{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T21:41:13Z","timestamp":1790804473903,"version":"4.1.0"},"reference-count":43,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2022,6,21]],"date-time":"2022-06-21T00:00:00Z","timestamp":1655769600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Biomolecules"],"abstract":"<jats:p>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 (n = 121) and without PAD (n = 77). The cohort was followed for 2 years. uCystatinC was normalized to urinary creatinine (uCr) (uCystatinC\/uCr; \u03bcg\/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 \u2265 0.15). Multivariable Cox regression and Kaplan\u2013Meier 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 \u03bcg\/g [14.2\u201332.9] vs. 20.9 \u03bcg\/g [11.1\u201327.8], p = 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\u20132.83, p = 0.015), which persisted after controlling for baseline demographic and clinical characteristics (adjusted HR 1.79 [95% CI 1.11\u20132.87], p = 0.017). Patients with high uCystatinC\/uCr had a lower 2-year freedom from MALE (77% vs. 89%, p = 0.025) and worsening PAD status (63% vs. 87%, p = 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.<\/jats:p>","DOI":"10.3390\/biom12070860","type":"journal-article","created":{"date-parts":[[2022,6,21]],"date-time":"2022-06-21T04:39:55Z","timestamp":1655786395000},"page":"860","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":18,"title":["Urinary Cystatin C Has Prognostic Value in Peripheral Artery Disease"],"prefix":"10.3390","volume":"12","author":[{"given":"Ben","family":"Li","sequence":"first","affiliation":[{"name":"Division of Vascular Surgery, St. Michael\u2019s Hospital, Unity Health Toronto, University of Toronto, Toronto, ON M5B 1W8, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3291-5902","authenticated-orcid":false,"given":"Abdelrahman","family":"Zamzam","sequence":"additional","affiliation":[{"name":"Division of Vascular Surgery, St. Michael\u2019s Hospital, Unity Health Toronto, University of Toronto, Toronto, ON M5B 1W8, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4697-5260","authenticated-orcid":false,"given":"Muzammil H.","family":"Syed","sequence":"additional","affiliation":[{"name":"Division of Vascular Surgery, St. Michael\u2019s Hospital, Unity Health Toronto, University of Toronto, Toronto, ON M5B 1W8, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Niousha","family":"Jahanpour","sequence":"additional","affiliation":[{"name":"Division of Vascular Surgery, St. Michael\u2019s Hospital, Unity Health Toronto, University of Toronto, Toronto, ON M5B 1W8, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shubha","family":"Jain","sequence":"additional","affiliation":[{"name":"Division of Vascular Surgery, St. Michael\u2019s Hospital, Unity Health Toronto, University of Toronto, Toronto, ON M5B 1W8, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rawand","family":"Abdin","sequence":"additional","affiliation":[{"name":"Department of Medicine, McMaster University, Hamilton, ON L8S 4K1, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammad","family":"Qadura","sequence":"additional","affiliation":[{"name":"Division of Vascular Surgery, St. Michael\u2019s Hospital, Unity Health Toronto, University of Toronto, Toronto, ON M5B 1W8, Canada"},{"name":"Department of Surgery, University of Toronto, Toronto, ON M5S 1A1, Canada"},{"name":"Keenan Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute, St. Michael\u2019s Hospital, Unity Health Toronto, University of Toronto, Toronto, ON M5B 1W8, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,6,21]]},"reference":[{"key":"ref_1","unstructured":"Zemaitis, M.R., Boll, J.M., and Dreyer, M.A. (2021, June 14). 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