The value of NT-proBNP paired with Cys-C in early diagnosis of the type 1 cardiorenal syndrome / 中华急诊医学杂志

ABSTRACT

Objective To study the value of plasma amino-terminal pro-B-type natriuretic peptide precursor (NT-proBNP) along with cystatin C (Cys-C) used together in early diagnosis of the type 1 cardiorenal syndrome (CRS) in patients with acute heart failure.Methods From January 2011 to January 2014,the data of 395 acute heart failure patients in Wenzhou People' s Hospital were retrospectively analyzed.Plasma concentrations of NT-proBNP and Cys-C of 395 patients with acute heart failure were measured by using PETIA and ECLIA methods at about 24 hours after admission.And the incidence of type 1 CRS syndrome was analyzed by statistics.ROC analyses were performed to evaluate the early diagnosing value of plasma NT-proBNP along with Cys-C in determining type 1 CRS and in discerning the optimal cut-off point for early diagnosing type 1 CRS patients.Results A total of 395 patients with acute heart failure aged from 29-96 years with (74.3 ± 13.0) years in mean,and 61.3％ male were enrolled in this study.Of them,82 patients were suffered from CRS syndrome.Logistic regression analysis showed diabetes,chronic heart failure,Cys-C and NT-proBNP were independent risk factors for predicting type 1 CRS,and serum Cys-C level was the most important predictor.ROC analysis showed the areas under the curve (AUC) of plasma NT-proBNP and Cys-C for early diagnosing CRS were 0.835 (95％ CI0.785-0.886,P ＜ 0.01) and 0.885 (95％ CI0.825-0.944,P ＜0.01),respectively.The value of plasma NT-proBNP alone in early diagnosing the type 1 CRS was limited with Youden index up to 0.483.When the NT-proBNP paired with Cys-C,the diagnostic reliability has been greatly improved,especially specificity with Youden index up to 0.717.Therefore,NT-proBNP doupled with Cys-C has great reference value in early diagnosing the type 1 CRS.Conclusion Plasma NT-proBNP level coupled with Cys-C level is a valuable biomarker for early diagnosing type 1 cardio-renal syndrome in patients with acute heart failure.If the levels of plasma NT-proBNP and Cys-C are detected simultaneously,the diagnostic reliability of CRS will be greatly improved,especially in the diagnostic specificity.