The relationship between serum creatinine/cystatin C ratio and mortality in hypertensive patients

Trends in Obesity Prevalence Among Adults With Hypertension in the United States, 2001 to 2023

BACKGROUND

Obesity is a factor contributing to the occurrence of hypertension and a risk factor for adverse outcomes in populations with hypertension. The changes in the prevalence of obesity in populations with hypertension remain unclear. Investigating the changes in the prevalence of obesity in populations with hypertension can provide information for the treatment and management of hypertension.

METHODS

The clinical data from adults aged ≥20 years with hypertension were extracted from the National Health and Nutrition Examination Survey 2001 to 2023. The primary outcome was the prevalence of obesity (body mass index≥30 kg/m2). The trend in the prevalence of obesity among American adults with hypertension was evaluated via a trend test.

RESULTS

The age-standardized prevalence of obesity among populations with hypertension in America increased from 39.6% in 2001 to 55.4% in 2023 (P for trend<0.001). This trend was observed in men (35.4%-53.6%; P for trend<0.001) and women (45.6%-57.7%; P for trend<0.001) populations with hypertension. While the prevalence of grade II (35 kg/m2≤body mass index<40 kg/m2) and grade III obesity (body mass index≥40 kg/m2) increased significantly in both sexes, the prevalence of grade I obesity (30 kg/m2≤body mass index<35 kg/m2) increased significantly only in men (23.2%-30.0%; P for trend=0.003) and did not significantly change in women (22.2%-21.7%; P for trend=0.135).

CONCLUSIONS

The prevalence of obesity among American adults with hypertension increased from 2001 to 2023. In men, the prevalence of grades I, II, and III obesity increased. Among women, the prevalence of only grades II and III obesity increased.

The Relationship Between Muscle Metabolic Index (Cr/CysC) Levels and Short-Term Prognosis with Acute Ischemic Stroke: Findings from a Cohort Study

OBJECTIVE

Sarcopenia significantly impacts prognosis in patients with acute ischemic stroke (AIS). This study investigates the relationship between serum creatinine/serum cystatin C (Cr/CysC) levels and short-term prognosis in AIS patients, aiming to inform post-treatment strategies.

METHODS

We analyzed AIS patients at the First Affiliated Hospital of the University of Science and Technology of China from January 2022 to January 2024. Baseline data were collected through interviews and medical records, with a 3-month follow-up for prognosis assessment. 265 were included in the final analysis. Cr/CysC levels were categorized into quartiles (Q1-Q4). Logistic regression and restricted cubic spline analysis were employed to evaluate the association between Cr/CysC and prognosis.

RESULTS

Among the 265 patients, the average age was 66.18 ± 12.41 years, and 129 (48.68%) had poor short-term prognosis. Multivariate logistic regression showed that patients in the lowest quartile of Cr/CysC (Q1) had a significantly lower risk of poor prognosis compared to those in the highest quartile (Q4) (odds ratio = 0.287, 95% confidence interval: 0.090-0.917, P = 0.035). A linear relationship was identified between Cr/CysC and prognosis (P overall<0.001, P nonlinear = 0.571).

CONCLUSIONS

This study establishes a significant linear correlation between Cr/CysC levels and poor short-term prognosis in AIS patients. Encouraging muscle function exercises may enhance patient outcomes.

Serum creatinine and serum cystatin C as an index of muscle mass in adults

PURPOSE OF REVIEW

Serum creatinine reflects both muscle mass and kidney function. Serum cystatin C has recently been recommended as an additional marker for estimating kidney function, and use of both markers together may provide an index of muscle mass. This review aims to describe the biological basis for and recent research examining the relationship of these markers to muscle mass in a range of adult populations and settings.

RECENT FINDINGS

This review identified 67 studies, 50 of which had direct measures of muscle mass, and almost all found relationships between serum creatinine and cystatin C and muscle mass and related outcomes. Most studies have been performed in older adults, but similar associations were found in general populations as well as in subgroups with cancer, chronic kidney disease (CKD), and other morbid conditions. Creatinine to cystatin C ratio was the measure examined the most often, but other measures showed similar associations across studies.

SUMMARY

Measures of serum creatinine and cystatin C together can be an index of muscle mass. They are simple and reliable measures that can be used in clinical practice and research. Further study is needed to determine actionable threshold values for each measure and clinical utility of testing and intervention.

Association of serum creatinine to cystatin C to waist circumference ratios and hypertension: evidence from China health and retirement longitudinal study

Background

The objective of this study was to explore the association between the ratio of serum creatinine to cystatin C to waist circumference (CCR/WC) and hypertension.

Methods

The study utilized data extracted from the China Health and Retirement Longitudinal Study. In the cross-sectional analysis, logistic regression analyses were employed to examine the association between the CCR/WC ratio and hypertension. By utilizing restricted cubic splines, potential non-linear associations between the CCR/WC ratio and hypertension were explored. In the longitudinal analysis, the association between CCR/WC quartiles (Q1-Q4) and the risk of new-onset hypertension was evaluated by Cox proportional-hazards models.

Results

In total, 7,253 participants were enrolled. The study unveiled an inverse association with hypertension, demonstrating an odds ratio (OR) of 0.29 (95% confidence interval [CI]: 0.23-0.37, P < 0.001). Among males, an OR of 0.38 (95% CI: 0.25-0.58, P < 0.001) was observed, while among females, an OR of 0.41 (95% CI: 0.28-0.60, P < 0.001) was noted. There was an absence of a nonlinear association between the CCR/WC ratio and hypertension. Cox regression analysis unveiled a reduced risk of hypertension in Q3 (Hazard ratios [HR]: 0.69, 95% CI: 0.58-0.82, P < 0.001) and Q4: (HR: 0.70, 95% CI: 0.59-0.83, P < 0.001) in compared to the Q1 of the CCR/WC ratio, and sex-specific analysis yielded consistent results.

Conclusion

This study emphasizes the potential association between an elevated CCR/WC ratio and a reduced risk of hypertension.

Creatinine-to-cystatin C ratio and body composition predict response to PD-1 inhibitors-based combination treatment in metastatic gastric cancer

Background

Creatinine-to-cystatin C ratio (CCR) and body composition (BC) parameters have emerged as significant prognostic factors in cancer patients. However, the potential effects of CCR in gastric cancer (GC) remains to be elucidated. This multi-center retrospective study explored the predictive and prognostic value of CCR and BC-parameters in patients with metastatic GC receiving PD-1 inhibitors-based combination therapy.

Methods

One hundred and thirteen GC patients undergoing PD-1 inhibitors-based combination therapy were enrolled at three academic medical centers from January 2021 to July 2023. A deep-learning platform based on U-Net was developed to automatically segment skeletal muscle index (SMI), subcutaneous adipose tissue index (SATI) and visceral adipose tissue index (VATI). Patients were divided into two groups based on the median of CCR or the upper tertile of BC-parameters. Logistic and Cox regression analysis were used to determine the effect of CCR and BC-parameters in predicting response rates and survival rates.

Results

The CCR was positively correlated with SMI (r=0.43; P<0.001), but not with SATI or VATI (P>0.05). Multivariable logistic analysis identified that both low CCR (OR=0.423, P=0.066 for ORR; OR=0.026, P=0.005 for DCR) and low SATI (OR=0.270, P=0.020 for ORR; OR=0.149, P=0.056 for DCR) were independently associated with worse objective response rate (ORR) and disease control rate (DCR). Patients with low CCR or low SATI had significantly lower 8-month progression-free survival (PFS) rate and 16-month overall survival (OS) rate than those with high CCR (PFS rate, 37.6% vs. 55.1%, P=0.011; OS rate, 19.4% vs. 44.9%, P=0.002) or those with high SATI (PFS rate, 37.2% vs. 53.8%, P=0.035; OS rate, 8.0% vs. 36.0%, P<0.001). Multivariate Cox analysis showed that low CCR (HR=2.395, 95% CI: 1.234-4.648, P=0.010 for PFS rate; HR=2.528, 95% CI: 1.317-4.854, P=0.005 for OS rate) and low SATI (HR=2.188, 95% CI: 1.050-4.560, P=0.037 for PFS rate; HR=2.818, 95% CI: 1.381-5.752, P=0.004 for OS rate) were both independent prognostic factors of poor 8-month PFS rate and 16-month OS rate. A nomogram based on CCR and BC-parameters showed a good performance in predicting the 12- and 16-month OS, with a concordance index of 0.756 (95% CI, 0.722-0.789).

Conclusions

Low pre-treatment CCR and SATI were independently associated with lower response rates and worse survival in patients with metastatic GC receiving PD-1 inhibitors-based combination therapy.