Wang Sheng, Li Ming, Wang Xiangyu, Luo Jing, Zou Yulin, Hu Yang, Liu Xingtai, Ao Hua, Yao Xueer, Li Chufeng, Yang Tingting
Department of Clinical Laboratory, The Third Clinical Medical College of the Three Gorges University, Gezhouba Central Hospital of Sinopharm, Yichang, China.
Department of Nephrology, The Third Clinical Medical College of the Three Gorges University, Gezhouba Central Hospital of Sinopharm, Yichang, China.
Front Cardiovasc Med. 2021 Nov 12;8:731864. doi: 10.3389/fcvm.2021.731864. eCollection 2021.
The N-terminal pro B type natriuretic peptide (NT-proBNP) is important for prognosis of heart failure in patients with chronic kidney disease (CKD). However, the NT-proBNP level is easily affected by renal insufficiency, which limits its clinical use. This study included 396 patients with CKD. Plasma levels of NT-proBNP and cystatin C (CysC) were measured during hospitalization. The echocardiographic parameters were also detected. Patients were divided into the heart failure group and control group according to the European Society of Cardiology Guideline on Chronic Heart Failure 2021. Multiple modeling analysis of the values of NT-proBNP and CysC, including NT-proBNP/Cysc and NT-proBNP/n was performed. The receiver operating characteristic (ROC) curve, combined with the cardiac function, was used to determine the formula with the best diagnostic efficiency. Then, the sensitivity and specificity of new predictors for cardiac insufficiency in CKD patients were calculated. Pearson correlation analysis was used to analyze the relationship between new predictors and the NT-proBNP level. The clinical data of CKD patients from another local hospital were used to validate the new predictors and the cut-off values. An elevated NT-proBNP/CysC ratio was an independent risk factor for cardiac dysfunction in CKD and the best predictor derived from multiple modeling analysis. There was no correlation between the NT-proBNP/CysC ratio and the NT-proBNP level ( = 0.376, = 6.909). The area under the ROC curve for the NT-proBNP/CysC ratio was 0.815 (95% confidence interval: 0.772-0.858), and for a cut-off point of 847.964, this ratio had a sensitivity of 78.24%, and a specificity of 69.44%. When applied to the data of CKD patients from another local hospital, the NT-proBNP to CysC ratio had a sensitivity of 70.27% and a specificity of 67.74%. The NT-proBNP to CysC ratio was superior to NT-proBNP alone for predicting cardiac dysfunction in patients with CKD.
N 末端 B 型利钠肽原（NT-proBNP）对慢性肾脏病（CKD）患者心力衰竭的预后具有重要意义。然而，NT-proBNP 水平易受肾功能不全影响，这限制了其临床应用。本研究纳入了 396 例 CKD 患者。住院期间检测血浆 NT-proBNP 和胱抑素 C（CysC）水平。同时检测超声心动图参数。根据 2021 年欧洲心脏病学会慢性心力衰竭指南将患者分为心力衰竭组和对照组。对 NT-proBNP 和 CysC 的值进行了多种建模分析，包括 NT-proBNP/Cysc 和 NT-proBNP/n。采用受试者工作特征（ROC）曲线并结合心功能，确定诊断效率最佳的公式。然后，计算 CKD 患者心脏功能不全新预测指标的敏感性和特异性。采用 Pearson 相关分析分析新预测指标与 NT-proBNP 水平之间的关系。使用另一家当地医院 CKD 患者的临床数据验证新预测指标及截断值。NT-proBNP/CysC 比值升高是 CKD 患者心脏功能障碍的独立危险因素，也是多种建模分析得出的最佳预测指标。NT-proBNP/CysC 比值与 NT-proBNP 水平之间无相关性（r = 0.376，P = 6.909）。NT-proBNP/CysC 比值的 ROC 曲线下面积为 0.815（95%置信区间：0.772 - 0.858），截断点为 847.964 时，该比值的敏感性为 78.24%，特异性为 69.44%。应用于另一家当地医院 CKD 患者的数据时，NT-proBNP 与 CysC 比值的敏感性为 70.27%，特异性为 67.74%。在预测 CKD 患者心脏功能障碍方面，NT-proBNP 与 CysC 比值优于单独的 NT-proBNP。
