Advanced

The predictive value of s-cystatin C for mortality after coronary artery bypass surgery

Dardashti, Alain LU ; Nozohoor, Shahab LU ; Algotsson, Lars LU ; Ederoth, Per LU and Bjursten, Henrik LU (2016) In Journal of Thoracic and Cardiovascular Surgery 152(1). p.139-146
Abstract

OBJECTIVES: To evaluate serum creatinine (s-creatinine) and serum cystatin C (s-cystatin C) levels and estimated glomerular filtration rate (eGFR) at different time points as predictors for mortality in patients undergoing coronary artery bypass grafting (CABG).

METHODS: A total of 1638 patients undergoing elective CABG were studied prospectively over a median follow-up of 3.5 years (range, 2.0-5.0 years). Renal function was assessed by a comparison of s-creatinine, s-cystatin C values measured preoperatively and at the lowest postoperative level of renal function. The eGFR was estimated by different formulas: Modification of Diet in Renal Disease, the 2009 Chronic Kidney Disease Epidemiology (CDK-EPI) for s-creatinine, the 2012... (More)

OBJECTIVES: To evaluate serum creatinine (s-creatinine) and serum cystatin C (s-cystatin C) levels and estimated glomerular filtration rate (eGFR) at different time points as predictors for mortality in patients undergoing coronary artery bypass grafting (CABG).

METHODS: A total of 1638 patients undergoing elective CABG were studied prospectively over a median follow-up of 3.5 years (range, 2.0-5.0 years). Renal function was assessed by a comparison of s-creatinine, s-cystatin C values measured preoperatively and at the lowest postoperative level of renal function. The eGFR was estimated by different formulas: Modification of Diet in Renal Disease, the 2009 Chronic Kidney Disease Epidemiology (CDK-EPI) for s-creatinine, the 2012 CKD-EPI formula for s-cystatin C, the 2012 CKD-EPI formula for s-cystatin C and s-creatinine in combination, and the Caucasian Asian, Pediatric, and Adult subjects formula for s-cystatin C. Cox proportional hazards model analysis and C-statistics were used to evaluate independent predictors of mortality and to assess the predictive ability of the different renal function measures.

RESULTS: The 30-day mortality was 0.8%. Overall survival was 96.1% ± 0.4% at 2 years and 90.0% ± 1.2% at 5 years. Preoperative s-cystatin C showed greater predictive power than s-creatinine for overall mortality (area under the curve, 0.794 vs 0.653). Preoperative s-cystatin C (hazard ratio [HR], 1.65; 95% confidence interval [CI], 1.36-1.99) and eGFR based on s-cystatin C (HR, 0.96; 95% CI, 0.95-0.98), were both independent predictors of mortality. The unadjusted HR for mortality comparing the lowest preoperative cystatin C quintile (Q1) with Q4-Q5 were as follows: Q1 versus Q5, HR, 2.0; 95% CI, 1.6-2.5 (P < .001); Q1 versus Q4, HR, 1.6; 95% CI, 1.2-2.2 (P = .005).

CONCLUSIONS: The s-cystatin C level and s-cystatin C-based eGFR measured preoperatively are strong predictors for mortality after elective CABG.

(Less)
Please use this url to cite or link to this publication:
author
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Journal of Thoracic and Cardiovascular Surgery
volume
152
issue
1
pages
139 - 146
publisher
Mosby
external identifiers
  • Scopus:84962366905
ISSN
1097-685X
DOI
10.1016/j.jtcvs.2016.02.070
language
English
LU publication?
yes
id
91f89da5-e3a5-4469-a987-0797890de70b
date added to LUP
2016-05-03 12:53:07
date last changed
2016-10-13 05:07:29
@misc{91f89da5-e3a5-4469-a987-0797890de70b,
  abstract     = {<p>OBJECTIVES: To evaluate serum creatinine (s-creatinine) and serum cystatin C (s-cystatin C) levels and estimated glomerular filtration rate (eGFR) at different time points as predictors for mortality in patients undergoing coronary artery bypass grafting (CABG).</p><p>METHODS: A total of 1638 patients undergoing elective CABG were studied prospectively over a median follow-up of 3.5 years (range, 2.0-5.0 years). Renal function was assessed by a comparison of s-creatinine, s-cystatin C values measured preoperatively and at the lowest postoperative level of renal function. The eGFR was estimated by different formulas: Modification of Diet in Renal Disease, the 2009 Chronic Kidney Disease Epidemiology (CDK-EPI) for s-creatinine, the 2012 CKD-EPI formula for s-cystatin C, the 2012 CKD-EPI formula for s-cystatin C and s-creatinine in combination, and the Caucasian Asian, Pediatric, and Adult subjects formula for s-cystatin C. Cox proportional hazards model analysis and C-statistics were used to evaluate independent predictors of mortality and to assess the predictive ability of the different renal function measures.</p><p>RESULTS: The 30-day mortality was 0.8%. Overall survival was 96.1% ± 0.4% at 2 years and 90.0% ± 1.2% at 5 years. Preoperative s-cystatin C showed greater predictive power than s-creatinine for overall mortality (area under the curve, 0.794 vs 0.653). Preoperative s-cystatin C (hazard ratio [HR], 1.65; 95% confidence interval [CI], 1.36-1.99) and eGFR based on s-cystatin C (HR, 0.96; 95% CI, 0.95-0.98), were both independent predictors of mortality. The unadjusted HR for mortality comparing the lowest preoperative cystatin C quintile (Q1) with Q4-Q5 were as follows: Q1 versus Q5, HR, 2.0; 95% CI, 1.6-2.5 (P &lt; .001); Q1 versus Q4, HR, 1.6; 95% CI, 1.2-2.2 (P = .005).</p><p>CONCLUSIONS: The s-cystatin C level and s-cystatin C-based eGFR measured preoperatively are strong predictors for mortality after elective CABG.</p>},
  author       = {Dardashti, Alain and Nozohoor, Shahab and Algotsson, Lars and Ederoth, Per and Bjursten, Henrik},
  issn         = {1097-685X},
  language     = {eng},
  month        = {02},
  number       = {1},
  pages        = {139--146},
  publisher    = {ARRAY(0xb07b848)},
  series       = {Journal of Thoracic and Cardiovascular Surgery},
  title        = {The predictive value of s-cystatin C for mortality after coronary artery bypass surgery},
  url          = {http://dx.doi.org/10.1016/j.jtcvs.2016.02.070},
  volume       = {152},
  year         = {2016},
}