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A combined index of cardiac biomarkers as a risk factor for early cardiovascular mortality in hemodialysis patients

  • Anne-Sophie Bargnoux , Marion Morena , Isabelle Jaussent , Francois Maurice , Lotfi Chalabi , Hélène Leray-Moragues , Nathalie Terrier , Anne-Marie Dupuy , Stéphanie Badiou , Bernard Canaud und Jean-Paul Cristol EMAIL logo
Veröffentlicht/Copyright: 12. Februar 2013
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Clinical Chemistry and Laboratory Medicine
Aus der Zeitschrift Clinical Chemistry and Laboratory Medicine Band 51 Heft 9

Abstract

Background: Cardiac biomarkers, including cardiac troponin-I (cTn-I) and N-terminal pro brain natriuretic peptide (NT-proBNP) have been associated with poor outcome in hemodialysis (HD) patients. The present study was designed to evaluate these biomarkers as biological risk factors for early and late mortality in HD patients. In addition, a multimarker approach including inflammatory index was performed in order to improve the cardiovascular risk assessment of these patients.

Methods: cTnI, NT-proBNP and C-reactive protein (CRP) were measured at baseline (October through November 2002) in 130 HD patients [median age 69.0 (23.4–87.7) years old, 76 females, 54 males]. Patients were followed during 8 years. Adjusted hazard ratios (HRs) of death and 95% confidence intervals (CIs) were estimated using Cox proportional hazard models.

Results: During the follow-up, 82 patients died, mainly from cardiac cause (63.4%). Elevated cTnI, NT-proBNP or CRP were all associated with increased early (death within 2 years of follow-up) but not late mortality. Moreover, the combination of all parameters (CRP ≥10.51 mg/L and cTnI ≥0.037 µg/L and NT-proBNP ≥10,204 pg/mL) dramatically increased the short-term mortality especially the cardiovascular mortality (HR 8.58, 95% CI 1.59–46.2; p=0.0007).

Conclusions: A combined index of cardiovascular risk factors could provide supplementary risk stratification in HD patients for early cardiovascular mortality, strongly supporting the annual routine determination of these biomarkers.

Keywords: cardiac troponin-I (cTnI); cardiovascular disease; C-reactive protein (CRP); hemodialysis; mortality; N-terminal pro brain natriuretic peptide (NT-proBNP)
Corresponding author: Jean-Paul Cristol, Department of Biochemistry, Lapeyronie University Hospital, 191 Avenue du Doyen Gaston Giraud, 34295 Montpellier cedex 5, France, Phone: +33 467 338314, Fax: +33 467 338393

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Received: 2012-10-2
Accepted: 2013-1-14
Published Online: 2013-02-12
Published in Print: 2013-09-01

©2013 by Walter de Gruyter Berlin Boston

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https://doi.org/10.1515/cclm-2012-0664
Schlagwörter für diesen Artikel
cardiac troponin-I (cTnI); cardiovascular disease; C-reactive protein (CRP); hemodialysis; mortality; N-terminal pro brain natriuretic peptide (NT-proBNP)

Artikel in diesem Heft

  1. Masthead
  2. Masthead
  3. Editorials
  4. What is a biomarker? It’s time for a renewed definition
  5. Biomarker research and leading causes of death worldwide: a rather feeble relationship
  6. Thiosulfate in urine: new hope or new failure of a biomarker for prostate cancer?
  7. Review
  8. Acute coronary syndrome – the present and future role of biomarkers1)
  9. Mini Review
  10. Advance in molecular diagnostic tools for hepatitis B virus detection
  11. Opinion Paper
  12. Standardization and analytical goals for glycated hemoglobin measurement
  13. Guidelines and Recommendations
  14. Proposal for the use in emergency departments of cardiac troponins measured with the latest generation methods in patients with suspected acute coronary syndrome without persistent ST-segment elevation
  15. General Clinical Chemistry and Laboratory Medicine
  16. Current status of verification practices in clinical biochemistry in Spain
  17. Two site evaluation of the performance of a new generation point-of-care glucose meter for use in a neonatal intensive care unit
  18. Trp64Arg (rs4994) polymorphism of β3-adrenergic receptor gene is associated with hyperuricemia in a Chinese male population
  19. Quantification of vancomycin in human serum by LC-MS/MS
  20. Automated indirect immunofluorescence antinuclear antibody analysis is a standardized alternative for visual microscope interpretation
  21. Autocorrelation and cross-correlation between hCGβ and PAPP-A in repeated sampling during first trimester of pregnancy
  22. Platelet oxidative stress and systemic inflammation in chronic spontaneous urticaria
  23. Reference Values
  24. Establishment of reference values for novel urinary biomarkers for renal damage in the healthy population: are age and gender an issue?
  25. Risks of mortality associated with common laboratory tests: a novel, simple and meaningful way to set decision limits from data available in the Electronic Medical Record
  26. Cancer Diagnostics
  27. Cancer antigen 125, human epididymis 4, kallikrein 6, osteopontin and soluble mesothelin-related peptide immunocomplexed with immunoglobulin M in epithelial ovarian cancer diagnosis
  28. Thiosulfate in urine as a facilitator in the diagnosis of prostate cancer for patients with prostate-specific antigen less or equal 10 ng/mL
  29. Anemia and iron biomarkers in patients with early breast cancer. Diagnostic value of hepcidin and soluble transferrin receptor quantification1)
  30. Sensitive detection of EML4-ALK fusion oncoprotein of lung cancer by in situ proximity ligation assay
  31. Re-evaluation of laboratory predictors of response to current anemia treatment regimens of erythropoiesis stimulating agents in cancer patients
  32. Cardiovascular Diseases
  33. Evaluation of four sensitive troponin assays for risk assessment in acute coronary syndromes using a new clinically oriented approach for comparison of assays
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  43. Falsely elevated cobalamin concentration in multiple assays in a patient with pernicious anemia: a case study
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  45. Research forever – Klaus Jung
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