Cystatin C-based CKD-EPI estimated glomerular filtration rate equations as a better strategy for mortality stratification in acute heart failure

Cheang, Iokfai; Liao, Shengen; Yao, Wenming; Lu, Xinyi; Gao, Rongrong; Zhou, Yanli; Zhang, Haifeng; Li, Xinli

doi:10.1097/md.0000000000022996

Cited by 11 publications

(5 citation statements)

References 28 publications

(34 reference statements)

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“…There is evidence that increased CysC levels are associated with risk of cardiovascular diseases 42 and CKD‐EPI CysC has been shown to have a better predictive value for adverse outcomes in AHF patients than CKD‐EPI SCr or CKD‐EPI Scr‐CysC. 43 Consistently, in our cohort, we observed a more accurate, but still imperfect, reflection of mGFR changes by CysC.…”

Section: Discussionsupporting

confidence: 87%

Serum creatinine and cystatin C‐based estimates of glomerular filtration rate are misleading in acute heart failure

et al. 2021

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AimsWe aimed to test whether the endogenous filtration markers serum creatinine or cystatin C and equation-based estimates of glomerular filtration rate (GFR) based on these markers appropriately reflect changes of measured GFR in patients with acute heart failure. Methods In this prospective cohort study of 50 hospitalized acute heart failure patients undergoing decongestive therapy, we applied an intravenous visible fluorescent injectate (VFI), consisting of a low molecular weight component to measure GFR and a high molecular weight component to correct for measured plasma volume. Thirty-eight patients had two sequential GFR measurements 48 h apart. The co-primary endpoints of the study were safety of VFI and plasma stability of the high molecular weight component. A key secondary endpoint was to compare changes in measured GFR (mGFR) to changes of serum creatinine, cystatin C and estimated GFR. Results VFI-based GFR measurements were safe and consistent with plasma stability of the high molecular weight component and glomerular filtration of the low molecular weight component. Filtration marker-based point estimates of GFR, when compared with mGFR, provided only moderate correlation (Pearson's r, range 0.80-0.88, depending on equation used), precision (r 2 , range 0.65-0.78) and accuracy (56%-74% of estimates scored within 30% of mGFR). Correlations of 48-h changes GFR estimates and changes of mGFR were significant (P < 0.05) but weak (Pearson's r, range 0.35-0.39). Observed decreases of eGFR by more than 15% had a low sensitivity (range 38%-46%, depending on equation used) in detecting true worsening mGFR, defined by a >15% decrease in mGFR. Conclusions In patients hospitalized for acute heart failure, serum creatinine-and cystatin C-based predictions performed poorly in detecting actual changes of GFR. These data challenge current clinical strategies to evaluate dynamics of kidney function in acute heart failure.

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Section: Discussionsupporting

confidence: 87%

Serum creatinine and cystatin C‐based estimates of glomerular filtration rate are misleading in acute heart failure

et al. 2021

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“…Our study adds to the growing body of literature pointing to the discrepancies in kidney function assessment using the above mentioned renal biomarkers, and suggesting that the use of CysC in the HF population results in markedly lower eGFR when compared with sCr. 19 , 20 Recent HF guidelines preferentially recommend the use of sCr as the renal biomarker of choice (Class I, Level C). 21 However, Kidney Disease Improving Global Outcomes guidelines 16 and a position statement from the European Society of Cardiology 18 favour CysC in patients with sarcopenia.…”

Section: Discussionmentioning

confidence: 99%

The difference between cystatin C‐ and creatinine‐based assessment of kidney function in acute heart failure

et al. 2022

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Aims Acute heart failure (HF) is associated with muscle mass loss, potentially leading to overestimation of kidney function using serum creatinine‐based estimated glomerular filtration rate (eGFRsCr). Cystatin C‐based eGFR (eGFRCysC) is less muscle mass dependent. Changes in the difference between eGFRCysC and eGFRsCr may reflect muscle mass loss. We investigated the difference between eGFRCysC and eGFRsCr and its association with clinical outcomes in acute HF patients. Methods and results A post hoc analysis was performed in 841 patients enrolled in three trials: Diuretic Optimization Strategy Evaluation (DOSE), Renal Optimization Strategies Evaluation (ROSE), and Cardiorenal Rescue Study in Acute Decompensated Heart Failure (CARRESS‐HF). Intra‐individual differences between eGFRs (eGFRdiff) were calculated as eGFRCysC–eGFRsCr at serial time points during HF admission. We investigated associations of (i) change in eGFRdiff between baseline and day 3 or 4 with readmission‐free survival up to day 60; (ii) index hospitalization length of stay (LOS) and readmission with eGFRdiff at day 60. eGFRCysC reclassified 40% of samples to more advanced kidney dysfunction. Median eGFRdiff was −4 [−11 to 1.5] mL/min/1.73 m2 at baseline, became more negative during admission and remained significantly different at day 60. The change in eGFRdiff between baseline and day 3 or 4 was associated with readmission‐free survival (adjusted hazard ratio per standard deviation decrease in eGFRdiff: 1.14, P = 0.035). Longer index hospitalization LOS and readmission were associated with more negative eGFRdiff at day 60 (both P ≤ 0.026 in adjusted models). Conclusions In acute HF, a marked difference between eGFRCysC and eGFRsCr is present at baseline, becomes more pronounced during hospitalization, and is sustained at 60 day follow‐up. The change in eGFRdiff during HF admission and eGFRdiff at day 60 are associated with clinical outcomes.

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“…The study methods have been previously published. [23][24][25] Diagnosis of AHF was based on ESC acute heart failure guidelines at the time of presentation, and all patients received standard clinical evaluation and treatment. 26 Inclusion criteria: (1) age ≥ 18 years old, gender was not limited; (2) new-onset AHF or worsening preexisting heart failure, usually with symptoms of pulmonary congestion, systemic congestion or cardiac output reduction, NT-pro BNP level > 300 pg/ mL, and echocardiography indicating abnormalities in cardiac structure or function; (3) subjects participated in the study voluntarily and signed the informed consent.…”

Section: Study Populationmentioning

confidence: 99%

“…A detailed description of the study protocol, participants and data collection has been previously published. [23][24][25]…”

Section: Primary Endpoint and Follow-upmentioning

confidence: 99%

A Survival Prediction for Acute Heart Failure Patients via Web-Based Dynamic Nomogram with Internal Validation: A Prospective Cohort Study

Yin¹,

Shi²,

Zhu³

et al. 2022

JIR

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The current study aimed to develop a convenient and accurate prognostic dynamic nomogram model for the risk of allcause death in acute heart failure (AHF) patients that incorporates clinical characteristics including N-terminal pro-brain natriuretic peptide (NT-pro BNP) and growth stimulation expresses gene 2 protein (ST2). Patients and Methods: We prospectively studied 537 consecutive AHF patients and derived a clinical prediction model. The least absolute shrinkage and selection operator regression model combined with clinical characteristics were used for dimensional reduction and feature selection. Multivariate Cox proportional hazard analysis and "Dynnom" package were used to build the dynamic nomogram for prediction of 1-,2-,and 5-year overall survival for AHF. With bootstrap validation, the time-dependent concordance index (C-index) and calibration curves were used to assess predictive discrimination and accuracy. The contributions of NT-pro BNP and ST2 to the nomogram were evaluated using integrated discrimination improvement (IDI) and net reclassification improvement (NRI), while decision curve analysis (DCA) was used to assess clinical value. Results: Patients were randomly divided into derivation (74.9%, n=402) and validation (25.1%, n=135) cohorts. Optimal independent prognostic factors for 1-,2-, and 5-year all-cause mortality were BS-ACMR (B: NT-pro BNP; S: ST2; A: age; C: complete right bundle branch block; M: mean arterial pressure; and R: red cell distribution width >14.5%); these were incorporated into the dynamic nomogram (https://bs-acmr-nom.shinyapps.io/dynnomapp/) with bootstrap validation. The C-indexes in the derivation (0.793) and validation (0.782) cohorts were consistent with comparable performance parameters. The calibration curve showed good agreement between the nomogrampredicted and actual survival. Adding NT-pro BNP and ST2 provided a significant net benefit and improved performance over other less adequate schemes in terms of DCA of survival probability compared to those neglecting either of these two factors. Conclusion:The study constructed a dynamic BS-ACMR nomogram, which is a convenient, practical and effective clinical decisionmaking tool for providing accurate prognosis in AHF patients.

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Cystatin C-based CKD-EPI estimated glomerular filtration rate equations as a better strategy for mortality stratification in acute heart failure

Abstract: Supplemental Digital Content is available in the text

Cited by 11 publications

References 28 publications

Serum creatinine and cystatin C‐based estimates of glomerular filtration rate are misleading in acute heart failure

Serum creatinine and cystatin C‐based estimates of glomerular filtration rate are misleading in acute heart failure

The difference between cystatin C‐ and creatinine‐based assessment of kidney function in acute heart failure

A Survival Prediction for Acute Heart Failure Patients via Web-Based Dynamic Nomogram with Internal Validation: A Prospective Cohort Study

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