Obokata Masaru, Sunaga Hiroaki, Ishida Hideki, Ito Kyoko, Ogawa Tetsuya, Ando Yoshitaka, Kurabayashi Masahiko, Negishi Kazuaki
Department of Medicine and Biological Science, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan.
Menzies Research Institute Tasmania, Hobart, Australia.
Am Heart J. 2016 Sep;179:29-41. doi: 10.1016/j.ahj.2016.05.018. Epub 2016 Jun 18.
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.
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).
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.
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.
终末期肾病是一个重大的临床和公共卫生问题，心血管疾病占血液透析患者死亡率的一半。现有的死亡风险评分（AROii评分）或N末端脑钠肽前体（NT-proBNP）水平具有一定的预测能力，但仍有改进空间。新出现的心脏生物标志物（可溶性ST2[sST2]亚型、半乳糖凝集素-3[Gal-3]）和尿毒症毒性物质（硫酸吲哚酚）。我们试图确定这些生物标志物是否能预测血液透析患者的心血管结局，以及相对于临床评分和NT-proBNP水平是否具有额外的预后价值。
对423例血液透析患者进行前瞻性随访，观察主要终点（全因死亡）和次要终点（全因死亡或心脑血管事件的复合终点）。
在平均2.1±0.4年的随访期间，有48例全因死亡和78例复合终点事件。在对数秩检验和受试者工作特征分析中，ST2可溶性亚型、Gal-3和NT-proBNP与全因死亡相关，但硫酸吲哚酚与全因死亡无关。sST2和Gal-3对这两个结局均具有独立于AROii评分和NT-proBNP的额外预后价值。虽然添加sST2并没有使基于模型的AROii评分和NT-proBNP对全因死亡的分类重新调整，但进一步添加Gal-3则实现了重新调整。对有左心室射血分数测量值的患者（n = 301）进行亚组分析证实了这些结果，在调整风险评分和射血分数后，这两种生物标志物对全因死亡和复合终点事件仍具有独立性和额外性。
在血液透析患者中，sST2和Gal-3相对于NT-proBNP和既定风险评分具有独立的额外预后价值。对sST2和Gal-3的评估进一步加强了风险分层。
