{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T18:59:11Z","timestamp":1791917951758,"version":"4.3.4"},"reference-count":33,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2026,4,20]],"date-time":"2026-04-20T00:00:00Z","timestamp":1776643200000},"content-version":"vor","delay-in-days":19,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:00:00Z","timestamp":1775001600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Cardiology"],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Cystatin C (CysC)'s predictive utility for long\u2010term adverse outcomes in heart failure (HF) patients with normal to mild renal insufficiency remains unclear. This study investigates the relationship between CysC and adverse outcomes in HF patients across the whole ejection fraction (EF) spectrum with normal to mild renal insufficiency.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In this single\u2010center cohort study, 637 HF patients with normal to mild renal insufficiency were categorized into reduced EF (HFrEF), mid\u2010range EF (HFmrEF), and preserved EF (HFpEF) groups. Associations between natural log unit (CysC) and risks of all\u2010cause mortality and HF rehospitalization were examined using Cox regression models. C\u2010index, IDI, and NRI assessed the incremental prognostic value.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Over a follow\u2010up of 9.4 years, 271 patients died, and 330 were rehospitalized for HF. Multivariate Cox regression analysis indicated significant associations between elevated CysC levels and increased risks of all\u2010cause mortality (HR\u2009=\u20091.99, 95% CI: 1.57\u20132.54) and HF rehospitalization (HR\u2009=\u20091.95, 95% CI: 1.57\u20132.42) across all patients. HR's for all\u2010cause mortality observed for HFmrEF (HR 4.73, 95% CI: 2.08\u221210.74) and HFrEF (HR 15.11, 95% CI: 6.24\u221236.60) were higher compared to those for HFpEF patients (HR\u2009=\u20091.48, 95% CI 0.98\u22122.23), and CysC showed less prognostic impact on all\u2010cause mortality in HFpEF patients. Including CysC in the MAGGIC risk score\u2010based model provided additional prognostic value for all subjects, even with N\u2010terminal pro\u2010brain natriuretic peptide (NT\u2010proBNP) levels added.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>CysC is an independent risk factor for adverse outcomes in HF patients across EF spectrum with normal to mild renal insufficiency. Integrating CysC into the MAGGIC risk score\u2010based model enhances its prognostic capability for predicting adverse outcomes in the general HF population. Its prognostic effect on all\u2010cause mortality is limited in HFpEF patients.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/clc.70310","type":"journal-article","created":{"date-parts":[[2026,4,20]],"date-time":"2026-04-20T13:21:56Z","timestamp":1776691316000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Prognostic Value of Cystatin C Across Ejection Fraction Spectrum in Heart Failure With Normal to Mild Renal Dysfunction Original Investigation"],"prefix":"10.1002","volume":"49","author":[{"given":"Lyu","family":"Lyu","sequence":"first","affiliation":[{"name":"Department of Cardiology, Beijing Anzhen Hospital Capital Medical University Beijing China"},{"name":"Medical School of Chinese PLA Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Affiliated Xiaoshan Hospital Hangzhou Normal University Hangzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qiang","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Cardiology The Second Affiliated Hospital of Xi'an Jiaotong University Xi'an China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yun","family":"Wei","sequence":"additional","affiliation":[{"name":"Department of Cardiology The Second Affiliated Hospital of Xi'an Jiaotong University Xi'an China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benchuan","family":"Hao","sequence":"additional","affiliation":[{"name":"Department of Cardiology The Ninth Medical Center, Chinese PLA General Hospital Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hongbin","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Cardiology The Second Medical Center, Chinese PLA General Hospital Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,4,20]]},"reference":[{"key":"e_1_2_22_2_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCRESAHA.121.318172"},{"key":"e_1_2_22_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/ejhf.2115"},{"key":"e_1_2_22_4_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000000757"},{"key":"e_1_2_22_5_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/eht386"},{"key":"e_1_2_22_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jchf.2018.02.004"},{"key":"e_1_2_22_7_1","doi-asserted-by":"publisher","DOI":"10.1053\/ajkd.2000.8237"},{"key":"e_1_2_22_8_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.118.033343"},{"key":"e_1_2_22_9_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehl507"},{"key":"e_1_2_22_10_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCHEARTFAILURE.112.966960"},{"key":"e_1_2_22_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clinbiochem.2017.07.016"},{"key":"e_1_2_22_12_1","doi-asserted-by":"publisher","DOI":"10.1042\/BSR20181761"},{"issue":"5","key":"e_1_2_22_13_1","first-page":"404","article-title":"Cystatin C, N\u2010Terminal Probrain Natriuretic Peptides and Outcomes in Acute Heart Failure With Acute Kidney Injury in a 12\u2010month Follow\u2010Up: Insights into the Cardiorenal Syndrome","volume":"19","author":"Ruan Z. B.","year":"2014","journal-title":"Journal of Research in Medical Sciences: The Official Journal of Isfahan University of Medical Sciences"},{"key":"e_1_2_22_14_1","article-title":"Association Between Cystatin C and Cardiac Function and Long\u2010Term Prognosis in Patients With Chronic Heart Failure","volume":"26","author":"Wu X.","year":"2020","journal-title":"Medical Science Monitor"},{"key":"e_1_2_22_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cardfail.2010.07.248"},{"key":"e_1_2_22_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2018.01.119"},{"key":"e_1_2_22_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjmed.2008.10.042"},{"key":"e_1_2_22_18_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehs337"},{"key":"e_1_2_22_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2019.12.069"},{"key":"e_1_2_22_20_1","doi-asserted-by":"publisher","DOI":"10.1002\/ehf2.14208"},{"key":"e_1_2_22_21_1","doi-asserted-by":"publisher","DOI":"10.1002\/ehf2.13280"},{"key":"e_1_2_22_22_1","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.118.009594"},{"key":"e_1_2_22_23_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehab368"},{"key":"e_1_2_22_24_1","doi-asserted-by":"publisher","DOI":"10.1681\/ASN.2006040368"},{"key":"e_1_2_22_25_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1114248"},{"key":"e_1_2_22_26_1","doi-asserted-by":"publisher","DOI":"10.1177\/1753944717727498"},{"key":"e_1_2_22_27_1","doi-asserted-by":"publisher","DOI":"10.1097\/HJH.0000000000000757"},{"key":"e_1_2_22_28_1","doi-asserted-by":"publisher","DOI":"10.1373\/clinchem.2009.128397"},{"key":"e_1_2_22_29_1","doi-asserted-by":"publisher","DOI":"10.1172\/JCI181"},{"key":"e_1_2_22_30_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.ajkd.2007.11.019"},{"key":"e_1_2_22_31_1","doi-asserted-by":"publisher","DOI":"10.1038\/ki.2008.638"},{"key":"e_1_2_22_32_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clinbiochem.2006.03.017"},{"key":"e_1_2_22_33_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamacardio.2017.4987"},{"key":"e_1_2_22_34_1","doi-asserted-by":"publisher","DOI":"10.1002\/ejhf.414"}],"container-title":["Clinical Cardiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/clc.70310","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/clc.70310","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/clc.70310","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T19:06:12Z","timestamp":1786475172000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/clc.70310"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4]]},"references-count":33,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2026,4]]}},"alternative-id":["10.1002\/clc.70310"],"URL":"https:\/\/doi.org\/10.1002\/clc.70310","archive":["Portico"],"relation":{},"ISSN":["0160-9289","1932-8737"],"issn-type":[{"value":"0160-9289","type":"print"},{"value":"1932-8737","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4]]},"assertion":[{"value":"2024-05-01","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-04-10","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-04-20","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70310"}}