Can Serum Cystatin C predict long-term survival in cardiac surgery patients?

Abstract

Renal dysfunction is a risk factor for morbidity and mortality in cardiac surgery patients. Serum Cystatin C (sCysC) is a well-recognized marker of early renal dysfunction but few reports evaluate its prognostic cardio-vascular role. The aim of the study is to consider the prognostic value of sCysC for cardiovascular mortality. Four hundred twenty-four cardiac-surgery patients (264 men and 160 women) were enrolled. At admission, all patients were tested for renal function and inflammatory status. Patients were subdivided in subgroups according to the values of the following variables: sCysC, serum Creatinine (sCrea), age, high sensitivity-C Reactive Protein, fibrinogen, surgical procedures and Kaplan-Meier cumulative survival curves were plotted. The primary end-point was cardiovascular mortality. In order to evaluate the simultaneous independent impact of all measured variables on survival we fitted a multivariate Cox-Proportional Hazard Model (CPHM). In Kaplan-Meier analysis 124 patients (29.4%) reached the end-point. In multivariate CPHM, the only significant predictors of mortality were sCysC (p<0.00001, risk ratio: 1.529, CI: 1.29-1.80) and age (p=0.039, risk ratio: 1.019, CI: 1.001-1.037). When replacing sCysC with sCrea, the only significant predictor of mortality was sCrea (p=0.0026; risk ratio 1.20; CI: 1.06-1.36). Increased levels of sCysC can be considered a useful biomarker of cardiovascular mortality in cardiac-surgery patients.

Utility of SIFT-MS to evaluate volatile organic compounds in nephropathic patients’ breath

“…Recently, some authors have highlighted how the accumulation of TMAO is not only indicative of an increased CV risk but it also represents a potential early biomarker of renal dysfunction. In fact, a remarkable study has shown how in a cohort of non-CKD subjects, the highest levels of TMAO were associated with higher levels of cystatin C, highlighting how the TMAO increase may precede a slatentized kidney disease 40 , 41 . This data is confirmed by animal studies in which the TMAO increase and the chronic high dietary intake of choline are interconnected with the progression of renal tubule-interstitial fibrosis and with the development of renal dysfunction 30 , 33 , 42 .…”

Female Sex as a Thromboembolic Risk Factor in the Era of Nonvitamin K Antagonist Oral Anticoagulants

“…This condition could also favour a hypercoagulable state also through an increased production of inflammatory cytokines [ 2 ]. Several prothrombotic biomarkers, such as D-dimer, von Willebrand factor, and beta-thromboglobulin are present in higher concentrations in patients affected by atrial fibrillation (AF) [ 3 , 4 ].…”

Mirror mirror on the wall, who is going to be readmitted after all?

“…Cytostatin C is a nonglycosylated basic protein of the family of cysteine protease inhibitors and is used as a biomarker of renal function and recently has also been evaluated as a potential predictor of the onset or worsening of cardiovascular disease. Many studies evidenced how the easiness and speed of measurement makes cytostatin C a potentially valuable biomarker for early diagnosis of renal failure, and a formidable predictor of long‐term outcome after cardiac surgery 7 . It is interesting that a major clinical trial such as the ORIGIN trial did not consider this biomarker 8 .…”

“…Many studies evidenced how the easiness and speed of measurement makes cytostatin C a potentially valuable biomarker for early diagnosis of renal failure, and a formidable predictor of long-term outcome after cardiac surgery. 7 It is interesting that a major clinical trial such as the ORIGIN trial did not consider this biomarker. 8 Instead, the trial found that the NT-proBNP, angiopoietin 2, and glutathione S transferase α were associated to the survival rate at follow-up.…”