Abstract 11395: Glomerular Filtration Rate Estimated by Cystatin C- versus Creatinine-Based Equations for Predicting Cardiovascular Mortality in Patients Hospitalized for Worsening Heart Failure Without Advanced Renal Impairment
Background: Recently, new glomerular filtration rate (GFR)-estimating equations based on standard cystatin C for a Japanese population were developed. We prospectively investigated whether GFR estimated by the serum cystatin C-based equations (GFRcys) was superior to GFR estimated by the serum creatinine-based equations (GFRcre) for predicting cardiovascular mortality in patients with acute heart failure without advanced renal impairment.
Methods: A total of 398 consecutive patients hospitalized for worsening heart failure with GFRcre ≥15 mL/min/1.73 m2 were examined by the measurement of GFRcys and GFRcre. There were 134 patients in NYHA functional class III, and 264 patients in class IV. GFRcys and GFRcre were calculated by the following formulas; GFRcys = [104 х (cystatin C)-1.019 х 0.996age х 0.929 (if female)] - 8, GFRcre = 194 х (creatinine)-1.094 х (age)-0.287 х 0.739 (if female).
Results: GFRcys was positively correlated with GFRcre (r = 0.62, P <0.0001). During a median follow-up period of 933 days after admission, there were 74 (19%) cardiovascular deaths, and 85 all-cause deaths. In stepwise Cox regression analyses including GFRcys and GFRcre (either as continuous variables or as variables categorized into quartiles), age, sex, diabetes, ischemic etiology, NYHA functional class, systolic blood pressure, left ventricular ejection fraction, and medical treatments, GFRcys (P <0.0001), but not GFRcre, was independently associated with cardiovascular mortality. The area under the receiver operating characteristic curve for GFRcys between patients who died from cardiovascular causes and who did not was higher than that for GFRcre (0.75 vs. 0.69). Similar results were also obtained from all-cause deaths. Adjusted relative risks of cardiovascular and all-cause mortalities according to quartiles of GFRcys were shown in Figure .
Conclusion: GFRcys may improve the early risk stratification compared with GFRcre in this population.
- © 2013 by American Heart Association, Inc.