Department of Internal Medicine, Division of Endocrinology, Diabetology, Angiology and Nephrology, University Hospital of Tuebingen, Otfried-Mueller-Str. 10, 72076 Tuebingen, Germany.
Department of Internal Medicine, Division of Endocrinology, Diabetology, Vascular Disease, Nephrology and Clinical Chemistry, University Hospital Tuebingen, Tuebingen, Germany.
Clin Chem Lab Med. 2019 Jul 26;57(8):1261-1270. doi: 10.1515/cclm-2018-1176.
Background High sensitivity assays for the determination of cardiac troponin I (cTnI) are able to reliably measure cTnI far below the 99th percentile of healthy persons (hs-cTnI) and display sex-specific differences. There is uncertainty regarding the clinical utility of hs-cTnI in asymptomatic hemodialysis (HD) patients and if sex-specific differences also apply in this cohort. Methods In this multicenter study we measured hs-cTnI and sensitive cTnI (s-TnI) concentrations (both on Siemens Centaur) in 215 HD patients from a predialytic sample to determine the prevalence of elevated concentrations above the 99th percentile, the association with baseline characteristics, prognostic accuracy for death, and sex-specific differences. Results Hs-cTnI and s-cTnI concentrations were below the 99th percentile in 93% and 85% of patients with a median concentration of 12 ng/L (interquartile range 7-66) and 19 ng/L (12; 31, p < 0.0001). Hs-cTnI and s-cTnI concentrations were independently associated with age (p < 0.05) and ischemic cardiac disease (p < 0.05), but not with residual renal function. Both hs-cTnI and s-cTnI were predictors of death after median follow-up of 2.6 years with an AUC of 0.733 and 0.744, respectively (both p < 0.0001). Important sex-differences emerged for hs-cTnI, but not for s-cTnI: first, women had significantly lower hs-cTnI concentrations than men (p = 0.03); second, hs-cTnI had significantly higher prognostic accuracy for death in women than for men (AUC 0.824 vs. 0.674, p = 0.04). Conclusions The majority of HD patients have (h)s-cTnI concentrations below the 99th percentile. High normal values are predictive of death. Hs-cTnI allows to elucidate important sex-differences in HD patients with lower concentrations and higher prognostic accuracy in women.
高敏检测法测定心脏肌钙蛋白 I（cTnI）可可靠地测量健康人群第 99 百分位值以下（高敏肌钙蛋白 I，hs-cTnI）的 cTnI，并显示出性别特异性差异。在无症状血液透析（HD）患者中，hs-cTnI 的临床应用尚不确定，并且这种性别特异性差异是否也适用于该队列。
在这项多中心研究中，我们在透析前样本中测量了 215 名 HD 患者的 hs-cTnI 和敏感 cTnI（s-TnI）浓度（均使用西门子 Centaur 进行检测），以确定浓度高于第 99 百分位值的患者比例、与基线特征的相关性、对死亡的预后准确性以及性别特异性差异。
93%的患者 hs-cTnI 和 s-cTnI 浓度低于第 99 百分位值，中位数浓度分别为 12ng/L（四分位间距 7-66）和 19ng/L（12；31，p<0.0001）。hs-cTnI 和 s-cTnI 浓度与年龄（p<0.05）和缺血性心脏疾病（p<0.05）独立相关，但与残余肾功能无关。在中位随访 2.6 年后，hs-cTnI 和 s-cTnI 均为死亡的预测因素，AUC 分别为 0.733 和 0.744（均 p<0.0001）。hs-cTnI 出现了重要的性别差异，但 s-cTnI 没有：首先，女性的 hs-cTnI 浓度明显低于男性（p=0.03）；其次，hs-cTnI 对女性死亡的预后准确性明显高于男性（AUC 0.824 与 0.674，p=0.04）。
大多数 HD 患者的（h）s-cTnI 浓度低于第 99 百分位值。高正常值可预测死亡。hs-cTnI 可阐明 HD 患者中重要的性别差异，女性的浓度更低，预后准确性更高。
