Urinary Cystatin C Has Prognostic Value in Peripheral Artery Disease
Despite its association with adverse outcomes, peripheral artery disease (PAD) remains undertreated. Cystatin C is elevated in patients with renal disease and may be a marker of cardiovascular disease. We examined the prognostic ability of urinary Cystatin C (uCystatinC) in predicting adverse PAD-re...
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MDPI AG
2022-06-01
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| Series: | Biomolecules |
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| Online Access: | https://www.mdpi.com/2218-273X/12/7/860 |
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| author | Ben Li Abdelrahman Zamzam Muzammil H. Syed Niousha Jahanpour Shubha Jain Rawand Abdin Mohammad Qadura |
| author_facet | Ben Li Abdelrahman Zamzam Muzammil H. Syed Niousha Jahanpour Shubha Jain Rawand Abdin Mohammad Qadura |
| author_sort | Ben Li |
| collection | DOAJ |
| description | Despite its association with adverse outcomes, peripheral artery disease (PAD) remains undertreated. Cystatin C is elevated in patients with renal disease and may be a marker of cardiovascular disease. We examined the prognostic ability of urinary Cystatin C (uCystatinC) in predicting adverse PAD-related events. In this prospective case-control study, urine samples were collected from patients with PAD (<i>n</i> = 121) and without PAD (<i>n</i> = 77). The cohort was followed for 2 years. uCystatinC was normalized to urinary creatinine (uCr) (uCystatinC/uCr; μg/g). The primary outcome was major adverse limb event (MALE; composite of vascular intervention (open or endovascular) or major limb amputation). The secondary outcome was worsening PAD status (drop in ABI ≥ 0.15). Multivariable Cox regression and Kaplan–Meier analyses were performed to assess the prognostic value of uCystatinC/uCr with regards to predicting MALE and worsening PAD status. Our analysis demonstrated that patients with PAD had significantly higher median [IQR] uCystatinC/uCr levels (24.9 μg/g [14.2–32.9] vs. 20.9 μg/g [11.1–27.8], <i>p</i> = 0.018). Worsening PAD status and MALE were observed in 39 (20%) and 34 (17%) patients, respectively. uCystatinC/uCr predicted worsening PAD status with a hazard ratio (HR) of 1.78 (95% CI 1.12–2.83, <i>p</i> = 0.015), which persisted after controlling for baseline demographic and clinical characteristics (adjusted HR 1.79 [95% CI 1.11–2.87], <i>p</i> = 0.017). Patients with high uCystatinC/uCr had a lower 2-year freedom from MALE (77% vs. 89%, <i>p</i> = 0.025) and worsening PAD status (63% vs. 87%, <i>p</i> = 0.001). Based on these data, higher uCystatinC/uCr levels are associated with adverse PAD-related events and have prognostic value in risk-stratifying individuals for further diagnostic vascular evaluation or aggressive medical management. |
| first_indexed | 2024-03-09T12:12:16Z |
| format | Article |
| id | doaj.art-eee03e5d5361422c8ee18a23664f4a84 |
| institution | Directory Open Access Journal |
| issn | 2218-273X |
| language | English |
| last_indexed | 2024-03-09T12:12:16Z |
| publishDate | 2022-06-01 |
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| spelling | doaj.art-eee03e5d5361422c8ee18a23664f4a842023-11-30T22:51:27ZengMDPI AGBiomolecules2218-273X2022-06-0112786010.3390/biom12070860Urinary Cystatin C Has Prognostic Value in Peripheral Artery DiseaseBen Li0Abdelrahman Zamzam1Muzammil H. Syed2Niousha Jahanpour3Shubha Jain4Rawand Abdin5Mohammad Qadura6Division of Vascular Surgery, St. Michael’s Hospital, Unity Health Toronto, University of Toronto, Toronto, ON M5B 1W8, CanadaDivision of Vascular Surgery, St. Michael’s Hospital, Unity Health Toronto, University of Toronto, Toronto, ON M5B 1W8, CanadaDivision of Vascular Surgery, St. Michael’s Hospital, Unity Health Toronto, University of Toronto, Toronto, ON M5B 1W8, CanadaDivision of Vascular Surgery, St. Michael’s Hospital, Unity Health Toronto, University of Toronto, Toronto, ON M5B 1W8, CanadaDivision of Vascular Surgery, St. Michael’s Hospital, Unity Health Toronto, University of Toronto, Toronto, ON M5B 1W8, CanadaDepartment of Medicine, McMaster University, Hamilton, ON L8S 4K1, CanadaDivision of Vascular Surgery, St. Michael’s Hospital, Unity Health Toronto, University of Toronto, Toronto, ON M5B 1W8, CanadaDespite its association with adverse outcomes, peripheral artery disease (PAD) remains undertreated. Cystatin C is elevated in patients with renal disease and may be a marker of cardiovascular disease. We examined the prognostic ability of urinary Cystatin C (uCystatinC) in predicting adverse PAD-related events. In this prospective case-control study, urine samples were collected from patients with PAD (<i>n</i> = 121) and without PAD (<i>n</i> = 77). The cohort was followed for 2 years. uCystatinC was normalized to urinary creatinine (uCr) (uCystatinC/uCr; μg/g). The primary outcome was major adverse limb event (MALE; composite of vascular intervention (open or endovascular) or major limb amputation). The secondary outcome was worsening PAD status (drop in ABI ≥ 0.15). Multivariable Cox regression and Kaplan–Meier analyses were performed to assess the prognostic value of uCystatinC/uCr with regards to predicting MALE and worsening PAD status. Our analysis demonstrated that patients with PAD had significantly higher median [IQR] uCystatinC/uCr levels (24.9 μg/g [14.2–32.9] vs. 20.9 μg/g [11.1–27.8], <i>p</i> = 0.018). Worsening PAD status and MALE were observed in 39 (20%) and 34 (17%) patients, respectively. uCystatinC/uCr predicted worsening PAD status with a hazard ratio (HR) of 1.78 (95% CI 1.12–2.83, <i>p</i> = 0.015), which persisted after controlling for baseline demographic and clinical characteristics (adjusted HR 1.79 [95% CI 1.11–2.87], <i>p</i> = 0.017). Patients with high uCystatinC/uCr had a lower 2-year freedom from MALE (77% vs. 89%, <i>p</i> = 0.025) and worsening PAD status (63% vs. 87%, <i>p</i> = 0.001). Based on these data, higher uCystatinC/uCr levels are associated with adverse PAD-related events and have prognostic value in risk-stratifying individuals for further diagnostic vascular evaluation or aggressive medical management.https://www.mdpi.com/2218-273X/12/7/860Cystatin Cperipheral arterial diseasemajor adverse limb events |
| spellingShingle | Ben Li Abdelrahman Zamzam Muzammil H. Syed Niousha Jahanpour Shubha Jain Rawand Abdin Mohammad Qadura Urinary Cystatin C Has Prognostic Value in Peripheral Artery Disease Biomolecules Cystatin C peripheral arterial disease major adverse limb events |
| title | Urinary Cystatin C Has Prognostic Value in Peripheral Artery Disease |
| title_full | Urinary Cystatin C Has Prognostic Value in Peripheral Artery Disease |
| title_fullStr | Urinary Cystatin C Has Prognostic Value in Peripheral Artery Disease |
| title_full_unstemmed | Urinary Cystatin C Has Prognostic Value in Peripheral Artery Disease |
| title_short | Urinary Cystatin C Has Prognostic Value in Peripheral Artery Disease |
| title_sort | urinary cystatin c has prognostic value in peripheral artery disease |
| topic | Cystatin C peripheral arterial disease major adverse limb events |
| url | https://www.mdpi.com/2218-273X/12/7/860 |
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