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

研究成果: Article査読

17 被引用数 (Scopus)

抄録

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.

本文言語English
ページ(範囲)656-663
ページ数8
ジャーナルCirculation Journal
79
3
DOI
出版ステータスPublished - 2015

All Science Journal Classification (ASJC) codes

  • 循環器および心血管医学

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