Key result
In patients with CKD, higher serum ceruloplasmin levels were associated with an increased risk of major adverse cardiac events at 3 years (adjusted HR 1.61; 95% CI 1.15-2.25; P=0.01).
Why the study?
Are higher serum ceruloplasmin levels associated with an increased risk of major adverse cardiac events in patients with CKD presenting for elective diagnostic coronary angiography?
Cohort (n=904)
Are higher serum ceruloplasmin levels associated with an increased risk of major adverse cardiac events in patients with CKD presenting for elective diagnostic coronary angiography?
Hazard Ratio: 1.61 (95% CI 1.15–2.25)
p-value: p=0.01
In patients with CKD undergoing elective coronary angiography, elevated serum ceruloplasmin is an independent predictor of long-term major adverse cardiac events.
Serum ceruloplasmin was associated with higher MACE risk in CKD; leaves open incremental prognostic value beyond standard biomarkers.
BACKGROUND AND OBJECTIVES: Increased serum levels of the acute-phase reactant ceruloplasmin predict adverse clinical outcomes in the setting of acute coronary syndromes and heart failure, but their role in patients with CKD is unclear. This study investigated the relationship of ceruloplasmin with clinical outcomes in CKD, especially with regard to traditional cardiac biomarkers. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Serum ceruloplasmin levels in consecutive study participants with CKD (n=654; estimated GFR<60 ml/min per 1.73 m(2)) as well as a control group of non-CKD participants matched for age and sex (n=250) were measured. Study participants were enrolled during 2001-2006 from a population of patients presenting for elective diagnostic coronary angiography and prospectively followed for 3 years (median follow-up=1095 days) to determine incident major adverse cardiac events (defined as a composite of death, nonfatal myocardial infarction, and stroke). RESULTS: Serum ceruloplasmin levels in CKD patients were elevated versus controls (median [interquartile range]; 25.5 [21.8-29.6] versus 22.7 [19.7-26.5] mg/dl; P<0.001) and associated with increased risk of future major adverse cardiac events (hazard ratio, 1.35; 95% confidence interval, 1.0 to 1.82; P=0.04). After adjusting for traditional risk factors, higher serum ceruloplasmin was still associated with higher risk of major adverse cardiac events at 3 years (hazard ratio, 1.61; 95% confidence interval, 1.15 to 2.25; P=0.01). CONCLUSION: In CKD patients, increased serum ceruloplasmin, a regulator of nitric oxide activity, is associated with increased risk of long-term adverse cardiovascular events, even after multivariable model adjustment for traditional clinical and biologic risk factors.
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Kennedy et al. (2013) conducted a cohort in Chronic Kidney Disease (CKD) (n=904). Higher serum ceruloplasmin levels vs. Lower serum ceruloplasmin levels was evaluated on Incident major adverse cardiac events (composite of death, nonfatal myocardial infarction, and stroke) (HR 1.61, 95% CI 1.15-2.25, p=0.01). In patients with CKD, higher serum ceruloplasmin levels were associated with an increased risk of major adverse cardiac events at 3 years (adjusted HR 1.61; 95% CI 1.15-2.25; P=0.01).
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