Multimarker approach to risk stratification for long-term mortality in patients on chronic hemodialysis

Junnichi Ishii, Hiroshi Takahashi, Fumihiko Kitagawa, Atsuhiro Kuno, Ryuunosuke Okuyama, Hideki Kawai, Takashi Muramatsu, Hiroyuki Naruse, Sadako Motoyama, Shigeru Matsui, Midori Hasegawa, Toru Aoyama, Daisuke Kamoi, Hirotake Kasuga, Hideo Izawa, Yukio Ozaki, Yukio Yuzawa

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Abstract

Background: We prospectively investigated the prognostic value of the combined use of cardiac troponin T (TnT), B-type natriuretic peptide (BNP), and high-sensitivity C-reactive protein (CRP) for long-term mortality in hemodialysis (HD) patients. Methods and Results: Baseline measurements of TnT, BNP, and CRP were performed in 516 patients on chronic HD. Patients were followed up for 10 years. Using the Cox multivariate model with these 3 biomarkers as variables categorized into tertiles for mortality, a simplified score was obtained by underscoring individual biomarkers based on the adjusted hazard ratio (HR). The multimarker score was defined as the sum of these points. TnT, BNP, and CRP levels were individually independent predictors for mortality (P<0.05). Among low-risk (multimarker score <4), intermediate-risk (multimarker score 4–7), and high-risk (multimarker score ≥7) groups, 10-year survival rates were 83.3%, 54.3%, and 27.2% (P<0.0001), respectively. After adjusting for other confounders, the multimarker score had strong predictive power for mortality (HR: 4.26; P<0.0001 for high-risk vs. low-risk group). Furthermore, adding the multimarker score to a baseline model with established risk factors improved the C-index (P<0.01), net reclassification improvement (P<0.0001), and integrated discrimination improvement (P<0.0001) greater than that of any single biomarker or baseline model alone. Conclusions: The multimarker approach (ie, simultaneous assessment of TnT, BNP, and CRP, which individually independently predict prognosis) may improve the prediction of long-term mortality in HD patients.

Original languageEnglish
Pages (from-to)656-663
Number of pages8
JournalCirculation Journal
Volume79
Issue number3
DOIs
Publication statusPublished - 01-01-2015

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Troponin T
Brain Natriuretic Peptide
Renal Dialysis
C-Reactive Protein
Mortality
Biomarkers
Proportional Hazards Models
Survival Rate
polypeptide C

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Ishii, Junnichi ; Takahashi, Hiroshi ; Kitagawa, Fumihiko ; Kuno, Atsuhiro ; Okuyama, Ryuunosuke ; Kawai, Hideki ; Muramatsu, Takashi ; Naruse, Hiroyuki ; Motoyama, Sadako ; Matsui, Shigeru ; Hasegawa, Midori ; Aoyama, Toru ; Kamoi, Daisuke ; Kasuga, Hirotake ; Izawa, Hideo ; Ozaki, Yukio ; Yuzawa, Yukio. / Multimarker approach to risk stratification for long-term mortality in patients on chronic hemodialysis. In: Circulation Journal. 2015 ; Vol. 79, No. 3. pp. 656-663.
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abstract = "Background: We prospectively investigated the prognostic value of the combined use of cardiac troponin T (TnT), B-type natriuretic peptide (BNP), and high-sensitivity C-reactive protein (CRP) for long-term mortality in hemodialysis (HD) patients. Methods and Results: Baseline measurements of TnT, BNP, and CRP were performed in 516 patients on chronic HD. Patients were followed up for 10 years. Using the Cox multivariate model with these 3 biomarkers as variables categorized into tertiles for mortality, a simplified score was obtained by underscoring individual biomarkers based on the adjusted hazard ratio (HR). The multimarker score was defined as the sum of these points. TnT, BNP, and CRP levels were individually independent predictors for mortality (P<0.05). Among low-risk (multimarker score <4), intermediate-risk (multimarker score 4–7), and high-risk (multimarker score ≥7) groups, 10-year survival rates were 83.3{\%}, 54.3{\%}, and 27.2{\%} (P<0.0001), respectively. After adjusting for other confounders, the multimarker score had strong predictive power for mortality (HR: 4.26; P<0.0001 for high-risk vs. low-risk group). Furthermore, adding the multimarker score to a baseline model with established risk factors improved the C-index (P<0.01), net reclassification improvement (P<0.0001), and integrated discrimination improvement (P<0.0001) greater than that of any single biomarker or baseline model alone. Conclusions: The multimarker approach (ie, simultaneous assessment of TnT, BNP, and CRP, which individually independently predict prognosis) may improve the prediction of long-term mortality in HD patients.",
author = "Junnichi Ishii and Hiroshi Takahashi and Fumihiko Kitagawa and Atsuhiro Kuno and Ryuunosuke Okuyama and Hideki Kawai and Takashi Muramatsu and Hiroyuki Naruse and Sadako Motoyama and Shigeru Matsui and Midori Hasegawa and Toru Aoyama and Daisuke Kamoi and Hirotake Kasuga and Hideo Izawa and Yukio Ozaki and Yukio Yuzawa",
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Ishii, J, Takahashi, H, Kitagawa, F, Kuno, A, Okuyama, R, Kawai, H, Muramatsu, T, Naruse, H, Motoyama, S, Matsui, S, Hasegawa, M, Aoyama, T, Kamoi, D, Kasuga, H, Izawa, H, Ozaki, Y & Yuzawa, Y 2015, 'Multimarker approach to risk stratification for long-term mortality in patients on chronic hemodialysis', Circulation Journal, vol. 79, no. 3, pp. 656-663. https://doi.org/10.1253/circj.CJ-14-0915

Multimarker approach to risk stratification for long-term mortality in patients on chronic hemodialysis. / Ishii, Junnichi; Takahashi, Hiroshi; Kitagawa, Fumihiko; Kuno, Atsuhiro; Okuyama, Ryuunosuke; Kawai, Hideki; Muramatsu, Takashi; Naruse, Hiroyuki; Motoyama, Sadako; Matsui, Shigeru; Hasegawa, Midori; Aoyama, Toru; Kamoi, Daisuke; Kasuga, Hirotake; Izawa, Hideo; Ozaki, Yukio; Yuzawa, Yukio.

In: Circulation Journal, Vol. 79, No. 3, 01.01.2015, p. 656-663.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Multimarker approach to risk stratification for long-term mortality in patients on chronic hemodialysis

AU - Ishii, Junnichi

AU - Takahashi, Hiroshi

AU - Kitagawa, Fumihiko

AU - Kuno, Atsuhiro

AU - Okuyama, Ryuunosuke

AU - Kawai, Hideki

AU - Muramatsu, Takashi

AU - Naruse, Hiroyuki

AU - Motoyama, Sadako

AU - Matsui, Shigeru

AU - Hasegawa, Midori

AU - Aoyama, Toru

AU - Kamoi, Daisuke

AU - Kasuga, Hirotake

AU - Izawa, Hideo

AU - Ozaki, Yukio

AU - Yuzawa, Yukio

PY - 2015/1/1

Y1 - 2015/1/1

N2 - Background: We prospectively investigated the prognostic value of the combined use of cardiac troponin T (TnT), B-type natriuretic peptide (BNP), and high-sensitivity C-reactive protein (CRP) for long-term mortality in hemodialysis (HD) patients. Methods and Results: Baseline measurements of TnT, BNP, and CRP were performed in 516 patients on chronic HD. Patients were followed up for 10 years. Using the Cox multivariate model with these 3 biomarkers as variables categorized into tertiles for mortality, a simplified score was obtained by underscoring individual biomarkers based on the adjusted hazard ratio (HR). The multimarker score was defined as the sum of these points. TnT, BNP, and CRP levels were individually independent predictors for mortality (P<0.05). Among low-risk (multimarker score <4), intermediate-risk (multimarker score 4–7), and high-risk (multimarker score ≥7) groups, 10-year survival rates were 83.3%, 54.3%, and 27.2% (P<0.0001), respectively. After adjusting for other confounders, the multimarker score had strong predictive power for mortality (HR: 4.26; P<0.0001 for high-risk vs. low-risk group). Furthermore, adding the multimarker score to a baseline model with established risk factors improved the C-index (P<0.01), net reclassification improvement (P<0.0001), and integrated discrimination improvement (P<0.0001) greater than that of any single biomarker or baseline model alone. Conclusions: The multimarker approach (ie, simultaneous assessment of TnT, BNP, and CRP, which individually independently predict prognosis) may improve the prediction of long-term mortality in HD patients.

AB - Background: We prospectively investigated the prognostic value of the combined use of cardiac troponin T (TnT), B-type natriuretic peptide (BNP), and high-sensitivity C-reactive protein (CRP) for long-term mortality in hemodialysis (HD) patients. Methods and Results: Baseline measurements of TnT, BNP, and CRP were performed in 516 patients on chronic HD. Patients were followed up for 10 years. Using the Cox multivariate model with these 3 biomarkers as variables categorized into tertiles for mortality, a simplified score was obtained by underscoring individual biomarkers based on the adjusted hazard ratio (HR). The multimarker score was defined as the sum of these points. TnT, BNP, and CRP levels were individually independent predictors for mortality (P<0.05). Among low-risk (multimarker score <4), intermediate-risk (multimarker score 4–7), and high-risk (multimarker score ≥7) groups, 10-year survival rates were 83.3%, 54.3%, and 27.2% (P<0.0001), respectively. After adjusting for other confounders, the multimarker score had strong predictive power for mortality (HR: 4.26; P<0.0001 for high-risk vs. low-risk group). Furthermore, adding the multimarker score to a baseline model with established risk factors improved the C-index (P<0.01), net reclassification improvement (P<0.0001), and integrated discrimination improvement (P<0.0001) greater than that of any single biomarker or baseline model alone. Conclusions: The multimarker approach (ie, simultaneous assessment of TnT, BNP, and CRP, which individually independently predict prognosis) may improve the prediction of long-term mortality in HD patients.

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U2 - 10.1253/circj.CJ-14-0915

DO - 10.1253/circj.CJ-14-0915

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C2 - 25746551

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VL - 79

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JO - Circulation Journal

JF - Circulation Journal

SN - 1346-9843

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