Abstract: Objective To evaluate the prognostic prediction value of serum cystatin C （Cys C） in acute heart failure （AHF）. Methods Three hundred and seventy-two patients with AHF were recruited from emergency center of Guangdong People’s Hospital between 12th April,2008 and 25th April,2011. At the time of admission,serum Cys C was examined and according to serum Cys C level, patients were divided into 4 groups: Q1（≤1.06 mg/L, n=94）, Q2（1.07-1.48 mg/L, n=94）, Q3（1.49-1.85 mg/L, n=92）, Q4（≥1.86 mg/L, n=92）. The prognostic value of serum Cys C in AHF was evaluated based on all cause of death and readmission due to cardiovascular events during the follow-up time. Results The median of follow-up visit was 389 days. The case fatality rate was 25.5% while the readmission rate due to cardiovascular events was 34.1%. Kaplan-Meier survival curve showed that with the increase of serum Cys C level, the survival time was obviously decreased and the readmission risk due to cardiovascular events was gradually increased. Adjusting for confounding factors by Cox regression correction, the death risk ratio of Q2, Q3 and Q4 was 1.88,2.42 and 3.71 compared with Q1（P ＜0.01 respectively） and the readmission risk ratio due to cardiovascular events was 1.57,2.50 and 3.06 respectively （P＜0.01）. Conclusion The increase of serum Cys C is the independent risk factor for AHF poor prognosis, which can be used as the risk stratification index for clinical adverse events in AHF patients.