High-Sensitivity Troponin as a Predictor of Cardiac Events and Mortality in the Stable Dialysis Population
| Autor: | Kenneth Howlin, S. T. Spicer, Andrew Jefferys, Jeffrey Wong, Bruce Cleland, Angela Makris, Hicham I. Cheikh Hassan, Govindarajan Suryanarayanan, Ananthakrishnapuram Aravindan, Bruce M. Hall, Michael Suranyi |
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| Rok vydání: | 2014 |
| Předmět: |
Male
medicine.medical_specialty medicine.medical_treatment Clinical Biochemistry Population Myocardial Infarction Kaplan-Meier Estimate Sensitivity and Specificity Peritoneal dialysis Troponin T Predictive Value of Tests Renal Dialysis Interquartile range Internal medicine medicine Humans Prospective Studies Myocardial infarction education Dialysis Aged Proportional Hazards Models education.field_of_study business.industry Biochemistry (medical) Hazard ratio Middle Aged medicine.disease Surgery Logistic Models Data Interpretation Statistical Cardiology Female Hemodialysis business Peritoneal Dialysis Biomarkers |
| Zdroj: | Clinical Chemistry. 60:389-398 |
| ISSN: | 1530-8561 0009-9147 |
| DOI: | 10.1373/clinchem.2013.207142 |
| Popis: | BACKGROUND High-sensitivity cardiac troponin T (hs-cTnT) is a biomarker used in diagnosing myocardial injury. The clinical utility and the variation of this biomarker over time remain unclear in hemodialysis (HD) and peritoneal dialysis (PD) patients. We sought to determine whether hs-cTnT concentrations were predictive of myocardial infarction (MI) and death and to examine hs-cTnT variability over a 1-year period. METHODS A total of 393 nonacute HD and PD patients (70% HD and 30% PD) were followed in a prospective observational study for new MI and death. RESULTS Median hs-cTnT was 57 ng/L (interquartile range, 36–101 ng/L) with no observed difference between HD and PD patients (P = 0.11). Incremental increases in mortality (P = 0.024) and MI (P = 0.001) were observed with increasing hs-cTnT quartiles. MI incidence increased significantly across quartiles in both HD and PD patients (P = 0.012 and P = 0.025, respectively), whereas mortality increased only in HD patients (P = 0.015). For every increase of 25 ng/L in hs-cTnT, the unadjusted hazard ratio (HR) was 1.10 for mortality in the whole group (95% CI, 1.04–1.16, P = 0.001) and 1.16 for MI (95% CI, 1.08–1.23, P < 0.001). Adjusted HR for mortality was 1.07 (95% CI, 1.01–1.15, P = 0.04) and 1.14 for MI (95% CI, 1.06–1.22, P < 0.001). Changes in hs-cTnT from baseline concentrations after 1 year were minimal (55 ng/L vs 53 ng/L, P = 0.22) even in patients who had an MI (P = 0.53). CONCLUSIONS hs-cTnT appears to have a useful role in predicting MI and death in the dialysis population. Over a 1-year period concentrations remained stable even in patients who sustained a new cardiac event. |
| Databáze: | OpenAIRE |
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