Relative value of cystatin C and creatinine-based estimates of glomerular filtration rate in predicting long-term mortality after cardiac surgery: a cohort study
Objective Renal dysfunction predicts an increased risk of both early and long-term mortality after cardiac surgery. Cystatin C enables glomerular filtration rate (GFR) to be estimated accurately and may be superior in this regard to creatinine-based estimates. We hypothesised, therefore, that cystat...
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BMJ Publishing Group
2019-09-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/9/9/e029379.full |
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| author | Graham S Hillis Clara K Chow Vincent W Lee John F Mooney Bernard L Croal Sean Cassidy Brian H Cuthbertson |
| author_facet | Graham S Hillis Clara K Chow Vincent W Lee John F Mooney Bernard L Croal Sean Cassidy Brian H Cuthbertson |
| author_sort | Graham S Hillis |
| collection | DOAJ |
| description | Objective Renal dysfunction predicts an increased risk of both early and long-term mortality after cardiac surgery. Cystatin C enables glomerular filtration rate (GFR) to be estimated accurately and may be superior in this regard to creatinine-based estimates. We hypothesised, therefore, that cystatin C and derived estimates of GFR would independently predict long-term survival after cardiac surgery and would be superior in this respect to traditional estimates of GFR. The current study tests this hypothesis in a large and well-characterised cohort of patients.Design A prospective cohort study.Setting Regional cardiothoracic centre in Northeast Scotland.Participants 1010 patients undergoing non-emergent cardiac surgery between 2004 and 2007. Serum creatinine and cystatin C levels were measured preoperatively and demographic and clinical variables were recorded.Primary outcome measure All-cause mortality, established from the National Records of Scotland.Results The median duration of follow-up after surgery was 9.7 years (IQR 8.9–10.6 years), during which 297 participants died. Preoperative creatinine and cystatin C levels and estimates of GFR derived from these were all strong predictors of death using Cox regression and remained independently predictive after adjustment for the logistic European System for Cardiac Operative Risk Evaluation, a well-validated clinical risk score and a range of other clinical predictors. Cystatin C-based measures were superior to creatinine-based estimates of GFR.Conclusions Cystatin C and creatinine derived eGFR are powerful and independent predictors of long-term mortality following cardiac surgery. Estimates of GFR derived from cystatin C convey superior prognostic information to conventional creatinine-based estimates, but the observed differences are modest. |
| format | Article |
| id | doaj-art-0b49277a6382478c8747dd4aff63662e |
| institution | OA Journals |
| issn | 2044-6055 |
| language | English |
| publishDate | 2019-09-01 |
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| spelling | doaj-art-0b49277a6382478c8747dd4aff63662e2025-08-20T02:01:57ZengBMJ Publishing GroupBMJ Open2044-60552019-09-019910.1136/bmjopen-2019-029379Relative value of cystatin C and creatinine-based estimates of glomerular filtration rate in predicting long-term mortality after cardiac surgery: a cohort studyGraham S Hillis0Clara K Chow1Vincent W Lee2John F Mooney3Bernard L Croal4Sean Cassidy5Brian H Cuthbertson69 Cardiology, Royal Perth Hospital, Perth, Western Australia, AustraliaCardiology, The George Institute for Global Health, Sydney, New South Wales, AustraliaFaculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia1 Cardiovascular Division, The George Institute for Global Health, Sydney, New South Wales, Australia3 Department of Clinical Biochemistry, Aberdeen Royal Infirmary, Aberdeen, UK2 Department of Biochemistry, Aberdeen Royal Infirmary, Aberdeen, UK6 Critical Care Medicine, Sunnnybrook Health Sciences Centre, Toronto, Ontario, CanadaObjective Renal dysfunction predicts an increased risk of both early and long-term mortality after cardiac surgery. Cystatin C enables glomerular filtration rate (GFR) to be estimated accurately and may be superior in this regard to creatinine-based estimates. We hypothesised, therefore, that cystatin C and derived estimates of GFR would independently predict long-term survival after cardiac surgery and would be superior in this respect to traditional estimates of GFR. The current study tests this hypothesis in a large and well-characterised cohort of patients.Design A prospective cohort study.Setting Regional cardiothoracic centre in Northeast Scotland.Participants 1010 patients undergoing non-emergent cardiac surgery between 2004 and 2007. Serum creatinine and cystatin C levels were measured preoperatively and demographic and clinical variables were recorded.Primary outcome measure All-cause mortality, established from the National Records of Scotland.Results The median duration of follow-up after surgery was 9.7 years (IQR 8.9–10.6 years), during which 297 participants died. Preoperative creatinine and cystatin C levels and estimates of GFR derived from these were all strong predictors of death using Cox regression and remained independently predictive after adjustment for the logistic European System for Cardiac Operative Risk Evaluation, a well-validated clinical risk score and a range of other clinical predictors. Cystatin C-based measures were superior to creatinine-based estimates of GFR.Conclusions Cystatin C and creatinine derived eGFR are powerful and independent predictors of long-term mortality following cardiac surgery. Estimates of GFR derived from cystatin C convey superior prognostic information to conventional creatinine-based estimates, but the observed differences are modest.https://bmjopen.bmj.com/content/9/9/e029379.full |
| spellingShingle | Graham S Hillis Clara K Chow Vincent W Lee John F Mooney Bernard L Croal Sean Cassidy Brian H Cuthbertson Relative value of cystatin C and creatinine-based estimates of glomerular filtration rate in predicting long-term mortality after cardiac surgery: a cohort study BMJ Open |
| title | Relative value of cystatin C and creatinine-based estimates of glomerular filtration rate in predicting long-term mortality after cardiac surgery: a cohort study |
| title_full | Relative value of cystatin C and creatinine-based estimates of glomerular filtration rate in predicting long-term mortality after cardiac surgery: a cohort study |
| title_fullStr | Relative value of cystatin C and creatinine-based estimates of glomerular filtration rate in predicting long-term mortality after cardiac surgery: a cohort study |
| title_full_unstemmed | Relative value of cystatin C and creatinine-based estimates of glomerular filtration rate in predicting long-term mortality after cardiac surgery: a cohort study |
| title_short | Relative value of cystatin C and creatinine-based estimates of glomerular filtration rate in predicting long-term mortality after cardiac surgery: a cohort study |
| title_sort | relative value of cystatin c and creatinine based estimates of glomerular filtration rate in predicting long term mortality after cardiac surgery a cohort study |
| url | https://bmjopen.bmj.com/content/9/9/e029379.full |
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