Jaroszyński Andrzej J, Jaroszyńska Anna, Przywara Stanisław, Zaborowski Tomasz, Książek Andrzej, Dąbrowski Wojciech
Institute of Medical Sciences, Jan Kochanowski University in Kielce, Kielce, Poland.
Department of Family Medicine, Medical University of Lublin, Lublin, Poland.
PLoS One. 2016 Sep 29;11(9):e0163532. doi: 10.1371/journal.pone.0163532. eCollection 2016.
Left ventricular hypertrophy is associated withincreased mortality in hemodialysis (HD) patients.Syndecan-4 plays a role in many processes that are involved in the heart fibrosis and hypertrophy.We designed this study to prospectively determine whether syndecan-4 was predictive of mortality in a group of HD patients.
In total, 191 HD patients were included. Clinical, biochemical and echocardiographic parameters were recorded. HD patients were followed-up for 23.18 ± 4.02 months.
Syndecan-4 levels correlated strongly with geometrical echocardiographic parameters and ejection fraction. Relations with pressure-related parameters were weak and only marginally significant. Using the receiver operating characteristics the optimal cut-off points in predicting all-cause as well as cardiovascular (CV) mortality were evaluated and patients were divided into low and high syndecan-4 groups. A Kaplan-Meier analysis showed that the cumulative incidences of all-cause as well as CV mortality were higher in high serum syndecan-4 group compared with those with low serum syndecan-4 (p<0.001 in both cases).A multivariate Cox proportional hazards regression analysis revealed syndecan-4 concentration to be an independent and significant predictor of all-cause (hazard ratio, 2.99; confidence interval, 2.34 to 3.113; p<0.001)as well as CV mortality (hazard ratio, 2.81;confidence interval, 2.28to3.02; p<0.001).
Serum syndecan-4 concentration reflects predominantly geometrical echocardiographic parameters. In HD patients serum syndecan-4 concentration is independently associated with all-cause as well as CV mortality.
左心室肥厚与血液透析（HD）患者死亡率增加相关。Syndecan-4在许多与心脏纤维化和肥厚相关的过程中发挥作用。我们设计本研究以前瞻性地确定Syndecan-4是否可预测一组HD患者的死亡率。
共纳入191例HD患者。记录临床、生化和超声心动图参数。对HD患者进行了23.18±4.02个月的随访。
Syndecan-4水平与超声心动图几何参数和射血分数密切相关。与压力相关参数的关系较弱且仅具有边缘显著性。使用受试者工作特征曲线评估预测全因死亡率以及心血管（CV）死亡率的最佳切点，并将患者分为低Syndecan-4组和高Syndecan-4组。Kaplan-Meier分析显示，高血清Syndecan-4组的全因死亡率和CV死亡率的累积发生率均高于低血清Syndecan-4组（两种情况均p<0.001）。多变量Cox比例风险回归分析显示，Syndecan-4浓度是全因死亡率（风险比，2.99；置信区间，2.34至3.ll3；p<0.001）以及CV死亡率（风险比，2.81；置信区间，2.28至3.02；p<0.001）的独立且显著的预测指标。
血清Syndecan-4浓度主要反映超声心动图几何参数。在HD患者中，血清Syndecan-4浓度与全因死亡率以及CV死亡率独立相关。
