Key result
The combination of elevated hs-CRP (≥10 mg/l) and circulating cTnI (≥0.03 µg/l) was associated with a dramatically increased risk of all-cause mortality (RR 16.9; 95% CI 4.5-63.8).
Why the study?
Does the combination of elevated cTnI and hs-CRP predict all-cause and cardiovascular mortality in haemodialysis patients?
Cohort (n=191)
Does the combination of elevated cTnI and hs-CRP predict all-cause and cardiovascular mortality in haemodialysis patients?
Elevated baseline cTnI, especially when combined with elevated hs-CRP, is a strong predictor of all-cause and cardiovascular mortality in haemodialysis patients.
May refine mortality risk assessment in haemodialysis; leaves open whether biomarker-guided interventions improve outcomes.
BACKGROUND: Cardiac Troponin I (cTnI) levels are considered an important diagnostic tool in acute coronary events. They could be of predictive value in haemodialysis (HD) patients. However, the relationship between cTnI and the HD-induced inflammatory state remains unclear. The aim of this study was to explore the prognostic relevance to all-cause and cardiovascular mortalities in HD patients of cTnI, in combination with highly sensitive C-reactive protein (hs-CRP) levels. METHODS: We measured cTnI and hs-CRP at baseline (March 10 to November 16, 2001) in 191 HD patients without clinical signs of acute coronary artery disease [median age 66.7 years (range 22.3-93.5), 94 females, 97 males]. We used a cTnI concentration with a total imprecision of 10% (0.03 microg/l), determined in the laboratory, as the analytical threshold value. Patients were followed for mortality until 1 January, 2003 (median follow-up 418 days). The adjusted relative risks (RRs) of death and 95% confidence intervals (CIs) were estimated using Cox proportional hazard models. RESULTS: A significant proportion (25.1%) of patients had elevated CTnl, > or =0.03 microg/l; 40.3% of patients had CRP concentrations > or =10 mg/l. During follow-up, 29 patients died, 44.8% due to cardiac causes. Elevated cTnI or CRP levels were associated with increased mortality [RR adjusted for age, sex and duration of dialysis 4.2 (1.9-9.0) for cTnI > or =0.03 microg/l and 3.6 (1.6-8.1) for CRP > or =10 mg/l], cTnI being particularly predictive of cardiovascular death. Moreover, the combination of elevated hs-CRP (> or =10 mg/l) and circulating cTnI (> or =0.03 microg/l) dramatically impaired the HD survival rate [adjusted RR for all-cause mortality 16.9 (4.5-63.8)]. CONCLUSION: Circulating cTnI was associated with poor prognosis, especially when combined with elevated CRP, strongly supporting the adoption of regular cTnI testing in HD patients.
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Boulier et al. (2004) conducted a cohort in Haemodialysis (n=191). Elevated cTnI (≥0.03 µg/l) and hs-CRP (≥10 mg/l) vs. Non-elevated cTnI and hs-CRP was evaluated on All-cause mortality (RR 16.9, 95% CI 4.5-63.8). The combination of elevated hs-CRP (≥10 mg/l) and circulating cTnI (≥0.03 µg/l) was associated with a dramatically increased risk of all-cause mortality (RR 16.9; 95% CI 4.5-63.8).
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