Predictive effect of estimated glomerular filtrate rate by creatinine or cystatin C on mortality in patients with coronary artery disease

Abstract

Background

Renal dysfunction leads to poor prognosis of patients with coronary artery disease (CAD). Current studies have reported the prognosis or mortality of various diseases using different estimated glomerular filtrate rate (eGFR) formulas, while the performance of these equations is unclear in CAD patients. We aim to evaluate the predict effect of creatinine-based eGFR (eGFRcr), cystatin C-based eGFR (eGFRcys), and both creatinine and cystatin C-based eGFR (eGFRcr-cys) in CAD patients.

Methods

A total of 23,178 patients with CAD were included from CIN-II cohort study. The association of eGFRcr, eGFRcys and eGFRcr-cys with cardiovascular and all-cause mortality was detected by Cox regression analysis. The predictive effect of eGFRcr, eGFRcys and eGFRcr-cys on mortality was assessed.

Results

During a median follow up of 4.3 years, totally 2051 patients (8.8%) experience all-cause mortality, of which 1427 patients (6.2%) died of cardiovascular disease. For the detection of cardiovascular mortality among CAD patients, eGFRcr-cys had high discriminatory capacity with area under the curve (AUC) in receiver operator characteristic analysis of 0.730, which was significantly better than eGFRcr (AUC = 0.707, p < 0.001) and eGFRcys (AUC = 0.719, p < 0.001). Similar results were observed in all-cause mortality. Restricted cubic spline showed a U-shaped association between eGFRcr and all outcomes in patients with both reduced and supranormal eGFR levels, while a L-shaped association in eGFRcys and eGFRcr-cys.

Conclusions

Estimated GFR based on both creatinine and cystatin C has highest predictive effect for cardiovascular and all-cause mortality among CAD patients. Meanwhile, supranormal eGFRcr may indicate a higher risk of mortality.

Keywords:

• Estimated glomerular filtrate rate
• creatinine
• cystatin C
• coronary artery disease

Acknowledgement

None.

Ethical approval

The study protocol was approved by the Guangdong Provincial People’s Hospital ethics committee (No.GDREC2019-555H-2), all participating sites received institutional review board approval from their own ethics committees, and the study was performed according to the declaration of Helsinki. All the data used in this study were anonymized before its use. Since our study included retrospective cases, there was no additional intervention, and all patient information was desensitized.

Authors’ contributions

SQC and YL and were responsible for the study concept and data collection. YL, XG and DMW were responsible for study design. Data extraction was undertaken by SQC and ZGH. YZ, GXL and WYW were responsible for data analysis and intellectual direction. Drafting of the manuscript: YZ, GXL, LLS and YWG. All authors read and approved the final manuscript.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Additional information

Funding

This work was supported by grants from Key Laboratory of Emergency and Trauma of Ministry of Education (Hainan Medical University) (Grant.KLET-2022**), Guangdong Provincial science and technology project (2020B1111170011, DFJH201919); Guangdong Provincial science and technology project (KJ022021049); Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention (No.Y0120220151). The work was not funded by any industry sponsors.