The results of our study are in line with previously published elevated risk of (future) cardiovascular events and mortality in patients with high plasma values of Cystatin C12, 21, 22, 23 and high vesicle levels of Cystatin C.8In the current study, we found no difference between EV and plasma levels of Cystatin C, suggesting that the protein itself and not specific EV Cystatin C is important in the combined organ failure of the CRS. Here, CST4 is linked to congenital rubella syndrome.