Cystatin C–based <scp>CKD‐EPI</scp> Equations and N‐Terminal Pro‐B‐Type Natriuretic Peptide for Predicting Outcomes in Acutely Decompensated Heart Failure

Flores-Blanco, Pedro; Manzano‐Fernández, Sergio; Pérez-Calvo, Juan Ignacio; Pastor‐Pérez, Francisco J.; Ruiz‐Ruiz, Francisco J.; Carrasco-Sánchez, Francisco Javier; Morales-Rull, J.L.; Pascual-Figal, Domingo A.; Galisteo-Almeda, Luis; Januzzi, James L.

doi:10.1002/clc.22362

Cited by 18 publications

(9 citation statements)

References 48 publications

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“…Instead, CKD-EPI SCR formula based on serum creatinine, which is widely used in clinical practice and has high international recognition. CKD-EPI is closer to the accurate value compared with the previous MDRD algorithm (31).…”

Section: Study Limitationsmentioning

confidence: 79%

Prognostic Value of N-Terminal Pro-B-Type Natriuretic Peptide and Glomerular Filtration Rate in Patients With Acute Heart Failure

Wang

et al. 2020

Front. Cardiovasc. Med.

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Aims: To investigate the relationship between N-terminal pro-B-type natriuretic peptide (NT-proBNP), Glomerular Filtration Rate (GFR), and outcomes in patients hospitalized with acute heart failure (AHF). Methods: The trial was registered at http://www.chictr.org/cn/. (ChiCTR-ONC-12001944). A total of 493 patients hospitalized for AHF in cardiology department of the First Affiliated Hospital of Nanjing Medical University from March 2012 to October 2016 were enrolled into registry. The end event was the occurrence of all-cause death within an 18-month follow-up. The data collected from the participants in admission were used to calculate the GFR by chronic kidney disease epidemiology collaboration equation (CKD-EPI) and performed the according statistical analysis. Results: There were 74 participants (13.8%) dropped out and 91 (21.7%) passed away within the 18-month follow up. Comparison of clinical indicators between survival and death group were analyzed for the long-term prognosis of patients with AHF. In the single factor analysis, both NT-proBNP and GFR were statistically significant (P < 0.001). Combined NT-proBNP and GFR in multi-factor COX regression analysis showed significant predictive value (P < 0.001). In receiver operator characteristics (ROC) analyses, the area under the curves (AUC) for NT-proBNP was 0.648 [95%CI: 0.598-0.695, P < 0.001] and for GFR was 0.677 [95%CI: 0.627-0.723, P < 0.001]. According to the Youden index, the best prediction point of NT-proBNP was 2,137 pg/ml and GFR was 61.7 ml/(min•1.73 m 2). After using the Binary Logistic Regression to combine the two indicators, the AUC was 0.711, which was significantly compared to the AUC of either single factor. The sensitivity of the combined indicators were 0.535, the specificity were 0.853. According to the cutoff point, these two indexes were separated into four groups for further analysis by Kaplan-Meier survival curve comparison (log-rank test), which showed that patients in the group with higher NT-proBNP and lower GFR had the worst prognosis. Wang et al. GFR in AHF Patients Conclusions: In patients with NT-proBNP > 2,137 pg/ml and GFR < 61.7 ml/(min•1.73 m 2), the risk of death was significantly higher. The combination of GFR and NT-proBNP improved the predictive value for the long-term prognosis of AHF patients.

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Section: Study Limitationsmentioning

confidence: 79%

Prognostic Value of N-Terminal Pro-B-Type Natriuretic Peptide and Glomerular Filtration Rate in Patients With Acute Heart Failure

Wang

et al. 2020

Front. Cardiovasc. Med.

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“…Our group has previously demonstrated that both CysC-based CKD-EPI equations outperformed the MDRD equation and added complementary information to natriuretic peptides for predicting adverse outcomes in acute HF patients. 34,35 In patients with acute myocardial infarction, Abu-Assi et al 36 reported that both CysC-based CKD-EPI equations were the most accurate for predicting in-hospital mortality, rather than the MDRD and CKD-EPI SCr equations. Almeida et al 37 found that the CKD-EPI CysC equation revealed the highest discriminative performance in predicting long-term mortality in patients with ACS and added predictive value to the GRACE risk score.…”

Section: Resultsmentioning

confidence: 99%

Comparison of Risk Prediction With the CKD‐EPI and MDRD Equations in Non–ST‐Segment Elevation Acute Coronary Syndrome

Flores-Blanco

Januzzi

Marı́n

et al. 2016

Clinical Cardiology

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Background: Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations estimate glomerular filtration rate (GFR) more accurately than the Modification of Diet in Renal Disease (MDRD) equation. Hypothesis: New CKD-EPI equations improve risk stratification in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS) and provide complementary information to the Global Registry of Acute Coronary Events (GRACE) risk score. Methods: We studied 350 subjects (mean age, 68 ± 12 years; 70% male) with NSTE-ACS. Estimated GFR was calculated using the MDRD and new CKD-EPI equations based on serum creatinine (SCr) and/or cystatin C (CysC) concentrations obtained within 48 hours of hospital admission. The primary endpoint was all-cause death during follow-up. Results: Over the study period (median, 648 days [interquartile range, 236-1042 days]), 31 patients died (0.05% events per person-year). Decedents had poorer renal-function parameters (P < 0.001). Both CysC-based CKD-EPI equations had the highest areas under the receiver operating characteristic curve for the prediction of all-cause mortality. After multivariate adjustment, only CysC-based CKD-EPI equations were independent predictors of all-cause mortality (CKD-EPI SCr-CysC , per mL/min/1.73 m 2 : hazard ratio: 0.975, 95% confidence interval: 0.956-0.994, P = 0.009; CKD-EPI CysC , per mL/min/1.73 m 2 : hazard ratio: 0.976, 95% confidence interval: 0.959-0.993, P = 0.005). Reclassification analyses showed that only CysC-based CKD-EPI equations improved predictive accuracy of the GRACE risk score. Conclusions:In patients with NSTE-ACS, CysC-based CKD-EPI equations improved clinical risk stratification for mortality and added complementary prognostic information to the GRACE risk score.

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“…The possible reason for this finding may be that our hospital is a tertiary referral centre for heart transplant candidates, and younger patients with a worse clinical condition are mostly referred to our centre for advanced therapies. When we looked at similar studies evaluating mortality differences in ADHF patients, they principally included older subjects (60 years or more), 11,23,24 with an absence of younger patients, which might have limited data on differences in mortality rates in such patients.…”

Section: Discussionmentioning

confidence: 99%

“…9,10 In a previous report, a combination of cystatin C and NT-proBNP level was used as a predictor of unfavourable results in subjects with acute decompensated HF (ADHF). 11 The authors reported that combination of the two parameters was useful in predicting patients who had the highest risk for worse outcomes. However, in the literature, there are no data about the relationship between hospital admission cystatin C levels and mortality on an annual basis.…”

mentioning

confidence: 99%

The impact of admission cystatin C levels on in-hospital and three-year mortality rates in acute decompensated heart failure

Selçuk¹,

Selçuk²,

Maden³

et al. 2018

CVJA

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Background: Although tremendous advances have been made in preventative and therapeutic approaches in heart failure (HF), the hospitalisation and mortality rates for patients with HF is high. The aim of this study was to investigate the association between cystatin C and N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels and in-and out-of-hospital mortality rates in acute decompensated HF (ADHF). Methods: Between February 2008 and November 2011, 57 consecutive patients who were admitted with ADHF were included in this prospective study. These patients were clinically followed up every three months by means of visits or telephone interviews. The primary clinical endpoint of this study was any death from heart failure rehospitalisation and/or other causes. Results: The subjects who died during the in-hospital follow up were younger than the survivors (47.4 ± 17.5 vs 60.8 ± 15.8, p = 0.043). There was a notable correlation between plasma cystatin C and NT-proBNP levels (r = 0.324, p = 0.014) and glomerular filtration rate (GFR) (r =-0.638, p < 0.001). Multivariate logistic regression analysis revealed that only cystatin C level [odds ratio (OR): 12.311, 95% confidence interval (CI): 1.616-93.764, p = 0.015] and age [OR: 0.925, 95% CI: 0.866-0.990, p = 0.023] were linked to in-hospital mortality rate. In the multivariate Cox proportional hazard model, only admission sodium level appeared as a significant independent predictor of death during the 36-month follow up [hazard ratio: 0.937, 95% CI: 0.880-0.996, p = 0.037]. Conclusion: Evaluation of admission cystatin C levels may provide a reliable prediction of in-hospital mortality, compared to estimated GFR or NT-proBNP levels among patients with ADHF. However, in this trial, during long-term follow up, only admission sodium level significantly predicted death.

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Cystatin C–based CKD‐EPI Equations and N‐Terminal Pro‐B‐Type Natriuretic Peptide for Predicting Outcomes in Acutely Decompensated Heart Failure

Cited by 18 publications

References 48 publications

Prognostic Value of N-Terminal Pro-B-Type Natriuretic Peptide and Glomerular Filtration Rate in Patients With Acute Heart Failure

Prognostic Value of N-Terminal Pro-B-Type Natriuretic Peptide and Glomerular Filtration Rate in Patients With Acute Heart Failure

Comparison of Risk Prediction With the CKD‐EPI and MDRD Equations in Non–ST‐Segment Elevation Acute Coronary Syndrome

The impact of admission cystatin C levels on in-hospital and three-year mortality rates in acute decompensated heart failure

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