Oh Hyung Jung, Lee Mi Jung, Lee Hye Sun, Park Jung Tak, Han Seung Hyeok, Yoo Tae-Hyun, Kim Yong-Lim, Kim Yon Su, Yang Chul Woo, Kim Nam-Ho, Kang Shin-Wook
From the Department of Internal Medicine, College of Medicine, Brain Korea 21 for Medical Science, Severance Biomedical Science Institute, Yonsei University, Seoul, Korea (HJO, MJL, JTP, SHH, T-HY, S-WK); Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea (Y-LK); Department of Internal Medicine, Seoul National University of Medicine, Seoul, Korea (YSK); Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, Seoul, Korea (CWY); Department of Medicine, Chonnam National University Medical School, Gwangju, Korea (N-HK); and Department of Biostatistics, Yonsei University College of Medicine, Seoul, Korea (HSL).
Medicine (Baltimore). 2014 Dec;93(27):e241. doi: 10.1097/MD.0000000000000241.
Numerous studies have demonstrated that cardiac biomarkers are significant predictors of cardiovascular (CV) and all-cause mortality in ESRD patients, but most of the studies were retrospective or included small numbers of patients, only prevalent dialysis patients, or measured 1 or 2 biomarkers. This study was to analyze the association between 3 cardiac biomarkers and mortality in incident HD patients. A prospective cohort of 864 incident HD patients was followed for 30 months. Based on the median values of baseline NT-proBNP, cTnT, and hsCRP, the patients were divided into "high" and "low" groups, and CV and all-cause mortality were compared between each group. Additionally, time-dependent ROC curves were constructed, and the NRI and IDI of the models with various biomarkers were calculated. The CV survival rates were significantly lower in the "high" NT-proBNP and cTnT groups compared to the corresponding "low" groups, while there was no significant difference in CV survival rate between the 2 hsCRP groups. However, all-cause mortality rates were significantly higher in all 3 "high" groups compared to each lower group. In multivariate analyses, only Ln NT-proBNP was found to be an independent predictor of mortality. Moreover, NT-proBNP was a more prognostic marker for mortality compared to cTnT. In conclusion, NT-proBNP is the biomarker that results in the most added prognostic value on top of traditional risk factors for CV and all-cause mortality in incident HD patients.
大量研究表明，心脏生物标志物是终末期肾病（ESRD）患者心血管（CV）和全因死亡率的重要预测指标，但大多数研究为回顾性研究，或纳入患者数量较少，仅包括现患透析患者，或仅检测1或2种生物标志物。本研究旨在分析3种心脏生物标志物与新发血液透析（HD）患者死亡率之间的关联。对864例新发HD患者的前瞻性队列进行了30个月的随访。根据基线NT-proBNP、cTnT和hsCRP的中位数，将患者分为“高”组和“低”组，并比较每组的CV和全因死亡率。此外，构建了时间依赖性ROC曲线，并计算了包含各种生物标志物的模型的净重新分类指数（NRI）和综合判别改善指数（IDI）。与相应的“低”组相比，“高”NT-proBNP和cTnT组的CV生存率显著降低，而2个hsCRP组之间的CV生存率无显著差异。然而，所有3个“高”组的全因死亡率均显著高于各自的低组。在多变量分析中，仅发现Ln NT-proBNP是死亡率的独立预测指标。此外，与cTnT相比，NT-proBNP是更具预后价值的死亡率标志物。总之，对于新发HD患者的CV和全因死亡率，NT-proBNP是在传统危险因素基础上增加预后价值最多的生物标志物。
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