Utility of Cardiac Biomarkers (N-Terminal Pro-B-Type Natriuretic Peptide and Hs-Troponin-T) in Predicting Mortality, Cardiovascular, and Renal Outcomes in Patients with Chronic Kidney Disease.

IF 3.2 3区 医学 Q1 UROLOGY & NEPHROLOGY
Senthil K Vasan, Rajkumar Chinnadurai, Sharmilee Rengarajan, Darren Green, Helen Alderson, Nicolas Vuilleumier, Philip A Kalra
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引用次数: 0

Abstract

Introduction: Cardiac biomarkers, N-terminal pro-B-type natriuretic peptide (NT-proBNP), and high-sensitivity cardiac troponin-T (Hs-cTnT) are good prognostic indicators of long-term clinical cardiovascular outcomes in patients with chronic kidney disease (CKD). However, the clinical utility of combined biomarkers in predicting death and cardio-renal outcomes in patients with CKD remains unclear. This study examined the prognostic accuracy and incremental value of NT-proBNP and Hs-cTnT for all-cause mortality, major adverse cardiovascular event (MACE), and end-stage kidney disease (ESKD) in non-dialysis-dependent chronic kidney disease (NDD-CKD) patients.

Methods: Data from 1,946 individuals with NDD-CKD prospectively included in the Salford Kidney Study were used to investigate the associations between NT-proBNP and Hs-cTnT with study endpoints. Hazard ratio or sub-hazard ratio and 95% confidence intervals (95% CIs) were estimated using multivariate Cox-regression and competing risk models. The discriminatory power of NT-proBNP and Hs-cTnT along with kidney biomarkers (eGFR and uACR) and Framingham risk score (FRS) were calculated using Harrell's C-index. Endpoint-specific risk scores were generated using regression coefficients obtained in a training dataset and confirmed in a validation one.

Results: During median follow-up of 71.5 months, 931 (47.8%) deaths, 553 (28.4%) MACE, and 554 (28.5%) ESKD events occurred. Baseline NT-proBNP and Hs-cTnT elevations were associated with significant increased risk of mortality, MACE, and ESKD independently of FRS. Combining NT-proBNP, Hs-cTnT, and FRS yielded the highest prognostic accuracy for all-cause mortality and MACE (respective C-statistics: 0.713; 95% CI: 0.695-0.731, and 0.697; 95% CI: 0.673-0.721), while combining NT-proBNP and Hs-cTnT with eGFR and uACR performed best at predicting ESKD (C-statistics: 0.821; 95% CI: 0.786-0.826).

Conclusion: In NDD-CKD patients, NT-proBNP and Hs-cTnT are predictors of all-cause mortality, MACE, and ESKD, independently of eGFR and uACR. Combining NT-proBNP and Hs-cTnT with eGFR and uACR outperformed risk prediction for ESKD compared to kidney biomarkers used alone or in combination.

心脏生物标志物(NT-proBNP和Hs-Troponin-T)在预测慢性肾病患者死亡率、心血管和肾脏预后中的应用
心脏生物标志物n端前b型利钠肽(NT-proBNP)和高敏感性心肌肌钙蛋白-t (Hs-cTnT)是慢性肾病患者长期临床心血管预后的良好预后指标。然而,联合生物标志物在预测CKD患者死亡和心肾预后方面的临床应用仍不清楚。本研究检验了NT-proBNP和Hs-cTnT对非透析依赖性慢性肾病(NDD-CKD)患者全因死亡率、主要不良心血管事件(MACE)和终末期肾病(ESKD)的预后准确性和增量价值。方法:来自1946名NDD-CKD患者的数据被纳入索尔福德肾脏研究,用于研究NT-proBNP和Hs-cTnT与研究终点之间的关系。使用多变量cox -回归和竞争风险模型估计风险比或亚风险比和95%置信区间(95% ci)。采用Harrell's c指数计算NT-proBNP和Hs-cTnT与肾脏生物标志物(rbm: eGFR和UACR)和Framingham风险评分(FRS)的区分能力。终点特定风险评分使用在训练数据集中获得的回归系数生成,并在验证数据集中确认。结果:在中位随访71.5个月期间,发生931例(47.8%)死亡,553例(28.4%)MACE和554例(28.5%)ESKD事件。基线NT-proBNP和Hs-cTnT升高与死亡率、MACE和ESKD风险显著增加相关,独立于FRS和rbm。NT-proBNP、Hs-cTnT和FRS联合使用对全因死亡率和MACE的预后准确性最高(c -统计量分别为0.713;95%CI:0.695-0.731和0.697;95%CI:0.673-0.721,),而NT-proBNP和Hs-cTnT与rbm联合预测ESKD效果最好(C-statistics:0.821;95%置信区间:0.786—-0.826)。结论:在NDD-CKD患者中,NT-proBNP和Hs-cTnT是全因死亡率、MACE和ESKD的预测因子,独立于rbm。与单独使用或联合使用rbm相比,NT-proBNP和Hs-cTnT与rbm联合使用对ESKD的风险预测优于rbm。
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来源期刊
American Journal of Nephrology
American Journal of Nephrology 医学-泌尿学与肾脏学
CiteScore
7.50
自引率
2.40%
发文量
74
审稿时长
4-8 weeks
期刊介绍: The ''American Journal of Nephrology'' is a peer-reviewed journal that focuses on timely topics in both basic science and clinical research. Papers are divided into several sections, including:
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