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Huang PY, Hsu BG, Wang CH, Tsai JP. The Prognostic Role of Serum β-Trace Protein Levels among Patients on Maintenance Hemodialysis. Diagnostics (Basel) 2024; 14:974. [PMID: 38786272 PMCID: PMC11119092 DOI: 10.3390/diagnostics14100974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 04/30/2024] [Accepted: 05/02/2024] [Indexed: 05/25/2024] Open
Abstract
Cardiovascular (CV) diseases are the most commonly encountered etiology of mortality in patients having kidney failure. β-Trace protein (BTP) is a biomarker of glomerular filtration function as well as a potential predictor of adverse CV outcomes. This study aimed to determine the prognostic value of BTP in patients on chronic hemodialysis (HD). A total of 96 patients undergoing HD were enrolled. Baseline variables were collected, and the patients were tracked for 3 years. Twenty-five patients died at 3 years. Those who experienced mortality were noted to have higher serum concentrations of BTP and a higher incidence of diabetes mellitus (DM). The area under the receiver operating characteristic curve for serum BTP distinguishing mortality from survival was 0.659 (95% confidence interval [CI], 0.555-0.752; p = 0.027). After the adjustment of variables potentially affecting survival rates, BTP levels above the median (adjusted hazard ratio [aHR]: 2.913, 95% CI, 1.256-6.754; p = 0.013), the presence of DM (aHR: 2.474, 95% CI, 1.041-5.875; p = 0.040), and low serum albumin (aHR: 0.298, 95% CI, 0.110-0.806; p = 0.017) independently correlated with survival in HD patients. Serum BTP is a novel biomarker for predicting overall outcomes in HD patients.
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Affiliation(s)
- Po-Yu Huang
- Division of Nephrology, Department of Internal Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi 62247, Taiwan;
- Institute of Medical Sciences, Tzu Chi University, Hualien 97004, Taiwan
| | - Bang-Gee Hsu
- Division of Nephrology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 97004, Taiwan; (B.-G.H.); (C.-H.W.)
- School of Medicine, Tzu Chi University, Hualien 97004, Taiwan
| | - Chih-Hsien Wang
- Division of Nephrology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 97004, Taiwan; (B.-G.H.); (C.-H.W.)
- School of Medicine, Tzu Chi University, Hualien 97004, Taiwan
| | - Jen-Pi Tsai
- Division of Nephrology, Department of Internal Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi 62247, Taiwan;
- School of Medicine, Tzu Chi University, Hualien 97004, Taiwan
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Sun Y, Lu Q, Cheng B, Tao X. Prognostic value of cystatin C in patients with acute coronary syndrome: A systematic review and meta-analysis. Eur J Clin Invest 2021; 51:e13440. [PMID: 33128232 DOI: 10.1111/eci.13440] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 09/30/2020] [Accepted: 10/18/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Circulating cystatin C has been considered as an independent predictor of cardiovascular and all-cause mortality in the general population. The purpose of this study was to evaluate the prognostic value of baseline circulating cystatin C levels in patients with acute coronary syndrome (ACS) through meta-analysis. METHODS Prospective studies about the relationship between the level of cystatin C and the prognosis of ACS patients were searched on PubMed, Web of science, Cochrane Library and Embase databases from the establishment of the databases to July 2020. The prognostic values included in this analysis covered all-cause mortality, major adverse cardiovascular events (MACE) and recurrent myocardial infarction. The effect index between cystatin C level and ACS risk was carried out by hazard ratio (HR). Stata 15.0 software was used for statistical analysis. The quality of the included literature was evaluated according to Newcastle-Ottawa Scale (NOS). RESULTS A total of 10 studies were included in this meta-analysis. The results showed that high cystatin C levels significantly predicted the all-cause mortality of ACS, HR = 2.53 (95%CI: 1.72 ~ 3.72). High cystatin C level significantly predicted MACE of patients with ACS, HR = 3.24 (95%CI: 1.30 ~ 8.07). However, it had no significant predictive significance for recurrent myocardial infarction, HR = 1.71 (95%CI:0.99 ~ 2.97). CONCLUSION Our meta-analysis showed that high cystatin C levels were significantly associated with the death risk and MACE in ACS patients. Therefore, cystatin C can be included in the risk stratification model to guide the treatment of high-risk ACS patients.
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Affiliation(s)
- Ying Sun
- Department of Geriatric Cardiology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Qing Lu
- Department of Geriatric Cardiology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Biao Cheng
- Department of Geriatric Cardiology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Xuefei Tao
- Department of Geriatric Cardiology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
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Jin S, Xu J, Shen G, Gu P. Predictive value of circulating cystatin C level in patients with acute coronary syndrome: a meta-analysis. Scandinavian Journal of Clinical and Laboratory Investigation 2020; 81:1-7. [PMID: 33207943 DOI: 10.1080/00365513.2020.1846212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Circulating cystatin C level has been identified as a predictor of adverse outcomes in patients with coronary artery disease (CAD). This meta-analysis aimed to investigate the value of circulating cystatin C level for predicting adverse outcomes in patients with acute coronary syndrome (ACS). We comprehensively searched articles indexed in Pubmed and Embase databases from their inceptions to 30 November 2019. All available observational studies that investigated the association between circulating cystatin C level and major adverse cardiovascular events [MACE] (including death, heart failure, re-infarction, target vascular revascularization, angina and stroke) or all-cause mortality in patients with ACS were included. The prognostic value was expressed by pooling the multivariable-adjusted hazard risk (HR) with 95% confidence interval (CI) for the highest versus the lowest category of cystatin C level. Eleven eligible studies (12 articles) with 4600 ACS patients were identified. Meta-analysis indicated that the highest versus lowest category of cystatin C level was associated with higher risk of MACE (HR 2.28; 95% CI 1.92-2.71) and all-cause mortality (HR 2.89; 95% CI 1.43-5.83) after adjustment for estimated glomerular filtration rate (eGFR) or creatinine. Subgroup analysis by subtypes of patients, study design, follow-up duration and cutoff level of cystatin C further confirmed the value of cystatin C level for predicting MACE. Elevated circulating cystatin C level at baseline is strongly and independently associated with an increased risk of MACE and all-cause mortality in patients with ACS. Determination of circulating cystatin C level has potential to improve risk stratification of ACS patients.
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Affiliation(s)
- Song Jin
- Department of Geriatrics, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, PR China
| | - Jian Xu
- Department of Cardiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, PR China
| | - Gan Shen
- Department of Geriatrics, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, PR China
| | - Pengying Gu
- Department of Geriatrics, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, PR China
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Sert ET, Akilli N, Köylü R, Cander B, Kokulu K, Köylü Ö. The Effect of Beta-Trace Protein on Diagnosis and Prognosis in Patients with Acute Coronary Syndrome. Cureus 2020; 12:e7135. [PMID: 32257680 PMCID: PMC7105264 DOI: 10.7759/cureus.7135] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Objective The purpose of this study was to determine the effect of beta-trace protein (BTP) levels at the time of admission and at 8th hour on diagnosis and prognosis in patients who were under treatment and follow-up with acute coronary syndrome (ACS) diagnosis at coronary intensive care unit and emergency department. Materials and Methods This study was conducted between June 2014 and December 2014 at the Emergency Department of Konya Training and Research Hospital. Demographic characteristics, background, vital findings, laboratory findings, blood BTP levels, coronary angiography results, and echocardiography findings of the patients diagnosed with ACS were recorded. Risk classification was performed for patients with ACS and their mortality rates were recorded. Relation of BTP level with risk classification and mortality was evaluated. Results A total of 174 individuals, 138 patients and 36 control subjects, were included in the study. No significant difference was detected between BTP levels at the time of admission and at 8th hour in the patient group (p=0.883). There was no difference between the patient and control groups in terms of the BTP level (p=0.335). Ten patients (7.2%) died in the patient group. BTP levels measured at the time of admission and at 8th hour were not different for dead and living patients (admission p=0.085, 8th hour p=0.141). Conclusion We determined that there was a lack of biochemical markers that could be used for the prognosis of serum BTP levels in patients admitting to the emergency unit with ACS.
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Affiliation(s)
- Ekrem T Sert
- Emergency Medicine, Aksaray University Medical School, Aksaray, TUR
| | - Nazire Akilli
- Emergency Medicine, Konya Training and Research Hospital, University of Health Sciences, Konya, TUR
| | - Ramazan Köylü
- Emergency Medicine, Konya Training and Research Hospital, University of Health Sciences, Konya, TUR
| | - Basar Cander
- Emergency Medicine, Kanuni Sultan Süleyman Training and Research Hospital, University of Health Sciences, Istanbul, TUR
| | - Kamil Kokulu
- Emergency Medicine, University of Health Sciences, Ümraniye Training and Research Hospital, Istanbul, TUR
| | - Öznur Köylü
- Biochemistry, Konya Training and Research Hospital, University of Health Sciences, Konya, TUR
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Mutlu H, Kokulu K, Sert ET, Çağlar A. Lipocalin-type prostaglandin D synthase levels are associated with the severity of pulmonary embolism. Heart Vessels 2020; 35:996-1002. [PMID: 32076814 DOI: 10.1007/s00380-020-01568-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 02/07/2020] [Indexed: 10/25/2022]
Abstract
Pulmonary thromboembolism (PTE) is an acute emergency with high mortality and morbidity rates. This study aimed to investigate the importance of Lipocalin-type prostaglandin D synthase (L-PGDS) in predicting mortality and prognosis in PTE. The study prospectively included 90 patients who were admitted to the emergency department and in whom PTE was confirmed by computed tomographic pulmonary angiography as well as 40 healthy volunteers with no disease. L-PGDS levels in the venous blood were measured and compared. Pulmonary embolism severity index (PESI) prognosis scores of all patients and 1-month mortality rate were calculated. There was a statistically significant difference between the L-PGDS levels of the patient and control groups (P = 0.024), and 1-month mortality of patients diagnosed with PTE was 20% (n = 18). Furthermore, the patients were divided into two groups: patients deceased within 1 month following the diagnosis and survivors. L-PGDS levels of the deceased patients were significantly higher than those of the survivors (P < 0.001). Age, systolic blood pressure, pulse, shock index, lactate, and PESI scores were significantly different between the survivors and deceased patients. The cut-off value for L-PGDS obtained using receiver operating characteristic (ROC) curve analysis for 1-month mortality was 815.26 ng/mL (sensitivity: 83.33%; specificity: 79.17%; area under the curve: 0.851; 95% confidence interval 0.760-0.917; P < 0.001). Based on this cut-off value, logistic regression analysis revealed that increased L-PGDS, together with PESI, was an independent indicator of 1-month mortality. L-PGDS is associated with short-term mortality in patients with PTE; therefore, it can be used to predict mortality risk in patients with PTE.
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Affiliation(s)
- Hüseyin Mutlu
- Department of Emergency Medicine, Aksaray Training and Research Hospital, Aksaray, Turkey. .,School of Medicine, Aksaray University, Adana Yolu Üzeri E-90 Karayolu 7. Km, Aksaray, Turkey.
| | - Kamil Kokulu
- Department of Emergency Medicine, University of Health Sciences, Ümraniye Training and Research Hospital, Istanbul, Turkey
| | - Ekrem Taha Sert
- Department of Emergency Medicine, Aksaray Training and Research Hospital, Aksaray, Turkey
| | - Ahmet Çağlar
- Department of Emergency Medicine, Aksaray Training and Research Hospital, Aksaray, Turkey
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Wajda J, Dumnicka P, Sporek M, Maziarz B, Kolber W, Ząbek-Adamska A, Ceranowicz P, Kuźniewski M, Kuśnierz-Cabala B. Does Beta-Trace Protein (BTP) Outperform Cystatin C as a Diagnostic Marker of Acute Kidney Injury Complicating the Early Phase of Acute Pancreatitis? J Clin Med 2020; 9:jcm9010205. [PMID: 31940861 PMCID: PMC7019728 DOI: 10.3390/jcm9010205] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 12/31/2019] [Accepted: 01/07/2020] [Indexed: 12/12/2022] Open
Abstract
Acute pancreatitis (AP) belongs to the commonest acute gastrointestinal conditions requiring hospitalization. Acute kidney injury (AKI) often complicates moderately severe and severe AP, leading to increased mortality. Among the laboratory markers proposed for early diagnosis of AKI, few have been studied in AP, including cystatin C and neutrophil gelatinase-associated lipocalin (NGAL). Beta-trace protein (BTP), a low-molecular-weight glycoprotein proposed as an early marker of decreased glomerular filtration, has never been studied in AP. We investigated the diagnostic usefulness of serum BTP for early diagnosis of AKI complicating AP in comparison to previously studied markers. BTP was measured in serum samples collected over the first three days of hospital stay from 73 adult patients admitted within 24 h of mild to severe AP. Thirteen patients (18%) developed AKI in the early phase of AP. Serum BTP was higher in patients who developed AKI, starting from the first day of hospitalization. Strong correlations were observed between BTP and serum cystatin C but not serum or urine NGAL. On admission, BTP positively correlated with endothelial dysfunction. The diagnostic usefulness of BTP for AKI was similar to cystatin C and lower than NGAL. Increased BTP is an early predictor of AKI complicating AP. However, it does not outperform cystatin C or NGAL.
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Affiliation(s)
- Justyna Wajda
- Department of Anatomy, Jagiellonian University Medical College, 31-034 Krakow, Poland; (J.W.); (M.S.)
| | - Paulina Dumnicka
- Department of Medical Diagnostics, Faculty of Pharmacy, Jagiellonian University Medical College, 30-688 Krakow, Poland
- Correspondence: (P.D.); (P.C.); Tel.: +48-6205-622 (P.C.)
| | - Mateusz Sporek
- Department of Anatomy, Jagiellonian University Medical College, 31-034 Krakow, Poland; (J.W.); (M.S.)
- Surgery Department, The District Hospital, 34-200 Sucha Beskidzka, Poland
| | - Barbara Maziarz
- Department of Diagnostics, Chair of Clinical Biochemistry, Faculty of Medicine, Jagiellonian University Medical College, 31-501 Krakow, Poland; (B.M.); (B.K.-C.)
| | - Witold Kolber
- Department of Surgery, Complex of Health Care Centers in Wadowice, 34-100 Wadowice, Poland;
| | - Anna Ząbek-Adamska
- Diagnostics Department of University Hospital in Krakow, 31-501 Krakow, Poland;
| | - Piotr Ceranowicz
- Department of Nephrology, Jagiellonian University Medical College, 31-501 Kraków, Poland;
- Correspondence: (P.D.); (P.C.); Tel.: +48-6205-622 (P.C.)
| | - Marek Kuźniewski
- Department of Nephrology, Jagiellonian University Medical College, 31-501 Kraków, Poland;
| | - Beata Kuśnierz-Cabala
- Department of Diagnostics, Chair of Clinical Biochemistry, Faculty of Medicine, Jagiellonian University Medical College, 31-501 Krakow, Poland; (B.M.); (B.K.-C.)
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Biomarkers enhance the long-term predictive ability of the KAMIR risk score in Chinese patients with ST-elevation myocardial infarction. Chin Med J (Engl) 2019; 132:30-41. [PMID: 30628957 PMCID: PMC6629309 DOI: 10.1097/cm9.0000000000000015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Background: The Global Registry of Acute Coronary Events (GRACE) score is recommended by current ST-elevation myocardial infarction (STEMI) guidelines. But it has inherent defects. The present study aimed to investigate the more compatible risk stratification for Chinese patients with STEMI and to determine whether the addition of biomarkers to the Korea Acute Myocardial Infarction Registry (KAMIR) score could enhance its predictive value for long-term outcomes. Methods: A total of 1093 consecutive STEMI patients were included and followed up 48.2 months. Homocysteine, hypersensitive C-reactive protein (hs-CRP), and N-terminal pro-B-type natriuretic peptide (NT-proBNP) were detected. The KAMIR score and the GRACE score were calculated. The performance between the KAMIR and the GRACE was compared. The predictive power of the KAMIR alone and combined with biomarkers were assessed by the receiver-operating characteristic (ROC) curve. Results: The KAMIR demonstrated a better risk stratification and predictive ability than the GRACE (death: AUC = 0.802 vs. 0.721, P < 0.001; major adverse cardiovascular events (MACE): AUC = 0.683 vs. 0.656, P < 0.001). It showed that the biomarkers could independently predict death [homocysteine: HR = 1.019 (1.015–1.024), P < 0.001; hs-CRP: HR = 1.052 (1.000–1.104), P = 0.018; NT-pro BNP: HR = 1.142 (1.004–1.280), P = 0.021] and MACE [homocysteine: HR = 1.019 (1.015–1.024), P < 0.001; hs-CRP: HR = 1.012 (1.003–1.021), P = 0.020; NT-pro BNP: HR = 1.136 (1.104–1.168), P = 0.006]. When they were used in combination with the KAMIR, the area under the ROC curve (AUC) significantly increased for death [homocysteine: AUC = 0.802 vs. 0.890, Z = 5.982, P < 0.001; hs-CRP: AUC = 0.802 vs. 0.873, Z = 3.721, P < 0.001; NT-pro BNP: AUC = 0.802 vs. 0.871, Z = 2.187, P = 0.047; homocysteine, hs-CRP and NT-pro BNP: AUC = 0.802 vs. 0.940, Z = 6.177, P < 0.001] and MACE [homocysteine: AUC = 0.683 vs. 0.771, Z = 6.818, P < 0.001; hs-CRP: AUC = 0.683 vs. 0.712, Z = 2.022, P = 0.031; NT-pro BNP: AUC = 0.683 vs. 0.720, Z = 2.974, P = 0.003; homocysteine, hs-CRP and NT-pro BNP: AUC = 0.683 vs. 0.789, Z = 6.900, P < 0.001]. Conclusion: The KAMIR is better than the GRACE in risk stratification and prognosis prediction in Chinese STEMI patients. A combination of above-mentioned biomarkers can develop a more predominant prediction for long-term outcomes.
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Homocysteine enhances the predictive value of the GRACE risk score in patients with ST-elevation myocardial infarction. Anatol J Cardiol 2017; 18:182-193. [PMID: 28782750 PMCID: PMC5689049 DOI: 10.14744/anatoljcardiol.2017.7798] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Objective: The present study aims to investigate whether the addition of homocysteine level to the Global Registry of Acute Coronary Events (GRACE) risk score enhances its predictive value for clinical outcomes in ST-elevation myocardial infarction (STEMI). Methods: A total of 1143 consecutive patients with STEMI were included in this prospective cohort study. Homocysteine was detected, and the GRACE score was calculated. The predictive power of the GRACE score alone or combined with homocysteine was assessed by the receiver operating characteristic (ROC) analysis, methods of net reclassification improvement (NRI) and integrated discrimination improvement (IDI). Results: During a median follow-up period of 36.7 months, 271 (23.7%) patients reached the clinical endpoints. It showed that the GRACE score and homocysteine could independently predict all-cause death [GRACE: HR=1.031 (1.024–1.039), p<0.001; homocysteine: HR=1.023 (1.018–1.028), p<0.001] and MACE [GRACE: HR=1.008 (1.005–1.011), p<0.001; homocysteine: HR=1.022 (1.018–1.025), p<0.001]. When they were used in combination to assess the clinical outcomes, the area under the ROC curve significantly increased from 0.786 to 0.884 (95% CI=0.067–0.128, Z=6.307, p<0.001) for all-cause death and from 0.678 to 0.759 (95% CI=0.055–0.108, Z=5.943, p<0.001) for MACE. The addition of homocysteine to the GRACE model improved NRI (all-cause death: 0.575, p<0.001; MACE: 0.621, p=0.008) and IDI (all-cause death: 0.083, p<0.001; MACE: 0.130, p=0.016), indicating effective discrimination and reclassification. Conclusion: Both the GRACE score and homocysteine are significant and independent predictors for clinical outcomes in patients with STEMI. A combination of them can develop a more predominant prediction for clinical outcomes in these patients.
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9
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Predictive value of cystatin C in people with suspected or established coronary artery disease: A meta-analysis. Atherosclerosis 2017; 263:60-67. [PMID: 28599259 DOI: 10.1016/j.atherosclerosis.2017.05.025] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 04/28/2017] [Accepted: 05/18/2017] [Indexed: 11/21/2022]
Abstract
BACKGROUND AND AIMS Circulating cystatin C has been recognized as an independent predictor of cardiovascular and all-cause mortality in the general population. We aimed to evaluate the prognostic value of baseline circulating cystatin C levels in people with suspected or established coronary artery disease (CAD) by conducting a meta-analysis. METHODS We searched Pubmed and Embase databases up to October 2016 for prospective observational studies investigating the predictive value of elevated circulating cystatin C levels in people with suspected or established CAD. Adverse vascular outcomes included all-cause mortality, cardiovascular mortality, or total adverse vascular events consisting of death, myocardial infarction, revascularization, stroke, and heart failure. RESULTS Ten studies involving participants with known or suspected CAD were included in this meta-analysis. When comparing the highest with the lowest cystatin C levels, the pooled hazard ratio (HR) was 2.27 (95% confidence interval [CI] 1.86-2.78) for all-cause mortality, 2.24 (95% CI 1.69-2.97) for cardiovascular mortality, and 1.87 (95% CI 1.57-2.24) for total adverse vascular events, respectively. Subgroup analysis results showed that this association was not influenced by follow-up duration, region, or CAD type. CONCLUSIONS Elevated circulating cystatin C is independently associated with adverse vascular outcomes in people with suspected or established CAD in terms of all-cause mortality, cardiovascular mortality, and total adverse vascular events. This increased risk is probably independent of creatinine/estimated glomerular filtration rate.
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10
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Flores-Blanco PJ, López-Cuenca Á, Januzzi JL, Marín F, Sánchez-Martínez M, Quintana-Giner M, Romero-Aniorte AI, Valdés M, Manzano-Fernández S. Comparison of Risk Prediction With the CKD-EPI and MDRD Equations in Non-ST-Segment Elevation Acute Coronary Syndrome. Clin Cardiol 2016; 39:507-15. [PMID: 27249221 DOI: 10.1002/clc.22556] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 04/15/2016] [Indexed: 01/03/2023] Open
Abstract
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-EPISCr - CysC , per mL/min/1.73 m(2) : hazard ratio: 0.975, 95% confidence interval: 0.956-0.994, P = 0.009; CKD-EPICysC , 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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Affiliation(s)
- Pedro J Flores-Blanco
- Department of Cardiology, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain.
| | - Ángel López-Cuenca
- Department of Cardiology, Hospital de la Vega Lorenzo Guirao, Cieza, Murcia, Spain
| | - James L Januzzi
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Francisco Marín
- Department of Cardiology, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain.,Department of Cardiology, School of Medicine, University of Murcia, Murcia, Spain
| | | | - Miriam Quintana-Giner
- Department of Cardiology, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Ana I Romero-Aniorte
- Department of Cardiology, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Mariano Valdés
- Department of Cardiology, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain.,Department of Cardiology, School of Medicine, University of Murcia, Murcia, Spain
| | - Sergio Manzano-Fernández
- Department of Cardiology, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain.,Department of Cardiology, School of Medicine, University of Murcia, Murcia, Spain
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11
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Abid L, Charfeddine S, Kammoun S, Turki M, Ayedi F. Cystatin C: A prognostic marker after myocardial infarction in patients without chronic kidney disease. J Saudi Heart Assoc 2015; 28:144-51. [PMID: 27358531 PMCID: PMC4917710 DOI: 10.1016/j.jsha.2015.10.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 09/10/2015] [Accepted: 10/01/2015] [Indexed: 11/19/2022] Open
Abstract
Aims Cystatin C is an endogenous marker of renal function. It is a well established better marker of glomerular filtration rate than serum creatinine. There is also evidence that cystatin C is associated with atherosclerotic disease. The present prospective study evaluated the prognostic value of cystatin C after myocardial infarction in patients without chronic kidney disease. Methods and results A total of 127 patients who underwent coronary angiography after an acute coronary syndrome (ACS) were included. Cystatin C was associated with the severity of coronary artery disease (CAD). Cystatin C levels were significantly higher in patients with 3-vessels disease and severe CAD according to GENSINI score (p = 0.01 and p < 0.001 respectively). Among the patients admitted for ST elevation myocardial infarction, Cystatin C concentration was correlated with the initial TIMI flow in the culprit artery (p < 0.001). Mean duration of the follow-up period was 10.76 ± 2.1 months. High Cystatin C concentrations were associated to the occurrence of unfavourable outcomes and cardiovascular mortality during follow-up (1.19 ± 0.4 vs. 1.01 ± 0.35 mg/L, p = 0.01 and 1.21 ± 0.36 vs. 0.96 ± 0.27 mg/L, p = 0.03). Among different laboratory parameters, cystatin C was the best marker to predict the occurrence of major adverse cardiovascular events during the follow-up (Area under the receiveroperating characteristic curve = 0.743). Conclusion High cystatin C levels are associated with the severity of coronary artery disease in patients presenting an acute coronary syndrome and a normal renal function. Cystatin C is also associated to unfavourable cardiovascular outcomes during follow-up and appears as a strong predictor for risk of cardiovascular events and death.
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Affiliation(s)
- Leila Abid
- Cardiology Department, University Hédi Chaker Hospital, Sfax, Tunisia
- Corresponding author at: Cardiology Department, Hédi Chaker Hospital, Route Elain, Km 0.5, Sfax 3029, Tunisia.Cardiology DepartmentHédi Chaker HospitalRoute Elain, Km 0.5Sfax3029Tunisia
| | - Salma Charfeddine
- Cardiology Department, University Hédi Chaker Hospital, Sfax, Tunisia
| | - Samir Kammoun
- Cardiology Department, University Hédi Chaker Hospital, Sfax, Tunisia
| | - Mouna Turki
- Biochemistry Laboratory, Habib Bourguiba University Hospital, Tunisia
| | - Fatma Ayedi
- Biochemistry Laboratory, Habib Bourguiba University Hospital, Tunisia
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12
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Yalcin MU, Gurses KM, Kocyigit D, Kesikli SA, Tokgozoglu L, Guc D, Aytemir K, Ozer N. Elevated Serum Beta-Trace Protein Levels are Associated With the Presence of Atrial Fibrillation in Hypertension Patients. J Clin Hypertens (Greenwich) 2015; 18:439-43. [PMID: 26435487 DOI: 10.1111/jch.12703] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Revised: 08/03/2015] [Accepted: 08/10/2015] [Indexed: 01/13/2023]
Abstract
Beta-trace protein (BTP) has emerged as a novel biomarker of cardiovascular risk. In this study, the authors aimed to assess the relationship between BTP levels and presence of atrial fibrillation in patients who had controlled hypertension (HTN) and normal renal function. A total of 80 controlled HTN patients with paroxysmal atrial fibrillation (PAF) and 80 age- and sex-matched controls with controlled HTN were enrolled. Serum BTP levels were measured by enzyme-linked immunosorbent assay. BTP levels were found to be significantly higher in patients with PAF (P<.001). Other parameters including mean systolic and diastolic blood pressure values, serum creatinine levels, and glomerular filtration rate were similar between the two groups. Along with left atrial diameter (odds ratio, 1.504; P<.001), BTP levels (odds ratio, 1.015; P<.001) were independently associated with the presence of PAF. BTP levels were increased in controlled HTN patients with PAF compared with controls, and this association was observed within normal renal functions as reflected by normal glomerular filtration rate.
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Affiliation(s)
| | - Kadri M Gurses
- Department of Cardiology, Konya Training and Research Hospital, Konya, Turkey
| | - Duygu Kocyigit
- Department of Cardiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Sacit A Kesikli
- Basic Oncology Department, Hacettepe University Cancer Institute, Ankara, Turkey
| | - Lale Tokgozoglu
- Department of Cardiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Dicle Guc
- Basic Oncology Department, Hacettepe University Cancer Institute, Ankara, Turkey
| | - Kudret Aytemir
- Department of Cardiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Necla Ozer
- Department of Cardiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
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13
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When cardiac failure, kidney dysfunction, and kidney injury intersect in acute conditions: the case of cardiorenal syndrome. Crit Care Med 2014; 42:2109-17. [PMID: 24810531 DOI: 10.1097/ccm.0000000000000404] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE To review and describe diagnostic and prognostic value of biomarkers of renal function and renal injury in the cardiorenal syndrome complicating acutely decompensated heart failure. DATA SOURCES PubMed search and review of relevant medical literature. STUDY SELECTION Two reviewers screened and selected studies in English with diagnostic or prognostic assessment of biomarkers of renal injury. DATA EXTRACTION Narrative review of the medical literature. DATA SYNTHESIS Cardiorenal syndrome has a complex pathophysiology and has a generally poor prognosis in patients with acutely decompensated heart failure. Among the methods to recognize risk for cardiorenal syndrome may be the use of circulating or urinary biomarkers, which may allow for more accurate early diagnosis and risk stratification; use of biomarkers may provide important pathophysiologic understanding beyond risk prediction. However, different phenotypes of patients with acute renal dysfunction may be present, which has ramifications with respect to response to treatment strategies. Addition of biomarkers of renal injury may provide additional prognostic value to biomarkers of renal or cardiac function, but more data are needed. CONCLUSIONS Biomarkers reflecting renal function and injury are likely to better phenotype subgroups of patients with cardiorenal syndrome and to provide unique prognostic information. Future studies are needed relative to strategies using such biomarkers to guide care of affected patients.
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Filler G, Kusserow C, Lopes L, Kobrzyński M. Beta-trace protein as a marker of GFR--history, indications, and future research. Clin Biochem 2014; 47:1188-94. [PMID: 24833359 DOI: 10.1016/j.clinbiochem.2014.04.027] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Revised: 04/29/2014] [Accepted: 04/30/2014] [Indexed: 12/30/2022]
Abstract
OBJECTIVES Recent findings suggest that beta-trace protein (BTP), a small molecular weight protein, is at least equal if not superior to serum creatinine as a marker of glomerular filtration rate (GFR), particularly since it is independent from height, gender, age, and muscle mass. The authors sought to summarize knowledge on BTP and its use as a marker of GFR using the most recent literature available. DESIGN AND METHODS The authors compiled key articles and all relevant recent literature on this topic. Physical and chemical features of the molecule are described, as well as factors that may affect its expression. The use of BTP in estimating GFR as a whole and in specific patient groups, including pregnant women, neonates and infants, children and adolescents, and patients who have undergone renal transplantation is discussed. The use of BTP as a marker for cardiovascular risk factors is also briefly addressed. RESULTS Although its performance in the general population is marginally inferior to cystatin C, studies have suggested that it may be superior in accurately estimating GFR in select patient groups such as pregnant women and neonates. CONCLUSIONS This novel marker shows promise, but further research is required to clarify findings from available data.
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Affiliation(s)
- Guido Filler
- Department of Paediatrics, Schulich School of Medicine & Dentistry, London, ON N6A 5W9, Canada; Department of Pathology and Laboratory Medicine, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON N5A 5A5, Canada; Department of Medicine, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON N5A 5A5, Canada.
| | - Carola Kusserow
- Department of Paediatrics, Schulich School of Medicine & Dentistry, London, ON N6A 5W9, Canada
| | - Laudelino Lopes
- Department of Obstetrics & Gynaecology, Schulich School of Medicine & Dentistry, London, ON N6A 5W9, Canada
| | - Marta Kobrzyński
- Department of Paediatrics, Schulich School of Medicine & Dentistry, London, ON N6A 5W9, Canada
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15
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Manzano-Fernández S, Flores-Blanco PJ, Pérez-Calvo JI, Ruiz-Ruiz FJ, Carrasco-Sánchez FJ, Morales-Rull JL, Galisteo-Almeda L, Pascual-Figal D, Valdes M, Januzzi JL. Comparison of risk prediction with the CKD-EPI and MDRD equations in acute decompensated heart failure. J Card Fail 2014; 19:583-91. [PMID: 23910589 DOI: 10.1016/j.cardfail.2013.05.011] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2013] [Revised: 04/26/2013] [Accepted: 05/20/2013] [Indexed: 01/02/2023]
Abstract
BACKGROUND Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations estimate glomerular filtration rate (eGFR) more accurately than the Modification of Diet in Renal Disease (MDRD) equation. The aim of this study was to evaluate whether CKD-EPI equations based on serum creatinine and/or cystatin C (CysC) predict risk for adverse outcomes more accurately than the MDRD equation in a hospitalized cohort of patients with acute decompensated heart failure (ADHF). METHODS AND RESULTS A total of 526 subjects with ADHF were studied. Blood was collected within 48 hours from admission. eGFR was calculated with the use of MDRD and CKD-EPI equations. The occurrences of mortality and heart failure (HF) hospitalization were recorded. Over the study period (median 365 days [interquartile range 238-370]), 305 patients (58%) died or were rehospitalized for HF. Areas under the receiver operator characteristic curves for CKD-EPI CysC and CKD-EPI creatinine-CysC equations were significantly higher than that for the MDRD equation, especially in patients with >60 mL min(-1) 1.73 m(-2). After multivariate adjustment, all eGFR equations were independent predictors of adverse outcomes (P < .001). However, only CKD-EPI CysC and CKD-EPI creatinine-CysC equations were associated with significant improvement in reclassification analyses (net reclassification improvements 10.8% and 12.5%, respectively). CONCLUSIONS In patients with ADHF, CysC-based CKD-EPI equations were superior to the MDRD equation for predicting mortality and/or HF hospitalization especially in patients with >60 mL min(-1) 1.73 m(-2), and both CKD-EPI equations improved clinical risk stratification.
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Affiliation(s)
- Sergio Manzano-Fernández
- Division of Cardiology, University Hospital Virgen de la Arrixaca, School of Medicine, University of Murcia, Murcia, Spain.
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García-Salas JM, Tello-Montoliu A, Manzano-Fernández S, Casas-Pina T, López-Cuenca A, Pérez-Berbel P, Puche-Morenilla C, Martínez-Hernández P, Valdés M, Marín F. Interleukin-6 as a predictor of cardiovascular events in troponin-negative non-ST elevation acute coronary syndrome patients. Int J Clin Pract 2014; 68:294-303. [PMID: 24372920 DOI: 10.1111/ijcp.12245] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
AIM Risk stratification in acute coronary syndrome without ST-segment elevation (NSTE-ACS) and troponin-negative remains a challenge. We evaluated the value of interleukin-6 (IL-6) and amino-terminal pro-B-type natriuretic peptide (NT-proBNP) in the prognosis assessment of low-moderate risk NSTE-ACS and troponin-negative, and whether these biomarkers could improve the predictive performance of the established thrombolysis in myocardial infarction (TIMI) risk score. METHODS A total of 212 low-moderate risk patients with NSTE-ACS and troponin-negative were prospectively studied. Clinical follow up at 6 months was performed for adverse endpoints. RESULTS A total of 28 patients (13.5%) presented adverse clinical events. Those with adverse clinical events were associated with higher levels of IL-6 [8.58 (5.13-20.95) ng/l vs. 6.12 (4.16-9.14) ng/l, p = 0.043] and NT-proBNP [275.3 (108.6-548.2) ng/l vs. 126.8 (55.97-430.20) ng/l, p = 0.046]. In moderate risk group, we observed a higher event rate in patients with troponin-negative but elevated levels of IL-6 (p = 0.024). Only elevated IL-6 (> 12.40 ng/l) was an independent predictor of adverse outcomes [hazard ratios: 3.62, 95% confidence interval (CI) 1.69-7.75, p = 0.001]. The addition of IL-6 and history of ischaemic heart disease (IHD) to TIMI risk score significantly improved both the discrimination (integrated discrimination improvement, p = 0.003) and reclassification (Clinical Net reclassification improvement, p = 0.010) of the model for adverse events. CONCLUSIONS Interleukin-6 is an independent predictor of adverse events in low-moderate risk patients with NSTE-ACS and troponin-negative. Its use identifies a higher risk population in moderate-risk patients. This provides together with history of IHD a better discrimination and reclassification beyond that achieved with clinical risk variables from TIMI risk score in these patients.
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Affiliation(s)
- J M García-Salas
- Department of Clinical Analysis, University Hospital Virgen de la Arrixaca, Murcia, Spain
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Fu Z, Xue H, Guo J, Chen L, Dong W, Gai L, Liu H, Sun Z, Chen Y. Long-term prognostic impact of cystatin C on acute coronary syndrome octogenarians with diabetes mellitus. Cardiovasc Diabetol 2013; 12:157. [PMID: 24182196 PMCID: PMC4176996 DOI: 10.1186/1475-2840-12-157] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2013] [Accepted: 10/20/2013] [Indexed: 12/22/2022] Open
Abstract
Objective Cystatin C (Cys C) is a marker of renal dysfunction. Prior studies have shown that blood Cys C is related to the prognosis of coronary heart disease. The aim of the present study was to evaluate the long-term prognostic impact of Cys C on acute coronary syndrome (ACS) octogenarians with diabetes mellitus (DM). Methods We enrolled 660 consecutive ACS octogenarians who underwent coronary angiography and were classified into two groups based on diabetes. The baseline characters and Cys C level were measured on admission. Survival curve was calculated using the Kaplan-Meier method. Multivariate Cox regression was used to identify predictors of mortality and of major adverse cardiac events (MACE) rate. Results There were 223 and 398 patients in groups DM and non-DM who fulfilled the follow-up. The average follow-up period was 28 (IQR 16–38) months. Diastolic blood pressure (DBP) was lower, ratios of hypertension and chronic renal failure (CRF), fasting blood glucose, HbA1c and Cys C levels were higher in DM group than those in non-DM group (P<0.01). The cumulative survival of DM group was significantly lower than that of non-DM group in the long term (P = 0.018). All cause mortality and MACE of DM group were higher than those of non-DM group (P<0.05). The plasma Cys C concentration (OR = 3.32, 95% CI = 1.18-10.92, P = 0.023) was the uniqueness independent predictor for long-term all cause mortality. The plasma Cys C concentration (OR = 2.47, 95% CI = 1.07-7.86, P = 0.029) and Genesis score (OR = 1.01, 95% CI = 1.00-1.03, P = 0.043) were independent predictors for MACE in DM group. ROC curve analysis showed that the predictive cut-off value of Cys C for mortality of DM group was 1.605 (0.718, 0.704). Conclusions Cys C is an independent predictor for long-term mortality and MACE of ACS octogenarians with DM.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Yundai Chen
- Department of Cardiology, Chinese People's Liberation Army General Hospital, 28 Fuxing Road, Beijing, Haidian District 100853, People's Republic of China.
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Vílchez JA, Roldán V, Manzano-Fernández S, Fernández H, Avilés-Plaza F, Martínez-Hernández P, Vicente V, Valdés M, Marín F, Lip GY. β-Trace Protein and Prognosis in Patients With Atrial Fibrillation Receiving Anticoagulation Treatment. Chest 2013; 144:1564-1570. [DOI: 10.1378/chest.13-0922] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Orenes-Piñero E, Manzano-Fernández S, López-Cuenca Á, Marín F, Valdés M, Januzzi JL. β-Trace Protein: From GFR Marker to Cardiovascular Risk Predictor. Clin J Am Soc Nephrol 2013; 8:873-81. [DOI: 10.2215/cjn.08870812] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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