Higher cystatin C level predicts long-term mortality in patients with peripheral arterial disease

Abstract

Aims-Cystatin C and cathepsins could play a role in different processes and stages of the atherosclerotic disease. We aimed to investigate the relationship of cystatin C, and cathepsins L, and S, to lethal outcome in patients with peripheral arterial disease (PAD).Methods and results-We studied 378 patients with established PAD. Cox regression was used to assess relationships between serum cystatin C or cathepsins L and S, and time to lethal outcome. The role of cystatin for prognosis of cardiovascular death was assessed with c-statistic, and net reclassification improvement (NRI). Patients with cystatin C levels above 1 mg/l (fifth quintile) had a significantly increased adjusted risk for all-cause and cardiovascular mortality compared to patients with cystatin C levels below or equal to 1 mg/l (hazard ratios (HR) 2.2, 95% CI 1.22-4.12, and HR 3.2, 95% CI 1.39-7.59, respectively). Furthermore, high cystatin C levels were related with higher all-cause (adjusted HR 2.99, 95% CI 1.31-6.85) and cardiovascular mortality (adjusted HR 4.36, 95% CI 1.07-18.8) among PAD patients without renal impairment. Although the addition of cystatin C to conventional risk factors improved the accuracy of risk prediction model for cardiovascular mortality (0.72-0.79; p = 0.03), it did not reclassify a substantial proportion of patients to risk categories (NRI = 0.12, p = 0.128).Conclusions-Higher cystatin C levels independently predicted 5 years all-cause, and cardiovascular death in PAD patients. However, a small improvement in discrimination with the addition of cystatin C to conventional risk factors, and no improvement in reclassification of risk categories suggest that clinical usefulness of cystatin C for predicting cardiovascular mortality in PAD population might be modest.

Association of serum cystatin C levels with myocardial perfusion and cardiac functional recovery in patients with anterior wall ST elevation myocardial infarction treated with primary coronary intervention

“…However, we propose that two potential mechanisms might be responsible for the association of cystatin C with no-reflow after PPCI. First, cystatin C has been implicated in the local and systemic inflammatory response, and high cystatin C levels have been found to be strongly associated with high concentrations of CRP [22][23][24]. In the present study, we also found a significant positive correlation between high cystatin C levels and increased hs-CRP concentrations.…”

Cystatin C, creatinine, estimated glomerular filtration, and long-term mortality in stroke patients

“…18,39,40 Previously it has been shown that serum cystatin C is associated better with mortality than creatinine and estimated GFR based on creatinine in eldery, 26 in patients with coronary heart disease, 41 heart failure, 42 and also in patients with peripheral arterial disease. 43 Serum cystatin C was a strong and independent predictor of mortality also in patients with normal to moderately impaired renal function. 42,44,45 In these studies, GFR was estimated by using less accurate CockcroftGault or MDRD Study equations.…”

Cystatin C as a Predictor of In-Hospital Mortality After Exacerbation of COPD

“…18 One study reported that higher CysC levels independently predicted 5 y all-cause and cardiovascular death in subjects with peripheral arterial disease. 19 A positive correlation between CysC and inflammatory parameters, including interleukin-6, resistin, tumor necrosis factor, and C-reactive protein, has been reported. 20 Fig .…”