Independent and incremental prognostic value of novel cardiac biomarkers in chronic hemodialysis patients

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• 作者：Masaru Obokata ; MD ; PhD^a ; Hiroaki Sunaga ; PhD^b ; Hideki Ishida ; RN^c ; Kyoko Ito ; MD ; PhD^c ; ^d ; Tetsuya Ogawa ; MD ; PhD^c ; ^e ; Yoshitaka Ando ; MD^c ; Masahiko Kurabayashi ; MD ; PhD^a ; Kazuaki Negishi ; MD ; PhD^a ; ^b ; ^{kazz.negishi@nifty.com" class="auth_mail" title="E-mail the corresponding author} ; ^{Kazuaki.Negishi@utas.edu.au" class="auth_mail" title="E-mail the corresponding author}
• 刊名：American Heart Journal
• 出版年：2016
• 出版时间：September 2016
• 年：2016
• 卷：179
• 期：Complete
• 页码：29-41
• 全文大小：768 K

文摘

End-stage renal disease is a major clinical and public health problem, and cardiovascular disease accounts for half of the mortality in hemodialysis patients. An existing mortality risk score (AROii score) or N-terminal pro–brain natriuretic peptide (NT-proBNP) level have modest predictive power, but there is room for improvement. There are emerging cardiac biomarkers (soluble isoforms of ST2 [sST2], galectin-3 [Gal-3]), and uremic toxicity (indoxyl sulfate). We sought to determine whether these biomarkers predict cardiovascular outcomes in hemodialysis patients and have incremental prognostic value over the clinical score and NT-proBNP level.

Methods

A total of 423 hemodialysis patients were prospectively followed up for primary (all-cause death) and secondary end points (a composite of all-cause death or cerebrocardiovascular events).

Results

During a mean follow-up of 2.1 ± 0.4 years, there were 48 all-cause deaths and 78 composite outcomes. Soluble isoforms of ST2, Gal-3, and NT-proBNP were associated with all-cause deaths but indoxyl sulfate was not in both log-rank test and receiver operating characteristic analysis. Both sST2 and Gal-3 had independent and incremental prognostic value for both outcomes over the AROii score and NT-proBNP. Although adding sST2 did not reclassify over the model-based AROii score and NT-proBNP for all-cause death, further addition of Gal-3 did. Subgroup analyses of patients with left ventricular ejection fraction measurement (n = 301) corroborated these results, where the 2 biomarkers remained independent and incremental for both all-cause death and composite outcome after adjusting for the risk score and the ejection fraction.

Conclusions

Both sST2 and Gal-3 had independent and incremental prognostic values over NT-proBNP and an established risk score in patients with hemodialysis. Assessment of sST2 and Gal-3 further enhances risk stratification.