Prognostic Ability of Combination of Cystatin C, BNP and Troponin T in Acute Heart Failure Patients without Advanced Renal Impairment

Recently, we have reported that cystatin C may improve early risk stratification compared with estimated GFR in acute heart failure patients without advanced renal impairment. Thus, we investigated the prognostic utility of combination of cystatin C with BNP and cardiac troponin T on admission in 355 consecutive patients hospitalized for worsening chronic heart failure with estimated GFR >or=30 mL/min/1.73 m2. Results: During a mean follow-up period of 692 days after admission, there were 59 (17%) cardiac deaths. On a stepwise Cox regression analysis including 10 clinical and biochemical variables, elevation (>median value) in cystatin C (>1.09mg/L; relative risk [RR] 4.7, P<0.0001), BNP (>788 pg/mL; RR 2.0, P=0.02) and troponin T (>0.029ng/mL; RR 2.2, P=0.009) were independently associated with cardiac deaths. Each independent biomarker was assigned a number of points proportional to its RR as follows: cystatin C (2 points), BNP (1 point) and troponin T (1 point). When patients were categorized on the basis of the sum of their point numbers, cardiac mortality rate was 1.5% in patients with zero point, 8.0% in those with one,7.3% in those with two, 23.4% in those with three, and 42.2% in those with four. Conclusion: The combination of cystatin C, BNP and troponin T on admission improves early risk stratification for cardiac mortality in this population.