Serum creatinine to cystatin C ratio is associated with major adverse cardiovascular events in patients with obstructive coronary artery disease

Lu, Ya Wen; Tsai, Yi Lin; Chou, Ruey‐Hsing; Kuo, Cheng–Deng; Chang, Chun Chin; Huang, Po Hsun; Lin, Shing Jong

doi:10.1016/j.numecd.2021.01.024

Cited by 29 publications

(23 citation statements)

References 24 publications

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“…First, a low CCR showed increased risk of mortality in the population with normal renal function, but the association with mortality decreased in the case of renal impairment. Previous studies of low CCR have suggested an association with sarcopenia, and a low CCR has been considered to be an indicator of increased risk of mortality in various diseases ( 9 , 11 , 18 ). A study of DM patients suggested a low CCR as a marker of sarcopenia, and reported that a low CCR lowered quality of life and increased mortality ( 9 ).…”

Section: Discussionmentioning

confidence: 99%

“…A study of DM patients suggested a low CCR as a marker of sarcopenia, and reported that a low CCR lowered quality of life and increased mortality ( 9 ). Another study on patients with obstructive coronary artery disease also suggested that CCR is a surrogate marker for sarcopenia, and a lower CCR was related to higher prevalence of major adverse cardiovascular events which including all-cause mortality ( 11 ). In addition to the association with sarcopenia, the association with mortality is also considered in terms of the clinical entity named "shrunken pore syndrome”, which was reported as a consequence of the decrease in the pore size of the glomerular filtration barrier ( 15 , 19 ).…”

Section: Discussionmentioning

confidence: 99%

“…In this context, several researchers have evaluated the difference between creatinine and cystatin C and tried to find the clinical implication of the discrepancy between the two biomarkers. Previous studies have shown that elevated serum creatinine/cystatin C ratio (CCR) is associated with various diseases, including chronic obstructive pulmonary disease (COPD) ( 8 ), DM ( 9 ), non-alcoholic fatty liver disease ( 10 ), obstructive coronary artery disease ( 11 ) and cancer ( 12 , 13 ) as well as all-cause mortality. Surprisingly, although both cystatin C and creatinine are cleared by renal excretion and are widely used as biomarkers of renal function, there is no study concerning renal impairment as a confounding variable in the relationship between CCR and hard outcomes.…”

Section: Introductionmentioning

confidence: 99%

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Changes in Mortality According to Creatinine/Cystatin C Ratio in Chronic Kidney Disease and Non-chronic Kidney Disease Patients

et al. 2022

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BackgroundSerum creatinine and cystatin C are not only good indicators of renal function but have also been confirmed to be related to disease prognosis and mortality in various diseases via creatinine/cystatin C ratio (CCR). However, although they are biomarkers of renal function, there is no study regarding renal impairment as a confounding variable in the relationship between CCR and all-cause mortality.MethodsPatients who had simultaneous measurements of serum creatinine and cystatin C between 2003 and 2020 were enrolled. The patients with chronic kidney disease (CKD) were defined as having an estimated glomerular filtration rate (eGFR) CKD-EPI Cr-Cystatin C < 60 ml/min/1.73 m2. CCR was calculated by dividing the serum creatinine level by the cystatin C level measured on the same day. The main outcome assessed was all-cause mortality according to CCR in CKD or non-CKD groups.ResultsAmong the 8,680 patients in whom creatinine and cystatin C levels were measured simultaneously, 4,301 were included in the CKD group, and 4,379 were included in the non-CKD group, respectively. CCR was 1.4 ± 0.6 in total participants. The non-CKD group showed higher mean CCR, (1.5 ± 0.7 vs. 1.3 ± 0.5) as well as a wider distribution of CCR (p < 0.001) when compared to the CKD group. In non-CKD group, 1st, 4th and 5th quintiles of CCR significantly increased the all-cause mortality risk compared to 2nd quintile of CCR, suggesting U-shaped mortality risk according to CCR in non-CKD. On the other hand, in CKD group, the risk of all-cause mortality linearly increased and 5th quintile of CCR showed 1.82 times risk of mortality compared to 2nd quintile of CCR. In the subgroup analysis of mortality by age and sex, the mortality difference according to CCR were diminished in old age and female sex subgroups.ConclusionWe discovered a U-shaped relationship between mortality and CCR levels in normal renal function, and an increased risk of mortality in CKD with elevated CCR.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Changes in Mortality According to Creatinine/Cystatin C Ratio in Chronic Kidney Disease and Non-chronic Kidney Disease Patients

et al. 2022

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“…Notably, the major outcomes of this study show increased MACE incidence, cardiovascular, and all-cause mortality in the high CysC cohort with AMI at the end of 4-year follow-up, indicating that CysC level is a potential independent predictor for cardiac prognosis after AMI. Increasing shreds of evidence have shown that higher CysC is associated with higher cardiovascular risk and mortality rate in patients with non-ST elevated acute coronary syndrome [ 24 ], and serum creatinine to cystatin C ratio is associated with major adverse cardiovascular events in patients with obstructive coronary artery disease [ 25 ]. In AMI patients, an increased admission CysC level was associated with a higher risk of in-hospital and 1-month death [ 26 ].…”

Section: Discussionmentioning

confidence: 99%

Association between Cystatin C and Cardiac Function in Acute Myocardial Infarction Patients: A Real-World Analysis

et al. 2022

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Background. Acute myocardial infarction (AMI), as well as its long-term and short-term complications, is known to present with high morbidity and mortality. Cardiac function deterioration and ventricular remodelling after AMI are known to be correlated to worse long-term outcomes. However, the underlying mechanism remains elusive and there is a shortage of serum prediction markers. This study investigates the relationship between in-hospital Cystatin C (CysC) and cardiac function and subsequent prognosis among AMI patients. Research Design and Methods. We measured admission CysC and cardiac function parameters, including ejection fraction (EF) and pro-BNP value in 5956 patients diagnosed with AMI. Simple and multiregression analyses were performed to investigate the correlation between CysC and cardiac function in AMI patients. Major adverse cardiovascular events (MACE), cardiovascular, and all-cause mortality were documented, and 351 participants with high cystatin (≥1.09 mg/L) and 714 low cystatin (<1.09 mg/L) were investigated for survival analysis during a 48-month follow-up. Results. 5956 patients with AMI were enrolled in the initial observational analysis, and 1065 patients of the whole cohort were included in the follow-up survival analysis. The admission CysC level was found to be significantly positively correlated to the pro-BNP level ( R square = 0.2142 , 95% CI 4758 to 5265, p < 0.0001 ) and negatively correlated to the EF value ( R square = 0.0095 , 95% CI -3.503 to -1.605, p < 0.0001 ). Kaplan-Meier survival analysis revealed significantly increased MACE incidence ( HR = 2.293 , 95% CI 1.400 to 3.755, p < 0.0001 ), cardiovascular mortality ( HR = 3.016 , 95% CI 1.694 to 5.371, p = 0.0002 ), and all-cause mortality ( HR = 3.424 , 95% CI 2.010 to 5.835, p < 0.0001 ) in high-admission CysC cohort with AMI at the end of 4-year follow-up. Conclusions. Admission CysC is negatively correlated with cardiac function in AMI patients and acts as a novel predictor for MACE incidence in the whole population. Further studies are needed to investigate the specific mechanism of CysC in the cardiac function deterioration among AMI patients.

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“…Previous studies have suggested that higher creatinine-tocystatin C ratio at baseline was associated with better prognostic outcomes including low risk of cardiovascular events 23,24 and short-and long-term mortality. [25][26][27] However, none of them has assessed whether changes in creatinine-to-cystatin C ratio were predictive for future health outcome.…”

Section: Interpretationsmentioning

confidence: 95%

Changes in creatinine‐to‐cystatin C ratio over 4 years, risk of diabetes, and cardiometabolic control: The China Health and Retirement Longitudinal Study

Qiu

Cai

Yuan

et al. 2021

Journal of Diabetes

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Background: Creatinine-to-cystatin C ratio has attracted substantial interest as a measure to reflect health well-being, but no studies have assessed whether its longitudinal changes are associated with risk of diabetes. We aimed to examine their association, along with the exploration of the relationship of such changes with cardiometabolic control in middle-aged and older adults. Methods: We included a total of 3278 participants aged ≥45 years who provided measurements of creatinine and cystatin C at baseline and 4 years later from the China Health and Retirement Longitudinal Study. Diabetes was diagnosed based on glucose, hemoglobin A1c (HbA1c), medical history, or use of antidiabetic mediations. Odds ratio (OR) and 95% confidence interval (CI) were obtained using logistic regression analyses.Results: After 4-year follow-up, 272 participants developed diabetes. Larger increases in creatinine-to-cystatin C ratio were associated with lower risk of diabetes. The multivariable-adjusted OR for diabetes per 1 SD increase in creatinine-to-cystatin C ratio was 0.84 (95% CI 0.72-0.98). Compared with participants showing decreases in creatinine-to-cystatin C ratio but increases in body mass index (BMI), those experiencing increases in creatinine-to-cystatin C ratio and decreases in BMI had the largest risk reduction (multivariableadjusted OR 0.52). Changes in creatinine-to-cystatin C ratio showed inverse correlation with blood pressure, HbA1c, lipids, and C-reactive protein at the 4-year follow-up. Moreover, they also correlated inversely with changes in HbA1c and C-reactive protein (all P ≤ 0.004). Conclusions: Increases in creatinine-to-cystatin C ratio led to reduced risk of diabetes and may benefit cardiometabolic control.

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Serum creatinine to cystatin C ratio is associated with major adverse cardiovascular events in patients with obstructive coronary artery disease

Cited by 29 publications

References 24 publications

Changes in Mortality According to Creatinine/Cystatin C Ratio in Chronic Kidney Disease and Non-chronic Kidney Disease Patients

Changes in Mortality According to Creatinine/Cystatin C Ratio in Chronic Kidney Disease and Non-chronic Kidney Disease Patients

Association between Cystatin C and Cardiac Function in Acute Myocardial Infarction Patients: A Real-World Analysis

Changes in creatinine‐to‐cystatin C ratio over 4 years, risk of diabetes, and cardiometabolic control: The China Health and Retirement Longitudinal Study

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