{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,7]],"date-time":"2025-11-07T08:04:49Z","timestamp":1762502689684,"version":"build-2065373602"},"reference-count":37,"publisher":"PeerJ","license":[{"start":{"date-parts":[[2025,11,7]],"date-time":"2025-11-07T00:00:00Z","timestamp":1762473600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Sichuan Science and Technology Program, China","award":["2022YFS0186"],"award-info":[{"award-number":["2022YFS0186"]}]},{"DOI":"10.13039\/501100001809","name":"the National Natural Science Foundation of China","doi-asserted-by":"crossref","award":["81600299"],"award-info":[{"award-number":["81600299"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"crossref"}]},{"name":"The Sichuan Science and Technology Program","award":["2023NSFSC1632"],"award-info":[{"award-number":["2023NSFSC1632"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Numerous studies across various populations have revealed that elevated cystatin-C levels are associated with an excessive risk of mortality. However, the prognostic value of cystatin-C remains unidentified in hypertrophic cardiomyopathy (HCM) patients. The objective of this study was to investigate whether serum cystatin-C could predict all-cause mortality independently in HCM patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Data from 456 HCM patients treated at West China Hospital were collected and stratified into two groups based on the median baseline serum cystatin-C level. All-cause mortality was the primary outcome. Cox regression models were used to analyze the association between cystatin-C levels and mortality risk.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 90 deaths were recorded over a median follow-up period of 4.67 years. Patients with higher cystatin-C levels had an increased risk of all-cause mortality (adjusted hazard ratio (HR): 2.11, 95% CI [1.30\u20133.42],\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.003) compared to those with lower levels. Time-dependent area under the curves (AUC) of cystatin-C in different time points, ranging from initial measurement to follow-up, showed a relatively stable fluctuation between 0.70 and 0.80. In comparison, the commonly used renal function markers, estimated glomerular filtration rate (eGFR) and serum creatinine, yielded lower AUC values. Restricted cubic spline curves showed that with median value of cystatin-C (1.01 mg\/L) as reference, there was a gradual rise in risk of all-cause mortality with cystatin-C increasing. Subgroup analyses in female, in the patients \u2265 58 years old, and in the patients with eGFR \u2265 60 mL\/min\/1.73 m\n                      <jats:sup>2<\/jats:sup>\n                      consistently confirmed robustness of the main findings.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Elevated serum cystatin-C levels are associated with a higher risk of all-cause mortality in HCM patients, providing valuable prognostic information beyond traditional renal function markers such as eGFR and serum creatinine.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.7717\/peerj.19631","type":"journal-article","created":{"date-parts":[[2025,11,7]],"date-time":"2025-11-07T08:00:22Z","timestamp":1762502422000},"page":"e19631","source":"Crossref","is-referenced-by-count":0,"title":["Serum cystatin-C and all-cause mortality in patients with hypertrophic cardiomyopathy: a retrospective cohort study"],"prefix":"10.7717","volume":"13","author":[{"given":"Lu","family":"Liu","sequence":"first","affiliation":[{"name":"Department of Cardiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yi","family":"Zheng","sequence":"additional","affiliation":[{"name":"Department of Cardiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Haiyan","family":"Ruan","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Hospital of Traditional Chinese Medicine, Shuangliu District, Chengdu,  Sichuan, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ziqiong","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Cardiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiaoping","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Cardiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sen","family":"He","sequence":"additional","affiliation":[{"name":"Department of Cardiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China"},{"name":"Karamay Hospital of Integrated Chinese and Western Medicine, Karamay, Xinjiang Uygur Autonomous Region, China"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"4443","published-online":{"date-parts":[[2025,11,7]]},"reference":[{"key":"10.7717\/peerj.19631\/ref-1","doi-asserted-by":"publisher","first-page":"1377","DOI":"10.1001\/jama.2017.12126","article-title":"Discrimination and calibration of clinical prediction models: users\u2019 guides to the medical literature","volume":"318","author":"Alba","year":"2017","journal-title":"Jama"},{"key":"10.7717\/peerj.19631\/ref-2","doi-asserted-by":"publisher","first-page":"1007","DOI":"10.1016\/j.clinbiochem.2017.07.016","article-title":"Diagnostic and prognostic value of cystatin C in acute heart failure","volume":"50","author":"Breidthardt","year":"2017","journal-title":"Clinical Biochemistry"},{"key":"10.7717\/peerj.19631\/ref-3","doi-asserted-by":"publisher","first-page":"1140093","DOI":"10.3389\/fendo.2023.1140093","article-title":"Serum creatinine levels, traditional cardiovascular risk factors and 10-year cardiovascular risk in Chinese patients with hypertension","volume":"14","author":"Chen","year":"2023","journal-title":"Frontiers in Endocrinology"},{"key":"10.7717\/peerj.19631\/ref-4","doi-asserted-by":"publisher","first-page":"221","DOI":"10.1053\/ajkd.2002.34487","article-title":"Serum cystatin C is superior to serum creatinine as a marker of kidney function: a meta-analysis","volume":"40","author":"Dharnidharka","year":"2002","journal-title":"American Journal of Kidney Diseases"},{"key":"10.7717\/peerj.19631\/ref-5","doi-asserted-by":"publisher","first-page":"2733","DOI":"10.1093\/eurheartj\/ehu284","article-title":"2014 ESC guidelines on diagnosis and management of hypertrophic cardiomyopathy: the task force for the diagnosis and management of hypertrophic cardiomyopathy of the european society of cardiology (ESC)","volume":"35","author":"Elliott","year":"2014","journal-title":"European Heart Journal"},{"key":"10.7717\/peerj.19631\/ref-6","doi-asserted-by":"publisher","first-page":"1800","DOI":"10.1016\/j.cjca.2019.05.035","article-title":"External validation of the model of thromboembolic risk in hypertrophic cardiomyopathy patients","volume":"35","author":"He","year":"2019","journal-title":"Canadian Journal of Cardiology"},{"key":"10.7717\/peerj.19631\/ref-7","doi-asserted-by":"publisher","first-page":"131","DOI":"10.1016\/j.amjcard.2020.12.063","article-title":"Effect of renal dysfunction on risk of sudden cardiac death in patients with hypertrophic cardiomyopathy","volume":"144","author":"Higuchi","year":"2020","journal-title":"The American Journal of Cardiology"},{"key":"10.7717\/peerj.19631\/ref-8","doi-asserted-by":"publisher","first-page":"1567","DOI":"10.1046\/j.1523-1755.2002.00299.x","article-title":"Methodological issues in studying the epidemiology of mild to moderate chronic renal insufficiency","volume":"61","author":"Hsu","year":"2002","journal-title":"Kidney International"},{"key":"10.7717\/peerj.19631\/ref-9","doi-asserted-by":"publisher","first-page":"92","DOI":"10.1016\/j.cca.2020.11.022","article-title":"Renal function as a predictor of outcomes in patients with hypertrophic cardiomyopathy: a cohort study of a hospitalized population","volume":"512","author":"Huang","year":"2021","journal-title":"Clinica Chimica Acta"},{"key":"10.7717\/peerj.19631\/ref-10","doi-asserted-by":"publisher","first-page":"257","DOI":"10.1136\/hrt.2004.040337","article-title":"New insights into the pathology of inherited cardiomyopathy","volume":"91","author":"Hughes","year":"2005","journal-title":"Heart"},{"key":"10.7717\/peerj.19631\/ref-11","doi-asserted-by":"publisher","first-page":"173","DOI":"10.1161\/circulationaha.106.644286","article-title":"Association of cystatin C with mortality, cardiovascular events, and incident heart failure among persons with coronary heart disease: data from the heart and soul study","volume":"115","author":"Ix","year":"2007","journal-title":"Circulation"},{"key":"10.7717\/peerj.19631\/ref-12","doi-asserted-by":"publisher","first-page":"53","DOI":"10.1186\/s12874-017-0332-6","article-title":"Time-dependent ROC curve analysis in medical research: current methods and applications","volume":"17","author":"Kamarudin","year":"2017","journal-title":"BMC Medical Research Methodology"},{"key":"10.7717\/peerj.19631\/ref-13","doi-asserted-by":"publisher","first-page":"501","DOI":"10.7326\/0003-4819-148-7-200804010-00006","article-title":"Differences in kidney function and incident hypertension: the multi-ethnic study of atherosclerosis","volume":"148","author":"Kestenbaum","year":"2008","journal-title":"Annals of Internal Medicine"},{"key":"10.7717\/peerj.19631\/ref-14","doi-asserted-by":"publisher","first-page":"558","DOI":"10.4097\/kja.19087","article-title":"Multicollinearity and misleading statistical results","volume":"72","author":"Kim","year":"2019","journal-title":"Korean Journal of Anesthesiology"},{"key":"10.7717\/peerj.19631\/ref-15","doi-asserted-by":"publisher","first-page":"233","DOI":"10.1093\/ehjci\/jev014","article-title":"Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging","volume":"16","author":"Lang","year":"2015","journal-title":"European Heart Journal\u2014Cardiovascular Imaging"},{"key":"10.7717\/peerj.19631\/ref-16","doi-asserted-by":"publisher","first-page":"14565","DOI":"10.1038\/s41598-019-50993-5","article-title":"Risk of end-stage renal disease in patients with hypertrophic cardiomyopathy: a nationwide population-based cohort study","volume":"9","author":"Lee","year":"2019","journal-title":"Scientific Reports"},{"key":"10.7717\/peerj.19631\/ref-17","doi-asserted-by":"publisher","first-page":"1753","DOI":"10.1038\/s41591-019-0627-8","article-title":"Glomerular filtration rate by differing measures, albuminuria and prediction of cardiovascular disease, mortality and end-stage kidney disease","volume":"25","author":"Lees","year":"2019","journal-title":"Nature Medicine"},{"key":"10.7717\/peerj.19631\/ref-18","doi-asserted-by":"publisher","first-page":"247","DOI":"10.7326\/0003-4819-145-4-200608150-00004","article-title":"Using standardized serum creatinine values in the modification of diet in renal disease study equation for estimating glomerular filtration rate","volume":"145","author":"Levey","year":"2006","journal-title":"Annals of Internal Medicine"},{"key":"10.7717\/peerj.19631\/ref-19","doi-asserted-by":"publisher","first-page":"604","DOI":"10.7326\/0003-4819-150-9-200905050-00006","article-title":"A new equation to estimate glomerular filtration rate","volume":"150","author":"Levey","year":"2009","journal-title":"Annals of Internal Medicine"},{"key":"10.7717\/peerj.19631\/ref-20","doi-asserted-by":"publisher","first-page":"17026","DOI":"10.1038\/s41598-020-72712-1","article-title":"Myocardial contraction fraction predicts mortality for patients with hypertrophic cardiomyopathy","volume":"10","author":"Liao","year":"2020","journal-title":"Scientific Reports"},{"key":"10.7717\/peerj.19631\/ref-21","doi-asserted-by":"publisher","first-page":"1356","DOI":"10.3389\/fonc.2020.01356","article-title":"The positive lymph node ratio predicts survival in T(1-4)N(1-3)M(0) non-small cell lung cancer: a nomogram using the SEER database","volume":"10","author":"Liao","year":"2020","journal-title":"Frontiers in Oncology"},{"key":"10.7717\/peerj.19631\/ref-22","doi-asserted-by":"publisher","first-page":"727","DOI":"10.7150\/ijms.50167","article-title":"Thromboembolism in patients with hypertrophic cardiomyopathy","volume":"18","author":"Liu","year":"2021","journal-title":"International Journal of Medical Sciences"},{"key":"10.7717\/peerj.19631\/ref-23","doi-asserted-by":"publisher","first-page":"73","DOI":"10.1001\/jamacardio.2019.4534","article-title":"Mortality among referral patients with hypertrophic cardiomyopathy vs the general european population","volume":"5","author":"Lorenzini","year":"2020","journal-title":"JAMA Cardiology"},{"key":"10.7717\/peerj.19631\/ref-24","doi-asserted-by":"publisher","first-page":"2549","DOI":"10.1016\/s0140-6736(17)32478-9","article-title":"Prevalence, awareness, treatment, and control of hypertension in China: data from 1.7 million adults in a population-based screening study (China PEACE Million Persons Project)","volume":"390","author":"Lu","year":"2017","journal-title":"Lancet"},{"key":"10.7717\/peerj.19631\/ref-25","doi-asserted-by":"publisher","first-page":"375","DOI":"10.1016\/j.atherosclerosis.2005.06.017","article-title":"Plasma cystatin-C and development of coronary heart disease: the PRIME study","volume":"185","author":"Luc","year":"2006","journal-title":"Atherosclerosis"},{"key":"10.7717\/peerj.19631\/ref-26","doi-asserted-by":"publisher","first-page":"1753","DOI":"10.1016\/j.amjcard.2009.02.029","article-title":"Complementary prognostic value of cystatin C, N-terminal pro-B-type natriuretic Peptide and cardiac troponin T in patients with acute heart failure","volume":"103","author":"Manzano-Fern\u00e1ndez","year":"2009","journal-title":"The American Journal of Cardiology"},{"key":"10.7717\/peerj.19631\/ref-27","doi-asserted-by":"publisher","first-page":"785","DOI":"10.1161\/01.cir.92.4.785","article-title":"Prevalence of hypertrophic cardiomyopathy in a general population of young adults. Echocardiographic analysis of 4111 subjects in the CARDIA study. Coronary artery risk development in (Young) adults","volume":"92","author":"Maron","year":"1995","journal-title":"Circulation"},{"key":"10.7717\/peerj.19631\/ref-28","doi-asserted-by":"publisher","first-page":"1915","DOI":"10.1016\/j.jacc.2015.02.061","article-title":"Hypertrophic cardiomyopathy in adulthood associated with low cardiovascular mortality with contemporary management strategies","volume":"65","author":"Maron","year":"2015","journal-title":"Journal of the American College of Cardiology"},{"key":"10.7717\/peerj.19631\/ref-29","doi-asserted-by":"publisher","first-page":"2073","DOI":"10.1016\/s0140-6736(10)60674-5","article-title":"Association of estimated glomerular filtration rate and albuminuria with all-cause and cardiovascular mortality in general population cohorts: a collaborative meta-analysis","volume":"375","author":"Matsushita","year":"2010","journal-title":"Lancet"},{"key":"10.7717\/peerj.19631\/ref-30","doi-asserted-by":"publisher","first-page":"e029379","DOI":"10.1136\/bmjopen-2019-029379","article-title":"Relative value of cystatin C and creatinine-based estimates of glomerular filtration rate in predicting long-term mortality after cardiac surgery: a cohort study","volume":"9","author":"Mooney","year":"2019","journal-title":"BMJ Open"},{"key":"10.7717\/peerj.19631\/ref-31","doi-asserted-by":"publisher","first-page":"467","DOI":"10.1080\/10408360490504934","article-title":"Biochemistry and clinical role of human cystatin C","volume":"41","author":"Mussap","year":"2004","journal-title":"Critical Reviews in Clinical Laboratory Sciences"},{"key":"10.7717\/peerj.19631\/ref-32","doi-asserted-by":"publisher","first-page":"3287","DOI":"10.1161\/STROKEAHA.107.489625","article-title":"Cystatin C, associated with hemorrhagic and ischemic stroke, is a strong predictor of the risk of cardiovascular events and death in Chinese","volume":"38","author":"Ni","year":"2007","journal-title":"Stroke"},{"key":"10.7717\/peerj.19631\/ref-33","doi-asserted-by":"publisher","first-page":"300","DOI":"10.1186\/s12916-020-01776-7","article-title":"Contribution of cystatin C- and creatinine-based definitions of chronic kidney disease to cardiovascular risk assessment in 20 population-based and 3 disease cohorts: the BiomarCaRE project","volume":"18","author":"Rothenbacher","year":"2020","journal-title":"BMC Medicine"},{"key":"10.7717\/peerj.19631\/ref-34","doi-asserted-by":"publisher","first-page":"497","DOI":"10.7326\/0003-4819-142-7-200504050-00008","article-title":"Cystatin C concentration as a risk factor for heart failure in older adults","volume":"142","author":"Sarnak","year":"2005","journal-title":"Annals of Internal Medicine"},{"key":"10.7717\/peerj.19631\/ref-35","doi-asserted-by":"publisher","first-page":"2049","DOI":"10.1056\/NEJMoa043161","article-title":"Cystatin C and the risk of death and cardiovascular events among elderly persons","volume":"352","author":"Shlipak","year":"2005","journal-title":"The New England Journal of Medicine"},{"key":"10.7717\/peerj.19631\/ref-36","doi-asserted-by":"publisher","first-page":"663","DOI":"10.1093\/ndt\/gfx004","article-title":"Measured glomerular filtration rate does not improve prediction of mortality by cystatin C and creatinine","volume":"32","author":"Sundin","year":"2017","journal-title":"Nephrology Dialysis Transplantation"},{"key":"10.7717\/peerj.19631\/ref-37","doi-asserted-by":"publisher","first-page":"121","DOI":"10.21037\/atm.2018.02.12","article-title":"Time-varying covariates and coefficients in Cox regression models","volume":"6","author":"Zhang","year":"2018","journal-title":"Annals of Translational Medicine"}],"container-title":["PeerJ"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/peerj.com\/articles\/19631.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/peerj.com\/articles\/19631.xml","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/peerj.com\/articles\/19631.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/peerj.com\/articles\/19631.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,7]],"date-time":"2025-11-07T08:00:25Z","timestamp":1762502425000},"score":1,"resource":{"primary":{"URL":"https:\/\/peerj.com\/articles\/19631"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,7]]},"references-count":37,"alternative-id":["10.7717\/peerj.19631"],"URL":"https:\/\/doi.org\/10.7717\/peerj.19631","archive":["CLOCKSS","LOCKSS","Portico"],"relation":{},"ISSN":["2167-8359"],"issn-type":[{"value":"2167-8359","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,7]]},"article-number":"e19631"}}