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Qi Y, Shang X, Han T, Han N, Jiang Z, Yan H, Yue S, Sun Q, Liu L, Cui C. Serum cystatin C and stroke risk: a national cohort and Mendelian randomization study. Front Endocrinol (Lausanne) 2024; 15:1355948. [PMID: 38681764 PMCID: PMC11045987 DOI: 10.3389/fendo.2024.1355948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 03/20/2024] [Indexed: 05/01/2024] Open
Abstract
Purpose The debate over the causal and longitudinal association between cystatin C and stroke in older adults persists. Our aim was to assess the link between cystatin C levels, both measured and genetically predicted, and stroke risk. Methods This study employed a retrospective cohort design using samples of the China Health and Retirement Longitudinal Study (CHARLS), which is a nationally representative cohort recruiting individuals aged 45 years or above. A multivariate logistic model and the two-sample Mendelian randomization framework were used to investigate the longitudinal and genetically predicted effect of serum cystatin C on stroke. Results The study population had a mean age of 59.6 (SD ±9.5), with 2,996 (46.1%) women. After adjusting for confounding factors, compared to those in the first quartile of cystatin C, those in the last quartile had the greatest risk of stroke incidence [odds ratio (OR), 1.380; 95% confidence interval (CI), 1.046-1.825]. The Mendelian randomization analysis showed that a genetically predicted cystatin C level was positively associated with total stroke (OR by inverse variance-weighted method, 1.114; 95% CI, 1.041-1.192). Conclusions This national cohort study suggests that higher serum cystatin C is associated with an increased risk of total stroke, which is further supported by Mendelian randomization.
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Affiliation(s)
- Yitian Qi
- China-Japan Union Hospital of Jilin University, Jilin University, Changchun, Jilin, China
| | - Xinyun Shang
- China-Japan Union Hospital of Jilin University, Jilin University, Changchun, Jilin, China
| | - Tianjiao Han
- China-Japan Union Hospital of Jilin University, Jilin University, Changchun, Jilin, China
| | - Ning Han
- China-Japan Union Hospital of Jilin University, Jilin University, Changchun, Jilin, China
| | - Ziwei Jiang
- China-Japan Union Hospital of Jilin University, Jilin University, Changchun, Jilin, China
| | - Han Yan
- China-Japan Union Hospital of Jilin University, Jilin University, Changchun, Jilin, China
| | - Siqi Yue
- China-Japan Union Hospital of Jilin University, Jilin University, Changchun, Jilin, China
| | - Qichao Sun
- The First Bethune Hospital of Jilin University, Jilin University, Changchun, Jilin, China
| | - Lin Liu
- China-Japan Union Hospital of Jilin University, Jilin University, Changchun, Jilin, China
| | - Cancan Cui
- China-Japan Union Hospital of Jilin University, Jilin University, Changchun, Jilin, China
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Wang R, Chen H, He M, Xu J. Serum cystatin C is correlated with mortality of traumatic brain injury patients partially mediated by acute kidney injury. Acta Neurol Belg 2023; 123:2235-2241. [PMID: 37171701 PMCID: PMC10175904 DOI: 10.1007/s13760-023-02282-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 05/05/2023] [Indexed: 05/13/2023]
Abstract
BACKGROUND Evaluating risk of poor outcome for Traumatic Brain Injury (TBI) in early stage is necessary to make treatment strategies and decide the need for intensive care. This study is designed to verify the prognostic value of serum cystatin C in TBI patients. METHODS 415 TBI patients admitted to West China hospital were included. Logistic regression was performed to explore risk factors of mortality and testify the correlation between cystatin C and mortality. Mediation analysis was conducted to test whether Acute Kidney Injury (AKI) and brain injury severity mediate the relationship between cystatin C level and mortality. Area under the receiver operating characteristic curve (AUC) was used to evaluate the prognostic value of cystatin C and the constructed model incorporating cystatin C. RESULTS The mortality rate of 415 TBI patients was 48.9%. Non-survivors had lower GCS (5 vs 8, p < 0.001) and higher cystatin C (0.92 vs 0.71, p < 0.001) than survivors. After adjusting confounding effects, multivariate logistic regression indicated GCS (p < 0.001), glucose (p < 0.001), albumin (p = 0.009), cystatin C (p < 0.001) and subdural hematoma (p = 0.042) were independent risk factors of mortality. Mediation analysis showed both AKI and brain injury severity exerted mediating effects on relationship between cystatin C and mortality of included TBI patients. The AUC of combining GCS with cystatin C was 0.862, which was higher than that of GCS alone (Z = 1.7354, p < 0.05). CONCLUSION Both AKI and brain injury severity are mediating variables influencing the relationship between cystatin C and mortality of TBI patients. Serum cystatin C is an effective prognostic marker for TBI patients.
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Affiliation(s)
- Ruoran Wang
- Department of Neurosurgery, West China Hospital, Sichuan University, No.37, Guoxue Alley, Chengdu, 610041, Sichuan Province, China
| | - Hongxu Chen
- Department of Neurosurgery, West China Hospital, Sichuan University, No.37, Guoxue Alley, Chengdu, 610041, Sichuan Province, China
| | - Min He
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China.
| | - Jianguo Xu
- Department of Neurosurgery, West China Hospital, Sichuan University, No.37, Guoxue Alley, Chengdu, 610041, Sichuan Province, China.
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Chaudhari UK, Hansen BC. Low serum creatinine, a surrogate marker of muscle mass, correlates with insulin sensitivity in nonhuman primates. J Med Primatol 2023; 52:100-107. [PMID: 36656041 DOI: 10.1111/jmp.12633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 12/05/2022] [Accepted: 01/03/2023] [Indexed: 01/20/2023]
Abstract
OBJECTIVES Decreased serum creatinine levels are associated with increased risk of type 2 diabetes (T2DM) in humans, however, its association with muscle mass and insulin sensitivity have not been studied in NHPs. METHODS Retrospective data of 229 adult NHPs were studied for association of serum creatinine levels with muscle mass and onset of T2DM. RESULTS Serum creatinine levels were positively correlated with lean muscle mass in nondiabetic (non-DM), male and female NHPs. Aged NHPs had significantly reduced lean muscle mass and corresponding creatinine levels compared to young age groups (p < .001). Creatinine was positively correlated with insulin sensitivity in nonDM male NHPs and significant decrease in creatinine was observed in T2DM (p < .001) compared to same age group nonDM NHPs. CONCLUSIONS The pathophysiology of T2DM in NHPs is similar to humans, low creatinine further provides utility of surrogate biomarkers of lower muscle mass and risk factor for T2DM NHPs.
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Affiliation(s)
- Uddhav K Chaudhari
- Department of Cell Physiology and Pathology, ICMR-National Institute for Research in Reproductive Child Health, Mumbai, India.,Morsani College of Medicine, Department of Internal Medicine, University of South Florida, Tampa, Florida, USA
| | - Barbara C Hansen
- Morsani College of Medicine, Department of Internal Medicine, University of South Florida, Tampa, Florida, USA
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Xie M, Yuan K, Zhu X, Chen J, Zhang X, Xie Y, Wu M, Wang Z, Liu R, Liu X. Systemic Immune-Inflammation Index and Long-Term Mortality in Patients with Stroke-Associated Pneumonia. J Inflamm Res 2023; 16:1581-1593. [PMID: 37092129 PMCID: PMC10120842 DOI: 10.2147/jir.s399371] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 03/02/2023] [Indexed: 04/25/2023] Open
Abstract
Background Systemic immune inflammation has been investigated as a prognostic marker of different diseases. This study is designed to assess the association of systemic immune-inflammation index (SII) with long-term mortality of stroke-associated pneumonia (SAP) patients. Methods Patients aged ≥18 years with SAP were selected from the Nanjing Stroke Registry Program in China. We retrospectively evaluated systemic immune-inflammation response with SII and pneumonia severity with the pneumonia severity index and the confusion, uremia, elevated respiratory rate, hypotension, and aged 65 years or older score. To explore the correlation between SII and mortality in SAP patients, multivariable Cox regressions and competing risk regressions were conducted. Mediation analysis was also performed to assess the role of pneumonia severity. Results Among 611 patients in the SAP population, death occurred in 164 patients (26.8%) during the median follow-up of 3.0 (1.2-4.6) years. In multivariate analysis, higher SII scores could predict increased mortality in patients with SAP (adjusted hazard ratio 2.061; 95% confidence interval, 1.256-3.383; P = 0.004), and the association was mediated by pneumonia severity. Moreover, adding SII to traditional models improved their predictive ability for mortality. Conclusion Our study displayed that SII was characterized in SAP patients with different prognoses. Elevated SII scores increased the risk of mortality. Further research is required for the clinical practice of the index among SAP patients.
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Affiliation(s)
- Mengdi Xie
- Department of Neurology, Jinling Hospital, Nanjing Medical University, Nanjing, People’s Republic of China
| | - Kang Yuan
- Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, People’s Republic of China
| | - Xinyi Zhu
- Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, People’s Republic of China
| | - Jingjing Chen
- Department of Neurology, Changhai Hospital, Navy Medical University, Shanghai, People’s Republic of China
| | - Xiaohao Zhang
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing, People’s Republic of China
| | - Yi Xie
- Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, People’s Republic of China
| | - Min Wu
- Department of Neurology, Jinling Hospital, Nanjing Medical University, Nanjing, People’s Republic of China
| | - Zhaojun Wang
- Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, People’s Republic of China
| | - Rui Liu
- Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, People’s Republic of China
- Rui Liu, Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, No. 305 East Zhongshan Road, Nanjing, 210000, Jiangsu Province, People’s Republic of China, Tel +86 2584801861, Fax +86 2584805169, Email
| | - Xinfeng Liu
- Department of Neurology, Jinling Hospital, Nanjing Medical University, Nanjing, People’s Republic of China
- Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, People’s Republic of China
- Stroke Center & Department of Neurology, Division of Life Sciences and Medicine, The First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, Anhui, People’s Republic of China
- Correspondence: Xinfeng Liu, Department of Neurology, Jinling Hospital, Nanjing Medical University, No. 305 East Zhongshan Road, Nanjing, Jiangsu Province, 210000, People’s Republic of China, Tel +86 2584801861, Fax +86 2584805169, Email
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Circulating Serum Cystatin C as an Independent Risk Biomarker for Vascular Endothelial Dysfunction in Patients with COVID-19-Associated Multisystem Inflammatory Syndrome in Children (MIS-C): A Prospective Observational Study. Biomedicines 2022; 10:biomedicines10112956. [PMID: 36428524 PMCID: PMC9687890 DOI: 10.3390/biomedicines10112956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 11/14/2022] [Accepted: 11/15/2022] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Multisystem inflammatory syndrome in children (MIS-C) is a new clinical entity that has emerged in the context of the COVID-19 pandemic. Despite the less severe course of the disease, varying degrees of cardiovascular events may occur in MIS-C; however, data on vascular changes occurring in MIS-C are still lacking. Endothelial dysfunction (ED) is thought to be one of the key risk factors contributing to MIS-C. BACKGROUND We conducted a prospective observational study. We investigated possible manifestations of cardiac and endothelial involvement in MIS-C after the treatment of the acute stage and potential predictive biomarkers in patients with MIS-C. METHODS Twenty-seven consecutive pediatric subjects (≥9 years), at least three months post-treated MIS-C of varying severity, in a stable condition, and twenty-three age- and sex-matched healthy individuals (HI), were enrolled. A combined non-invasive diagnostic approach was used to assess endothelial function as well as markers of organ damage using cardiac examination and measurement of the reactive hyperemia index (RHI), by recording the post- to pre-occlusion pulsatile volume changes and biomarkers related to ED and cardiac disease. RESULTS MIS-C patients exhibited a significantly lower RHI (indicative of more severe ED) than those in HI (1.32 vs. 1.80; p = 0.001). The cutoff of RHI ≤ 1.4 was independently associated with a higher cardiovascular risk. Age and biomarkers significantly correlated with RHI, while serum cystatin C (Cys C) levels were independently associated with a diminished RHI, suggesting Cys C as a surrogate marker of ED in MIS-C. CONCLUSIONS Patients after MIS-C display evidence of ED, as shown by a diminished RHI and altered endothelial biomarkers. Cys C was identified as an independent indicator for the development of cardiovascular disease. The combination of these factors has the potential to better predict the cardiovascular consequences of MIS-C. Our study suggests that ED may be implicated in the pathophysiology of this disease.
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Yan X, Chen H, Shang XL. Association between serum cystatin C level and post-stroke cognitive impairment in patients with acute mild ischemic stroke. Brain Behav 2022; 12:e2519. [PMID: 35148465 PMCID: PMC8933790 DOI: 10.1002/brb3.2519] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 12/19/2021] [Accepted: 01/24/2022] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Mild ischemic stroke (MIS) has been proved to be closely related to post-stroke cognitive impairment (PSCI). However, there are relatively few studies on the risk factors of MIS. We aimed to evaluate the relationship between serum cystatin C (CysC) level and cognitive function in patients with acute MIS. METHODS Four hundred consecutive patients with acute MIS were screened and 281 patients were eligible for this study. The serum CysC levels were detected within 24 h after admission. Cognitive function was assessed by Montreal Cognitive Assessment (MoCA) at 3 months after acute MIS. Logistic regression was used to identify the predictors of PSCI, and the receiver operating characteristic (ROC) curve was applied to explore the optimal cut-off value. RESULTS One hundred sixty-four (58.4%) patients were diagnosed with PSCI at 3 months follow-up. The serum CysC levels in patients with PSCI were significantly higher than patients without PSCI (p < .001). The binary logistic regression analysis showed that higher serum CysC level was an independent predictor for PSCI at 3 months (odds ratio [OR], 5.745; 95% confidence interval, [CI], 1.089-30.311; p = 0.039). The ROC curve showed that area under the curve (AUC) was 0.723, and at a 0.945 mg/l CysC cut-off point, the sensitivity and specificity for PSCI at 3 months were 79.9% and 58.1%, respectively. CONCLUSION Our findings suggested that the serum CysC levels were increased after acute MIS, and higher serum CysC levels at baseline might be an independent risk factor for PSCI in patients with acute MIS, but further research are warranted.
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Affiliation(s)
- Xu Yan
- Department of Neurology, The First Affiliated Hospital of China Medical University and The First people's Hospital of Shenyang., Shenyang, China.,Department of Neurology, The First people's Hospital of Shenyang, Shenyang, China
| | - Huan Chen
- Department of Neurology, The Fourth Affiliated Hospital of China Medical University, Shenyang, China
| | - Xiu-Li Shang
- Department of Neurology, The First Affiliated Hospital of China Medical University and The First people's Hospital of Shenyang., Shenyang, China
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Benoit S, Ciccia EA, Devarajan P. Cystatin C as a biomarker of chronic kidney disease: latest developments. Expert Rev Mol Diagn 2020; 20:1019-1026. [PMID: 32450046 PMCID: PMC7657956 DOI: 10.1080/14737159.2020.1768849] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 05/11/2020] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Chronic kidney disease (CKD) is common, occurring in over 10% of individuals globally, and is increasing in prevalence. The limitations of traditional biomarkers of renal dysfunction, such as serum creatinine, have been well demonstrated in the literature. Therefore, augmenting clinical assessment with newer biomarkers, such as serum cystatin C, has the potential to improve disease monitoring and patient care. AREAS COVERED The present paper assesses the utility and limitations of serum cystatin C as a biomarker for CKD in light of the current literature. EXPERT OPINION Serum cystatin C has been well established as an early and accurate biomarker of CKD that is particularly helpful in patients for whom creatinine is an inadequate marker or for whom more cumbersome methods of glomerular filtration rate (GFR) measurement are impractical. Current research questions are no longer focused on if, but rather when and how often cystatin C should be used in the evaluation of CKD patients. However, transition of all reagents and estimated GFR equations to the newly established International Standard is critical for developing generalizable data.
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Affiliation(s)
- Stefanie Benoit
- Nephrology and Hypertension, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA
| | - Eileen A. Ciccia
- Nephrology and Hypertension, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA
| | - Prasad Devarajan
- Nephrology and Hypertension, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA
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Shi J, Zhang C, Cao Y, Qu X, Liu H, You S. Prognostic Value of Cystatin C in Acute Ischemic Stroke Patients with Intravenous Thrombolysis. Curr Neurovasc Res 2020; 16:301-309. [PMID: 31490754 DOI: 10.2174/1567202616666190906110204] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 07/15/2019] [Accepted: 07/22/2019] [Indexed: 01/13/2023]
Abstract
BACKGROUND Less is known about the prognostic value of serum cystatin C in acute ischemic stroke (AIS) patients treated with intravenous thrombolysis (IVT). The aim of the present study was to examine the association between serum cystatin C levels and prognosis of AIS patients after IVT. METHODS Serum cystatin C was measured within 24 hours after recombinant tissue plasminogen activator (rt-PA) treatment in 280 consecutively recruited patients with AIS. The main outcomes included combination of death and major disability, death, major disability (modified Rankin Scale score 3-5) and vascular events at 3-month follow-up. RESULTS During the 3-month follow-up, 94 patients (33.6%) experienced death or major disability (28 deaths and 66 major disability) and 49 patients (17.5%) experienced vascular events. After multivariate adjustment, serum cystatin C was significantly associated with an increased risk of the combined outcome of death and major disability (OR=4.51, P = 0.006). Adding serum cystatin C quartiles to a model containing conventional risk factors improved the predictive power for the combined outcome of death and major disability (continuous net reclassification index 43.88%, P < 0.001; categorical net reclassification index 9.15%, P = 0.013; integrated discrimination improvement 2.31%, P = 0.025). Similar phenomena were also observed in major disability and vascular events. CONCLUSION Higher levels of serum cystatin C in AIS patients after IVT were independently associated with increased risks of poor functional outcomes and vascular events, especially combining conventional risk factors, suggesting that serum cystatin C might improve risk prediction for poor prognosis in AIS patients receiving rt-PA treatment.
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Affiliation(s)
- Jijun Shi
- Department of Neurology, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Chunyuan Zhang
- Department of Neurology, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Yongjun Cao
- Department of Neurology, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Xinyuan Qu
- Department of Epidemiology, School of Public Health, Medical College of Soochow University, Suzhou, China
| | - Huihui Liu
- Department of Neurology, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Shoujiang You
- Department of Neurology, The Second Affiliated Hospital of Soochow University, Suzhou, China
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Werner K, Christensson A, Legrand H, Pihlsgård M, Sterner G, Elmståhl S. Cystatin C and creatinine-based eGFR levels and their correlation to long-term morbidity and mortality in older adults. Aging Clin Exp Res 2019; 31:1461-1469. [PMID: 30560432 PMCID: PMC6763515 DOI: 10.1007/s40520-018-1091-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 12/06/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND The prevailing diagnostic criteria for CKD are age-independent, but have been challenged in light of the eGFR decline associated with normal aging. The stages of CKD communicate magnitude of risk of ESRD, cardiovascular morbidity, and mortality. AIMS This study aims to provide more insight into the morbidity and mortality associated with eGFR levels corresponding to the current CKD stages in older adults. METHODS The 2931 older adults in the Good Aging in Skåne study were randomized from the general population. The exposure variable used was eGFR level (CKD-EPI based on creatinine and cystatin C) with eGFR 60-89 mL/min/1.73 m2 as a reference; the outcomes were mortality, acute cardiovascular disease, congestive heart failure, and rapid kidney function decline (RKFD; defined as a decline in eGFR by 3 mL/min/1.73 m2 per year or more). RESULTS The mean age at baseline was 73 (SD 11) and mean follow-up time 11 (SD 5) years. Mortality was higher at lower eGFR levels with adjusted HR (95% CI) being 1.58 (1.34-1.88), 1.22 (1.05-1.41), 1 (reference), and 0.90 (0.67-1.21) for eGFR < 45, 45-59, 60-89 and ≥ 90 mL/min/1.73 m2, respectively. For acute CVD the adjusted HR (95% CI) were 1.23 (0.81-1.87), 1.21 (0.87-1.69), 1 (reference), and 0.53 (0.28-1.00) for the same eGFR levels. CONCLUSIONS This study confirms that mortality in older adults increases with decreasing eGFR at eGFR levels below today's threshold for CKD. The correlation was less certain for lower eGFR and incident cardiovascular disease.
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Affiliation(s)
- Karin Werner
- Department of Geriatrics, Skåne University Hospital, Jan Waldenströms gata 35, 20502, Malmö, Sweden.
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden.
| | - Anders Christensson
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
- Department of Nephrology, Skåne University Hospital, Malmö, Sweden
| | - Helen Legrand
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - Mats Pihlsgård
- Department of Geriatrics, Skåne University Hospital, Jan Waldenströms gata 35, 20502, Malmö, Sweden
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - Gunnar Sterner
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
- Department of Nephrology, Skåne University Hospital, Malmö, Sweden
| | - Sölve Elmståhl
- Department of Geriatrics, Skåne University Hospital, Jan Waldenströms gata 35, 20502, Malmö, Sweden
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
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Bevc S, Hojs N, Knehtl M, Ekart R, Hojs R. Cystatin C as a predictor of mortality in elderly patients with chronic kidney disease. Aging Male 2019; 22:62-67. [PMID: 29912597 DOI: 10.1080/13685538.2018.1479386] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The prevalence of chronic kidney disease (CKD) in the elderly is high. Serum cystatin C is an accurate marker of kidney function and it also has prognostic utility in CKD patients. The aim of our study was to determine the prediction of serum cystatin C and other markers of kidney function on long-term survival in elderly CKD patients. METHODS Fifty eight adult Caucasian patients, older than 65 years, without known malignancy, thyroid disease and/or not on steroid therapy were enrolled in the study. In each patient, 51CrEDTA clearance, serum creatinine, serum cystatin C, and estimated glomerular filtration rate using different equations were determined on the same day and patients were then followed for 11 years or until their death. RESULTS The means are as follows: 51CrEDTA clearance 53.3 ± 17.4 ml/min/1.73 m2, serum creatinine 1.62 ± 0.5 mg/dl, serum cystatin C 1.79 ± 0.5 mg/l, Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) creatinine equation 40.1 ± 14 ml/min/1.73 m2, Berlin Initiative Study 2 (BIS2) equation 38.9 ± 10.7 ml/min/1.73 m2, full age spectrum (FAS) creatinine equation 43.8 ± 13.8 ml/min/1.73 m2, FAS cystatin C equation 40.1 ± 11.7 ml/min/1.73 m2. In the follow up period, 47 (81%) patients died. Cox regression analysis showed different hazard ratios (HRs) for death: for 51CrEDTA clearance HR 1.022 (95% CI 1.004-1.042; p = .015), serum creatinine HR 1.013 (95% CI 1.006-1.019; p = .001), serum cystatin C HR 2.028 (95% CI 1.267-3.241; p = .003), CKD-EPI creatinine equation HR 1.048 (95% CI 1.019-1.076; p = .001), BIS2 equation HR 1.055 (95% CI 1.021-1.088; p = .001), FAS creatinine equation HR 1.046 (95% CI 1.017-1.074; p = .001), FAS cystatin C equation HR 1.039 (95% CI 1.010-1.071; p = .009). CONCLUSIONS Our results showed the highest HR for serum cystatin C among kidney function markers for prediction of outcome in elderly CKD patients.
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Affiliation(s)
- Sebastjan Bevc
- a Department of Nephrology, Clinic for Internal Medicine , University Clinical Centre Maribor , Maribor , Slovenia
- b Faculty of Medicine , University of Maribor , Maribor , Slovenia
| | - Nina Hojs
- a Department of Nephrology, Clinic for Internal Medicine , University Clinical Centre Maribor , Maribor , Slovenia
- b Faculty of Medicine , University of Maribor , Maribor , Slovenia
| | - Maša Knehtl
- a Department of Nephrology, Clinic for Internal Medicine , University Clinical Centre Maribor , Maribor , Slovenia
- b Faculty of Medicine , University of Maribor , Maribor , Slovenia
| | - Robert Ekart
- b Faculty of Medicine , University of Maribor , Maribor , Slovenia
- c Department of Dialysis, Clinic for Internal Medicine , University Clinical Centre Maribor , Maribor , Slovenia
| | - Radovan Hojs
- a Department of Nephrology, Clinic for Internal Medicine , University Clinical Centre Maribor , Maribor , Slovenia
- b Faculty of Medicine , University of Maribor , Maribor , Slovenia
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