Limited value of cystatin-C over estimated glomerular filtration rate for heart failure risk stratification.

<h4>Background</h4>To compare the prognostic value of estimated glomerular filtration rate, cystatin-C, an alternative renal biomarker, and their combination, in an outpatient population with heart failure. Estimated glomerular filtration rate is routinely used to assess renal function i...

Descripción completa

Guardado en:

Detalles Bibliográficos
Autores principales:	Elisabet Zamora, Josep Lupón, Marta de Antonio, Joan Vila, Amparo Galán, Paloma Gastelurrutia, Agustín Urrutia, Antoni Bayes-Genis
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2012
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/cfe0fa2957434bd8b3838664744a8663
Etiquetas:	Agregar Etiqueta Sin Etiquetas, Sea el primero en etiquetar este registro!

id	oai:doaj.org-article:cfe0fa2957434bd8b3838664744a8663
record_format	dspace
spelling	oai:doaj.org-article:cfe0fa2957434bd8b3838664744a86632021-11-18T08:05:36ZLimited value of cystatin-C over estimated glomerular filtration rate for heart failure risk stratification.1932-620310.1371/journal.pone.0051234https://doaj.org/article/cfe0fa2957434bd8b3838664744a86632012-01-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/23240006/pdf/?tool=EBIhttps://doaj.org/toc/1932-6203<h4>Background</h4>To compare the prognostic value of estimated glomerular filtration rate, cystatin-C, an alternative renal biomarker, and their combination, in an outpatient population with heart failure. Estimated glomerular filtration rate is routinely used to assess renal function in heart failure patients. We recently demonstrated that the Cockroft-Gault formula is the best among the most commonly used estimated glomerular filtration rate formulas for predicting heart failure prognosis.<h4>Methodology/principal findings</h4>A total of 879 consecutive patients (72% men, age 70.4 years [P(25-75) 60.5-77.2]) were studied. The etiology of heart failure was mainly ischemic heart disease (52.7%). The left ventricular ejection fraction was 34% (P(25-75) 26-43%). Most patients were New York Heart Association class II (65.8%) or III (25.9%). During a median follow-up of 3.46 years (P(25-75) 1.85-5.05), 312 deaths were recorded. In an adjusted model, estimated glomerular filtration rate and cystatin-C showed similar prognostic value according to the area under the curve (0.763 and 0.765, respectively). In Cox regression, the multivariable analysis hazard ratios were 0.99 (95% CI: 0.98-1, P = 0.006) and 1.14 (95% CI: 1.02-1.28, P = 0.02) for estimated glomerular filtration rate and cystatin-C, respectively. Reclassification, assessed by the integration discrimination improvement and the net reclassification improvement indices, was poorer with cystatin-C (-0.5 [-1.0;-0.1], P = 0.024 and -4.9 [-8.8;-1.0], P = 0.013, respectively). The value of cystatin-C over estimated glomerular filtration rate for risk-stratification only emerged in patients with moderate renal dysfunction (eGFR 30-60 ml/min/1.73 m(2), chi-square 12.9, P<0.001).<h4>Conclusions/significance</h4>Taken together, the results indicate that estimated glomerular filtration rate and cystatin-C have similar long-term predictive values in a real-life ambulatory heart failure population. Cystatin-C seems to offer improved prognostication in heart failure patients with moderate renal dysfunction.Elisabet ZamoraJosep LupónJosep LupónMarta de AntonioJoan VilaAmparo GalánPaloma GastelurrutiaAgustín UrrutiaAntoni Bayes-GenisPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 7, Iss 12, p e51234 (2012)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Elisabet Zamora Josep Lupón Josep Lupón Marta de Antonio Joan Vila Amparo Galán Paloma Gastelurrutia Agustín Urrutia Antoni Bayes-Genis Limited value of cystatin-C over estimated glomerular filtration rate for heart failure risk stratification.
description	<h4>Background</h4>To compare the prognostic value of estimated glomerular filtration rate, cystatin-C, an alternative renal biomarker, and their combination, in an outpatient population with heart failure. Estimated glomerular filtration rate is routinely used to assess renal function in heart failure patients. We recently demonstrated that the Cockroft-Gault formula is the best among the most commonly used estimated glomerular filtration rate formulas for predicting heart failure prognosis.<h4>Methodology/principal findings</h4>A total of 879 consecutive patients (72% men, age 70.4 years [P(25-75) 60.5-77.2]) were studied. The etiology of heart failure was mainly ischemic heart disease (52.7%). The left ventricular ejection fraction was 34% (P(25-75) 26-43%). Most patients were New York Heart Association class II (65.8%) or III (25.9%). During a median follow-up of 3.46 years (P(25-75) 1.85-5.05), 312 deaths were recorded. In an adjusted model, estimated glomerular filtration rate and cystatin-C showed similar prognostic value according to the area under the curve (0.763 and 0.765, respectively). In Cox regression, the multivariable analysis hazard ratios were 0.99 (95% CI: 0.98-1, P = 0.006) and 1.14 (95% CI: 1.02-1.28, P = 0.02) for estimated glomerular filtration rate and cystatin-C, respectively. Reclassification, assessed by the integration discrimination improvement and the net reclassification improvement indices, was poorer with cystatin-C (-0.5 [-1.0;-0.1], P = 0.024 and -4.9 [-8.8;-1.0], P = 0.013, respectively). The value of cystatin-C over estimated glomerular filtration rate for risk-stratification only emerged in patients with moderate renal dysfunction (eGFR 30-60 ml/min/1.73 m(2), chi-square 12.9, P<0.001).<h4>Conclusions/significance</h4>Taken together, the results indicate that estimated glomerular filtration rate and cystatin-C have similar long-term predictive values in a real-life ambulatory heart failure population. Cystatin-C seems to offer improved prognostication in heart failure patients with moderate renal dysfunction.
format	article
author	Elisabet Zamora Josep Lupón Josep Lupón Marta de Antonio Joan Vila Amparo Galán Paloma Gastelurrutia Agustín Urrutia Antoni Bayes-Genis
author_facet	Elisabet Zamora Josep Lupón Josep Lupón Marta de Antonio Joan Vila Amparo Galán Paloma Gastelurrutia Agustín Urrutia Antoni Bayes-Genis
author_sort	Elisabet Zamora
title	Limited value of cystatin-C over estimated glomerular filtration rate for heart failure risk stratification.
title_short	Limited value of cystatin-C over estimated glomerular filtration rate for heart failure risk stratification.
title_full	Limited value of cystatin-C over estimated glomerular filtration rate for heart failure risk stratification.
title_fullStr	Limited value of cystatin-C over estimated glomerular filtration rate for heart failure risk stratification.
title_full_unstemmed	Limited value of cystatin-C over estimated glomerular filtration rate for heart failure risk stratification.
title_sort	limited value of cystatin-c over estimated glomerular filtration rate for heart failure risk stratification.
publisher	Public Library of Science (PLoS)
publishDate	2012
url	https://doaj.org/article/cfe0fa2957434bd8b3838664744a8663
work_keys_str_mv	AT elisabetzamora limitedvalueofcystatincoverestimatedglomerularfiltrationrateforheartfailureriskstratification AT joseplupon limitedvalueofcystatincoverestimatedglomerularfiltrationrateforheartfailureriskstratification AT joseplupon limitedvalueofcystatincoverestimatedglomerularfiltrationrateforheartfailureriskstratification AT martadeantonio limitedvalueofcystatincoverestimatedglomerularfiltrationrateforheartfailureriskstratification AT joanvila limitedvalueofcystatincoverestimatedglomerularfiltrationrateforheartfailureriskstratification AT amparogalan limitedvalueofcystatincoverestimatedglomerularfiltrationrateforheartfailureriskstratification AT palomagastelurrutia limitedvalueofcystatincoverestimatedglomerularfiltrationrateforheartfailureriskstratification AT agustinurrutia limitedvalueofcystatincoverestimatedglomerularfiltrationrateforheartfailureriskstratification AT antonibayesgenis limitedvalueofcystatincoverestimatedglomerularfiltrationrateforheartfailureriskstratification
_version_	1718422258559483904

Limited value of cystatin-C over estimated glomerular filtration rate for heart failure risk stratification.

Ejemplares similares