Moderate elevations of high-sensitivity cardiac troponin I and B-type natriuretic peptide in chronic hemodialysis patients are associated with mortality

作者：Geerse Daniel A^*; van Berkel Miranda; Vogels Steffie; Kooman Jeroen P; Konings Constantijn J A M; Scharnhorst Volkher

来源：Clinical Chemistry and Laboratory Medicine, 2013, 51(6): 1321-1328.

DOI：10.1515/cclm-2012-0305

• biomarker
• B-type natriuretic peptide
• hemodialysis
• mortality
• troponin

Background: Several biomarkers are associated with mortality in hemodialysis patients. In particular, elevated cardiac troponin T and B-type natriuretic peptide (BNP) are strong predictors of mortality; however, less is known about cardiac troponin I (cTnI). Elevated troponin I is detected in many hemodialysis patients, but the association of moderate elevations with mortality is unclear. %26lt;br%26gt;Methods: The relation between mortality and cTnI, using a high-sensitivity cTnI assay, as well as BNP and C-reactive protein (CRP) was evaluated in 206 chronic hemodialysis patients. %26lt;br%26gt;Results: Median follow-up was 28 months with a total mortality of 35%. Mortality was significantly associated with elevated cTnI, BNP and CRP. Even patients with only moderate elevation of cTnI (0.01-0.10 mu g/L) showed 2.5-fold increased mortality. Interestingly, hazard ratios for mortality for single (random) measurements were comparable to those for mean/median measurements. Subsequently, subgroup analysis based on combined markers was performed. Patients with both cTnI %26lt;0.01 mu g/L and BNP in the first quartile had 100% survival. Patients with either cTnI %26lt;0.01 mu g/L or BNP in the lowest quartile had significantly lower mortality (12% and 13%, respectively) than patients with BNP levels in the second quartile or higher and cTnI of 0.01-0.05 mu g/L and patients with cTnI %26gt;= 0.05 mu g/L (mortality 46 and 58%, respectively). %26lt;br%26gt;Conclusions: A combination of moderate elevation of cTnI and BNP provided additional prognostic value. A single measurement of these biomarkers performed comparably to the mean/median of multiple measurements.

• 出版日期2013-6