Independent and incremental prognostic value of novel cardiac biomarkers in chronic hemodialysis patients
Autor: | Kazuaki Negishi, Kyoko Ito, Masahiko Kurabayashi, Hiroaki Sunaga, Masaru Obokata, Yoshitaka Ando, Hideki Ishida, Tetsuya Ogawa |
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Rok vydání: | 2016 |
Předmět: |
Male
medicine.medical_specialty medicine.drug_class Galectin 3 medicine.medical_treatment 030232 urology & nephrology Disease 030204 cardiovascular system & hematology 03 medical and health sciences 0302 clinical medicine Renal Dialysis Risk Factors Cause of Death Internal medicine Natriuretic Peptide Brain Natriuretic peptide Humans Medicine Prospective Studies Mortality Intensive care medicine Prospective cohort study Aged Cause of death Framingham Risk Score Ejection fraction business.industry Stroke Volume Stroke volume Middle Aged Prognosis Interleukin-1 Receptor-Like 1 Protein Peptide Fragments ROC Curve Cardiovascular Diseases Cardiology Kidney Failure Chronic Female Hemodialysis Cardiology and Cardiovascular Medicine business Indican Biomarkers |
Zdroj: | American Heart Journal. 179:29-41 |
ISSN: | 0002-8703 |
Popis: | Background End-stage renal disease is a major clinical and public health problem, and cardiovascular disease accounts for half of the mortality in hemodialysis patients. An existing mortality risk score (AROii score) or N-terminal pro–brain natriuretic peptide (NT-proBNP) level have modest predictive power, but there is room for improvement. There are emerging cardiac biomarkers (soluble isoforms of ST2 [sST2], galectin-3 [Gal-3]), and uremic toxicity (indoxyl sulfate). We sought to determine whether these biomarkers predict cardiovascular outcomes in hemodialysis patients and have incremental prognostic value over the clinical score and NT-proBNP level. Methods A total of 423 hemodialysis patients were prospectively followed up for primary (all-cause death) and secondary end points (a composite of all-cause death or cerebrocardiovascular events). Results During a mean follow-up of 2.1 ± 0.4 years, there were 48 all-cause deaths and 78 composite outcomes. Soluble isoforms of ST2, Gal-3, and NT-proBNP were associated with all-cause deaths but indoxyl sulfate was not in both log-rank test and receiver operating characteristic analysis. Both sST2 and Gal-3 had independent and incremental prognostic value for both outcomes over the AROii score and NT-proBNP. Although adding sST2 did not reclassify over the model-based AROii score and NT-proBNP for all-cause death, further addition of Gal-3 did. Subgroup analyses of patients with left ventricular ejection fraction measurement (n = 301) corroborated these results, where the 2 biomarkers remained independent and incremental for both all-cause death and composite outcome after adjusting for the risk score and the ejection fraction. Conclusions Both sST2 and Gal-3 had independent and incremental prognostic values over NT-proBNP and an established risk score in patients with hemodialysis. Assessment of sST2 and Gal-3 further enhances risk stratification. |
Databáze: | OpenAIRE |
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