Predictive value of cardiac troponin I and T for subsequent death in end-stage renal disease
Predictive value of cardiac troponin I and T for subsequent death in end-stage renal disease
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DOI：
10.1161/01.cir.0000041254.30637.34
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发表时间：
2002-12-03
期刊：
影响因子：
37.8
通讯作者：
Herzog, CA
中科院分区：
文献类型：
--
作者：
Apple, FS;Murakami, MM;Herzog, CA
背景-本研究确定了终末期肾病（ESRD）患者心肌肌钙蛋白I（cTnI）和T（cTnT）升高的患病率，以及肌钙蛋白升高是否预示死亡。方法和结果-从733例ESRD患者中获得血清，并测量cTnI和cTnT。采用考克斯比例风险回归估计相对风险，并对年龄、透析时间和冠状动脉疾病进行了校正。Kaplan-Meier曲线比较了两组之间的至事件时间数据。在每个临界值时，cTnT升高的患者百分比高于cTnI，如下所示：第99百分位数，82% vs 6%; 10%变异系数，53% vs 1.0%;受试者操作者特征，20% vs 0.4%。使用所有临界值和仅高于cTnI第99百分位数时，cTnT升高与正常相比可预测死亡率升高。两年累计死亡率增加（P < 0.001），cTnT较正常组有明显变化（< 0.01 mug/L，8.4%）至小（大于或等于0.01至< 0.04 mug/L，26%），中度（大于或等于0.04至< 0.1 μ g/L，39%），和大（大于或等于1.0 μ g/L，47%）增加。肌钙蛋白I < 0.1 μ g/L的患者两年死亡率为30%，大于或等于0.1 μ g/L的患者两年死亡率为52%。单变量和调整后的死亡相对风险与（>第99百分位数）cTnT为5.0 cTnI分别为2.0（CI，1.3 ~ 3.3; P = 0.008）和2.1（CI，1.3 ~ 3.3; P = 0.007）。年龄、冠状动脉疾病和透析时间也是死亡率的独立预测因子。结论：终末期肾病患者cTnT和cTnI的增加显示死亡率增加2- 5倍，更多的患者cTnT增加。
Background-This study determined the prevalence of increased cardiac troponin I (cTnI) and T (cTnT) in end-stage renal disease (ESRD) patients and whether an increased troponin was predictive of death.Methods and Results-Serum was obtained from 733 ESRD patients and measured for cTnI and cTnT. Relative risks were estimated using Cox proportional hazards regressions univariately and adjusted for age, time on dialysis, and coronary artery disease. Kaplan-Meier curves compared time to event data between groups. Greater percentages of patients had an increased cTnT versus cTnI at each cutoff, as follows: 99th percentile, 82% versus 6%; 10% coefficient of variation, 53% versus 1.0%; and receiver operator characteristic, 20% versus 0.4%. Increased versus normal cTnT was predictive of increased mortality using all cutoffs and only above the 99th percentile for cTnI. Two-year cumulative mortality rates increased (P < 0.001) with changes in cTnT from normal (< 0.01 mug/L, 8.4%) to small (greater than or equal to 0.01 to < 0.04 mug/L, 26%), moderate (greater than or equal to 0.04 to < 0.1 mug/L, 39%), and large (greater than or equal to 1.0 mug/L, 47%) increases. Two-year mortalities were 30% for cTnI < 0.1 mug/L and 52% if greater than or equal to 0.1 mug/L. Univariate and adjusted relative risks of death associated with elevated (> 99th percentile) cTnT were 5.0 (Cl, 2.5 to 10; P < 0.001) and 3.9 (Cl, 1.9 to 7.9; P < 0.001) and cTnI were 2.0 (CI, 1.3 to 3.3; P = 0.008) and 2.1 (CI, 1.3 to 3.3; P = 0.007). Age, coronary artery disease, and time on dialysis were also independent predictors of mortality.Conclusions-Increases in cTnT and cTnI in ESRD patients show a 2- to 5-fold increase in mortality, with a greater number of patients having an increased cTnT.