Key result
A high multimarker score combining cardiac troponin T, B-type natriuretic peptide, and C-reactive protein was associated with a 4.26-fold increased risk of all-cause mortality in hemodialysis patients.
Why the study?
Does a multimarker approach (TnT, BNP, CRP) improve prediction of long-term mortality in patients on chronic hemodialysis?
Cohort (n=516)
No
Does a multimarker approach (TnT, BNP, CRP) improve prediction of long-term mortality in patients on chronic hemodialysis?
Hazard Ratio: 4.26 (95% CI 2.59–7)
p-value: p=<0.0001
A multimarker approach combining TnT, BNP, and CRP significantly improves long-term mortality risk stratification in chronic hemodialysis patients.
May aid mortality prediction in hemodialysis; leaves open whether multimarker scores alter management or outcomes.
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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Ishii et al. (2015) conducted a cohort in Chronic hemodialysis (n=516). Multimarker score (TnT, BNP, CRP) vs. Low-risk multimarker score (<4) was evaluated on All-cause mortality (HR 4.26, 95% CI 2.59-7.00, p=<0.0001). A high multimarker score combining cardiac troponin T, B-type natriuretic peptide, and C-reactive protein was associated with a 4.26-fold increased risk of all-cause mortality in hemodialysis patients.
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