Complementary Prognostic Value of Cystatin C, N-Terminal Pro-B-Type Natriuretic Peptide and Cardiac Troponin T in Patients With Acute Heart Failure

Manzano‐Fernández, Sergio; Boronat-García, Miguel; Albaladejo-Otón, María Dolores; Pastor, Patricia; Garrido, Iris P.; Pastor‐Pérez, Francisco J.; Martı́nez-Hernández, Pedro; Valdés, Mariano; Pascual-Figal, Domingo A.

doi:10.1016/j.amjcard.2009.02.029

Cited by 91 publications

(62 citation statements)

References 21 publications

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“…Multiple factors, including female gender, low income status, single marital status, advanced age, co-morbid conditions (such as depression, coronary artery disease diabetes mellitus, atrial fibrillation, anemia, chronic kidney disease), worsening renal function, elevated cardiac troponin and increased length of initial hospitalization have been identified as potential predictors from previous studies [8] [13] [16]- [20].…”

Section: Discussionmentioning

confidence: 99%

Predictors of Early Readmission in Heart Failure Patients in an Inner-City Community Hospital

Xexemeku¹,

Singh²,

Adjepong³

et al. 2014

WJCD

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Heart failure (HF) is the most common hospital discharge diagnosis among the elderly. It accounts for nearly 1.4 million hospitalizations and $21 billion in spending per year in the United States. Readmission rates remain high with estimates ranging from 15-day readmission rates of 13%, 30-day readmission rates of 25%, to 6-month readmission rates of 50%. The Center for Medicare and Medicaid Services (CMS) has started penalizing hospitals with higher than expected readmission rates. Objective: To identify factors associated with increased 30-day readmission among heart failure patients in an inner-city community-based teaching hospital. Methods: A retrospective cohort study of patients with principal discharge diagnosis of acute Heart Failure between 2008 and 2010. Demographic, clinical characteristics, length of stay, discharge medications, disposition and all-cause 30-day readmission were abstracted from the hospital's administrative database and analyzed. Results: Almost 8 out of 10 patients were 65 years or older (mean age 75.4 ± 14.3) and 51% were female. The in-hospital mortality rate was 2.7% (95% confidence interval [CI], 1.6% -4.3%) with a median length of stay of 5.0 days (Interquartile range of 3 -7). The all-cause 30-day readmission rate was 17.7% (95% CI 14.9% -20.8%). By univariate analysis, readmissions were predicted by black race, prior history of HF, length of stay of more than 7 days and discharge to extended care facility (ECF). By logistic regression analysis, black race (OR 2.4, 95% CI 1.4 -3.8), prior history of HF (OR 1.7, 95% CI 1.5 -2.6) and discharge to an ECF (OR 2.4, 95% CI 1.5 -3.7) were the independent predictors of 30-day readmission. HF accounted for 43.7% of the readmissions. Conclusion: Prior diagnosis of HF, black race, and discharge to an ECF were independent predictors of 30-day readmission in this cohort, and over half of the readmissions were for reasons other than HF.

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Section: Discussionmentioning

confidence: 99%

Predictors of Early Readmission in Heart Failure Patients in an Inner-City Community Hospital

Xexemeku¹,

Singh²,

Adjepong³

et al. 2014

WJCD

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“…Two other studies showed that cystatin C was a stronger predictor of adverse events than conventional measures of kidney function. 88,89 Finally, Lassus et al 90 showed in a multicenter study that cystatin C above median (1.30 mg/L) was associated with a hazard ratio of 3.2 for mortality in AHF. Combining tertiles of NT-proBNP and cystatin C improved risk stratification further.…”

Section: Commentsmentioning

confidence: 99%

Renal Function, Health Outcomes, and Resource Utilization in Acute Heart Failure

Butler

Chirovsky

Phatak

et al. 2010

Circ: Heart Failure

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A cute heart failure (AHF) is common and is associated with adverse outcomes among chronic HF patients. According to the US National Discharge Survey, it is estimated that more than 1.1 million hospitalizations with a principal diagnosis of AHF occurred in 2004. 1 Data from Europe have also reported high AHF rates. [2][3][4][5] In patients with chronic HF, hospitalization for AHF is associated with increased mortality. 6 AHF patients are also particularly prone to readmission, with reported readmission rates between 44% to 60% within 6 to 9 months of discharge. 7,8 AHF hospitalizations account for more than half of the costs of HF treatment, 2,9 which in the United States are projected to reach $37 billion in 2009. 10 Renal impairment (RI) is common in HF and is associated with adverse outcomes in AHF patients. [11][12][13][14] In addition, approximately 20% to 30% of patients admitted for AHF have worsening renal function (WRF), which further worsens prognosis. [15][16][17] Consistent with these findings, guidelines for HF treatment acknowledge that RI or WRF compromise prognosis in AHF and recommend regular monitoring of renal function in these patients. 18 -21 However, despite its importance, there is no clear consensus on how RI and WRF should be defined and to what extent these conditions affect outcomes in AHF specifically. 22 Two recent systematic reviews and meta-analyses have evaluated the association of RI and long-term mortality in HF 23 as well as the association of WRF and mortality and readmission risk. 17,23 Smith et al, 23 in a meta-analysis of 7 chronic HF (nϭ16 106) and 2 AHF (nϭ54 305) studies found a 56% increase in long-term mortality risk with severe renal impairment; moreover, WRF was associated with a 47% increase in the risk of 6-month mortality, but there was only marginal association with readmissions in AHF patients. 23 Damman et al 17 reported a 61% increase in risk of mortality and 30% risk of all-cause readmission associated with WRF after 2 to 6 months of follow-up. Although these studies provide valuable insights, they were not designed to assess outcomes specifically in AHF and did not address short-term health and health care resource outcomes such as in-hospital mortality, risk of complications, and length of stay (LOS), which are uniquely relevant to AHF patients. 17,23 The objective of this systematic review was to enumerate the range of studies that have assessed the impact of RI and WRF on short-and long-term health outcomes and health care resource use in adult AHF patients. We also describe the range of definitions for RI and WRF as well as compare the associations of these definitions with relevant outcomes in AHF. Literature SearchA MEDLINE (PubMed) literature search was performed to identify peer-reviewed studies that assessed the association between RI or WRF and health outcomes and health care resource use in adult AHF patients (Figure). Because WRF epidemiology has been mainly defined after the Evaluation of Losartan in the Elderly (ELITE) trial was published in 1...

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“…Manzano-Fernandez et al confirmed these results and also included cTnT measurements in their multimarker risk stratification approach. 67 They found that each biomarker (cystatin C, NT-proBNP, and cTnT) provided independent and complementary prognostic information. Also, in elderly patients with chronic HF, cystatin C and NT-proBNP levels are reported to be a powerful combination for predicting cardiovascular mortality.…”

Section: Cystatin C In Hfmentioning

confidence: 99%

Heart Failure, Chronic Kidney Disease, and Biomarkers - An Integrated Viewpoint -

Iwanaga

Miyazaki

2010

Circ J

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Chronic kidney disease (CKD) is frequently associated with a progressive decrease in the glomerular filtration rate, which leads to endstage renal disease (ESRD). Heart failure (HF) is a complex syndrome rather than a primary diagnosis, and considered as the endpoint of all cardiovascular disorders. It is the leading cause of death among the cardiovascular diseases in patients with CKD and ESRD. There is some interaction between the heart and kidney (the so-called "cardiorenal syndrome"), and HF patients with the complication of CKD or ESRD show a worse prognosis. Thus, early diagnosis and aggressive management of HF are needed in patients with CKD and ESRD. A number of biomarkers appear to have growing clinical importance and are reported for detection and stratification of HF. Although HF and CKD have a close interrelationship, the utility of the biomarkers has not been adequately studied with regard to the relationship with renal dysfunction. This paper reviews of the current evidence about laboratory biomarkers in patients with HF or CKD, emphasizing the emerging cardiac biomarkers (ie, BNPs and cardiac troponins), and the biomarkers of renal injury (ie, cystatin C and neutrophil gelatinase-associated lipocalin). Furthermore, it discusses the potential role of these markers in terms of heart -kidney interactions and their utility in the diagnostic and therapeutic strategies for cardiorenal syndrome. (Circ J 2010; 74: 1274 - 1282

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Complementary Prognostic Value of Cystatin C, N-Terminal Pro-B-Type Natriuretic Peptide and Cardiac Troponin T in Patients With Acute Heart Failure

Cited by 91 publications

References 21 publications

Predictors of Early Readmission in Heart Failure Patients in an Inner-City Community Hospital

Predictors of Early Readmission in Heart Failure Patients in an Inner-City Community Hospital

Renal Function, Health Outcomes, and Resource Utilization in Acute Heart Failure

Heart Failure, Chronic Kidney Disease, and Biomarkers - An Integrated Viewpoint -

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