Regional Nephrology and Transplant Unit, Belfast City Hospital, Belfast, UK.
Centre for Public Health, Queen's University Belfast, Belfast, UK.
BMC Nephrol. 2020 Jan 28;21(1):22. doi: 10.1186/s12882-020-1690-6.
Soluble ST2 is a novel biomarker of myocardial fibrosis with an established role in prognostication of patients with heart failure. Its role in cardiovascular risk prediction for renal transplant recipients has not been investigated despite promising results for ST2 in other populations with renal disease.
In this prospective cohort study, 367 renal transplant recipients were followed up for a median of 16.2 years to investigate the association of soluble ST2 concentration with all-cause mortality. Cardiovascular mortality and major adverse cardiovascular events were secondary outcomes. Cox regression models were used to calculate hazard ratios and 95% confidence intervals for ST2 before and after adjustments. ST2 concentration was analysed both as a continuous variable and following categorisation according to the recommended cut-point of 35 ng/ml.
A twofold higher ST2 concentration was associated with a 36% increased risk of all-cause mortality after adjustment for conventional cardiovascular risk factors and high-sensitivity C-reactive protein (adjusted hazard ratio 1.36; 95% confidence interval 1.06-1.75; p = 0.016). Associations with ST2 concentration were similar for cardiovascular events (adjusted hazard ratio 1.31; 95% confidence interval 1.00-1.73; p = 0.054), but were stronger for cardiovascular mortality (adjusted hazard ratio 1.61; 95% confidence interval 1.07-2.41; p = 0.022). Addition of ST2 to risk prediction models for mortality and cardiovascular events failed to improve their predictive accuracy.
ST2 is associated with, but does not improve prediction of, adverse outcomes in renal transplant recipients.
可溶性 ST2 是一种新型的心肌纤维化生物标志物，在心力衰竭患者的预后评估中具有明确的作用。尽管 ST2 在其他肾脏病患者中具有良好的预测价值，但它在预测肾移植受者心血管风险方面的作用尚未得到研究。
在这项前瞻性队列研究中，对 367 例肾移植受者进行了中位时间为 16.2 年的随访，以研究可溶性 ST2 浓度与全因死亡率的关系。心血管死亡率和主要不良心血管事件是次要终点。使用 Cox 回归模型计算 ST2 在调整传统心血管危险因素和高敏 C 反应蛋白前后的风险比和 95%置信区间。ST2 浓度既作为连续变量进行分析，也根据推荐的 35ng/ml 截断值进行分类后进行分析。
调整传统心血管危险因素和高敏 C 反应蛋白后，ST2 浓度升高两倍与全因死亡率风险增加 36%相关（调整后的风险比 1.36；95%置信区间 1.06-1.75；p=0.016）。与 ST2 浓度的相关性与心血管事件相似（调整后的风险比 1.31；95%置信区间 1.00-1.73；p=0.054），但与心血管死亡率的相关性更强（调整后的风险比 1.61；95%置信区间 1.07-2.41；p=0.022）。将 ST2 加入到死亡率和心血管事件的风险预测模型中，并未提高其预测准确性。
ST2 与肾移植受者不良结局相关，但不能改善其预测能力。
