Prognostic efficacy of combined index of cardiac biomarkers for cardiovascular and all-cause mortality on hemodialysis patients / 中华肾脏病杂志

ABSTRACT

Objective To evaluate cardiac biomarkers as biological risk factors for cardiovascular and all-cause motality in HD patients.In addition,a multimarker approach including inflammatory index was performed to improve the cardiovascular and all-canse risk assessment of these patients.Methods The author measured Troponin-T (TnT),N-terminal pro brain natriuretic peptide (NT-proBNP) and high-sensitivity C-reactive protein (HsCRP),collected the clinical data at baseline (January 2012) in 229 HD patients in three hemodialysis centers in Haidian District of Beijing,recorded time and cause of death in the next 1000 days.Kaplan-Meier was used to calculate survival rate and impact factors of prognosis.Cox proportional hazard model was used to estimate significance of =TnT,NT-proBNP and HsCRP and adjusted hazard ratios (HRs) of death.Results During the followup,37 patients died,mainly from cardiac cause (54.05％,20/37).Univariate analysis found old age,diabetes,cardiovascular disease,low serum albumin,CRP≥3 mg/L,TnT≥0.1 mg/L,NT-proBNP≥ 4381 ng/L were associated with prognosis.Elevated cTnT,NT-proBNP or HsCRP were all associated with increased cardiovascular and all-cause motality.Moreover,the combination of all parameters (NTproBNP≥4381 ng/L and TnT≥0.1 mg/L and HsCRP≥3 mg/L) were dramatically associated with increased cardiovascular cause mortality (HR=25.25,P ＜ 0.01) and all-cause mortality (HR=27.33,P ＜ 0.01).The association were significant even after full adjustment for cardiovascular (HR=14.33,P ＜ 0.01) and all-cause mortality (HR=1 1.54,P ＜ 0.01) respectively.Conclusions A combined index of cardiovascular risk factors could provide supplementary risk stratification in HD patients for cardiovascular mortality and all-cause mortality,strongly supporting the annual routine determination of these biomarkers.