Frontiers in Neurology (Aug 2021)

Serum Cystatin C Predicts Stroke Clinical Outcomes at 1 Year Independent of Renal Function

  • Yarong Ding,
  • Yarong Ding,
  • Yarong Ding,
  • Yarong Ding,
  • Liping Liu,
  • Liping Liu,
  • Liping Liu,
  • Liping Liu,
  • Zimo Chen,
  • Zimo Chen,
  • Zimo Chen,
  • Zimo Chen,
  • Hao Li,
  • Hao Li,
  • Hao Li,
  • Hao Li,
  • Yuesong Pan,
  • Yuesong Pan,
  • Yuesong Pan,
  • Yuesong Pan,
  • Junfeng Wang,
  • Xia Meng,
  • Xia Meng,
  • Xia Meng,
  • Xia Meng,
  • Jinxi Lin,
  • Jinxi Lin,
  • Jinxi Lin,
  • Jinxi Lin,
  • Jing Jing,
  • Jing Jing,
  • Jing Jing,
  • Jing Jing,
  • Xuewei Xie,
  • Xuewei Xie,
  • Xuewei Xie,
  • Xuewei Xie,
  • Xianglong Xiang,
  • Xianglong Xiang,
  • Xianglong Xiang,
  • Xianglong Xiang,
  • Yongjun Wang,
  • Yongjun Wang,
  • Yongjun Wang,
  • Yongjun Wang

DOI
https://doi.org/10.3389/fneur.2021.676872
Journal volume & issue
Vol. 12

Abstract

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Objective: Serum cystatin C (CysC) is a sensitive marker of renal function to predict cardiovascular diseases. We aimed to investigate the predictive value of CysC for clinical outcomes independent of renal function in patients with acute ischemic stroke (AIS).Methods: We measured serum CysC levels in 10,256 AIS patients from Third China National Stroke Registry (CNSR-III). The primary outcome was a combination of all-cause mortality and major disability (modified Rankin scale score, 3–6). Secondary outcomes included stroke recurrence and combined vascular events at 1 year. Outcomes were analyzed using logistic regression and Cox proportional hazards models, respectively.Results: The median CysC of included patients was 0.95 mg/l (interquartile range, 0.83–1.10 mg/l). A U-shaped association was observed between CysC and primary outcome (all-cause mortality or major disability) [quartile (Q)1 vs. Q2: adjusted odds ratio (aOR) 1.29, 95% CI 1.06–1.58, p = 0.012; Q3 vs. Q2: aOR 1.12, 95% CI 0.93–1.35, p = 0.242; Q4 vs. Q2: aOR 1.35, 95% CI 1.10–1.65, p = 0.004]. A similar trend also existed in “preserved renal function” patients. Adding CysC to a model containing conventional risk factors improved the model performance with integrated discrimination improvement (IDI) of 0.13% (p = 0.016) and net reclassification index (NRI) of 13.10% (p <0.001) for primary outcome. No significant association was observed for stroke recurrence or combined vascular event rate in different CysC quartiles.Conclusions: CysC showed a U-shaped correlation with 1-year stroke clinical outcome, suggesting that serum CysC may not only be a simple candidate marker of renal function.

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