Work

Serum creatinine- and cystatin C-derived sarcopenia-related indices and the risk of all-cause mortality in patients undergoing transcatheter aortic valve implantation

Year: 2026

Type: article

Abstract: Background Sarcopenia is increasingly recognized as an important predictor of adverse outcomes after transcatheter aortic valve implantation (TAVI). However, the prognostic relevance of sarcopenia-related indices derived from serum creatinine and cystatin C in patients undergoing TAVI has not been fully established. Methods This prospective study included 465 patients who underwent TAVI for symptomatic aortic stenosis. Associations between sarcopenia-related indices and all-cause mortality were assessed using Kaplan–Meier survival analysis, Cox proportional hazards models, and restricted cubic spline analysis (RCS). Predictive performance and incremental prognostic value were compared across indices using time-dependent receiver operating characteristic curves (ROC), the Harrell’s C-index, net reclassification improvement (NRI), and integrated discrimination improvement (IDI). Subgroup and sensitivity analyses were performed to examine the robustness of the findings. Results During a median follow-up of 2.8 years, 59 (12.7%) deaths occurred. In the fully adjusted Cox model, each 1-standard deviation increase in eGFRcys/eGFRcr (HR 0.29, 95% CI 0.11–0.75; p = 0.011) and Cr * eGFRcys (HR 0.30, 95% CI 0.14–0.64; p = 0.002) was associated with a lower risk of all-cause mortality. Time-dependent ROC indicated that Cr * eGFRcys had the most favorable predictive performance among the evaluated indices. Adding Cr * eGFRcys to the fully adjusted model increased the concordance index from 0.696 to 0.736 and significantly improved risk reclassification and discrimination (NRI: 0.437, 95% CI 0.171–0.704, p = 0.001; IDI: 0.026, 95% CI 0.004–0.048, p = 0.022). Findings from subgroup and sensitivity analyses were broadly consistent. Conclusion Among patients with symptomatic aortic stenosis undergoing TAVI, lower eGFRcys/eGFRcr and Cr * eGFRcys were associated with a higher risk of all-cause mortality after the procedure. Notably, Cr * eGFRcys showed stronger prognostic value and may provide additional prognostic information for risk stratification in patients undergoing TAVI.

Source: Frontiers in Nutrition

DOI: 10.3389/fnut.2026.1937732