Department of Clinical and Molecular Medicine, Renal Unit, Sant'Andrea University Hospital, "Sapienza" University of Rome, Rome, Italy,
Department of Clinical and Molecular Medicine, Renal Unit, Sant'Andrea University Hospital, "Sapienza" University of Rome, Rome, Italy.
Blood Purif. 2022;51(2):155-162. doi: 10.1159/000515675. Epub 2021 Apr 28.
Cardiovascular events (CVE) remain the leading cause of mortality in hemodialysis (HD) patients. The ability to assess the risk of short-term CVE is of great importance. Soluble suppression of tumorogenicity-2 (sST2) is a novel biomarker that better stratifies risk of CVE than troponins in patients with heart failure. Few studies have investigated the role of sST2 in the HD population. The aim of this single-center study was to assess the predictive ability of sST2 on CVE in comparison to high-sensitive cardiac troponin I (hs-cTnI) and B-type natriuretic peptide (BNP) in HD patients.
This study used a prospective, observational cohort design. We enrolled 40 chronic HD patients asymptomatic for chest pain and without recent history of acute coronary syndrome. We tested sST2 pre-/post-HD, hs-cTnI, and BNP. Demographic/dialytic/echocardiographic data were evaluated. We recorded the number of CVE for 12 months. The patients were classified into 2 groups: those who developed CVE and those who did not.
Ten of the 40 patients (25%) developed CVE during a 12-month follow-up. Increased sST2 levels (p < 0.0001) as well as hs-cTnI and BNP are predictive of CVE. When analyzing biomarkers as binary variables for values above or below the normal range, the correlation remained significant only for sST2 (p = 0.001). A small variation in sST2 levels before and after HD sessions was found (-2.1 ng/mL). sST2 was correlated with left ventricular (LV) echocardiographic data: LV mass index (p = 0.0001), LV ejection fraction (p = 0.01), and diastolic bulging of septum (p = 0.015). BNP and sST2 combination increased the prediction of CVE in a statistical model.
Our study confirms that sST2 is useful for stratifying CV risk in the HD population. sST2 can be evaluated simply as a dichotomous value higher or lower than the normal range, making it easily interpretable. Dialysis and residual diuresis did not affect significantly sST2. A multimarker approach that incorporates sST2 and BNP may improve the prediction of CVE.
心血管事件（CVE）仍然是血液透析（HD）患者死亡的主要原因。评估短期 CVE 风险的能力非常重要。可溶性肿瘤抑制物 2（sST2）是一种新型生物标志物，其在心力衰竭患者中的 CVE 风险分层优于肌钙蛋白。很少有研究调查 sST2 在 HD 人群中的作用。本单中心研究的目的是评估 sST2 与高敏心肌肌钙蛋白 I（hs-cTnI）和 B 型利钠肽（BNP）相比，对 HD 患者 CVE 的预测能力。
本研究采用前瞻性观察队列设计。我们招募了 40 名无症状胸痛且无近期急性冠状动脉综合征病史的慢性 HD 患者。我们在 HD 前后检测 sST2、hs-cTnI 和 BNP。评估人口统计学/透析/超声心动图数据。我们记录了 12 个月内 CVE 的数量。患者分为 2 组：发生 CVE 和未发生 CVE。
在 12 个月的随访中，40 名患者中有 10 名（25%）发生了 CVE。升高的 sST2 水平（p < 0.0001）以及 hs-cTnI 和 BNP 可预测 CVE。当分析作为高于或低于正常范围的二分类变量的生物标志物时，相关性仅对 sST2 有意义（p = 0.001）。HD 前后 sST2 水平略有变化（-2.1ng/mL）。sST2 与左心室（LV）超声心动图数据相关：LV 质量指数（p = 0.0001）、LV 射血分数（p = 0.01）和室间隔舒张膨出（p = 0.015）。BNP 和 sST2 的组合增加了 CVE 的统计学模型预测。
我们的研究证实，sST2 可用于分层 HD 人群的 CV 风险。sST2 可以简单地作为高于或低于正常范围的二分类值进行评估，使其易于解释。透析和残余利尿对 sST2 没有显著影响。包含 sST2 和 BNP 的多标志物方法可能会提高 CVE 的预测能力。
