0.96 mg/L). Cox proportional regression models were used to estimate hazard ratio (HR) and 95% Confidence Interval (CI) for selected outcomes. Multivariate models were adjusted for traditional CV risk factors including GFR-C.

Results: The mean (SD) age, Cys-C and GFR-C for the 4842 participants (51 % females) was 57.8 (20) years, 0.89 (0.35) mg/L, and 99.5 (37.8) mL/min, respectively. After a mean (SD) follow up of 5.48 (1.43) years, the hazard of all-cause and CAD mortality in the Q2, Q3, and Q4 groups was higher than in group Q1 (p < 0.05). The hazard of any malignant neoplasm and CVD related mortality was higher in Q3 and Q4 than in Q1 group (p < 0.05). Adjustment for renal function using GFR-C, did not change any of the estimates.

Conclusions: Higher plasma Cys-C concentrations, in a dose-response manner, predict risk of all-cause mortality and mortality related to CVD, CAD or any malignant neoplasm independent of traditional CV risk factors and GFR-C among asymptomatic adults.