Serum C-reactive protein (CRP) and risk of death in chronic dialysis patients
Serum C-reactive protein (CRP) and risk of death in chronic dialysis patients
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DOI：
10.1093/ndt/14.8.1956
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发表时间：
1999-08-01
影响因子：
6.1
通讯作者：
Fukiyama, K
中科院分区：
文献类型：
--
作者：
Iseki, K;Tozawa, M;Fukiyama, K
背景慢性透析患者的预后很差，部分原因是心血管疾病的发病率很高。营养不良，如低白蛋白血症，已被证明是该组患者死亡的预测因子，而血清C反应蛋白（CRP）是心肌梗死和猝死的预测因子。因此，本研究的目的是确定CRP和血清白蛋白浓度之间的关系，以及基线CRP数据在预测死亡中的价值。在日本冲绳的一个透析单位中，基线CRP数据于1991年1月可用（n = 163，95名男性和68名女性）。根据基线CRP水平将这些患者分为两组，第1组由CRP ≥ 10 mg/l组成（n = 128），第2组由CRP ≥ 10 mg/l组成（n = 135），然后随访至1997年底。使用Kaplan-Meier方法计算存活曲线。以年龄、性别、糖尿病、血清白蛋白、血压等为协变量，采用多因素Logistic回归分析CRP水平与死亡风险的关系。第1组和第2组的血清白蛋白平均（SD）水平分别为38（3）g/l和36（3）g/l（P < 0.00001）。组2的5年生存率（44.4%）明显低于组1（82.5%）（P < 0.0001）。多因素考克斯比例风险分析结果显示，第2组患者的死亡风险显著高于第2组（相对危险度3.48（95%可信区间1.76-6.89），P < 0.0003）。无论血清白蛋白浓度是否在正常范围内，应仔细评估和监测CRP水平高的透析患者。
Background. The prognosis, of chronic dialysis patients is poor, in part due to the high incidence of cardiovascular disease. Malnutrition, such as hypoalbuminaemia, has been shown to be a predictor of death in this group of patients, while serum C-reactive protein (CRP) is a predictor of myocardial infarction and sudden death. Thus, the aim of the present study was to determine of the relationship between CRP and serum albumin concentration, and the value of baseline CRP data in the prediction of death.Methods. In one of the dialysis units in Okinawa, Japan, baseline CRP data was available (n = 163, 95 men and 68 women) in January 1991. These patients were divided into two groups according to their baseline CRP levels, with group 1 consisting of CRP greater than or equal to 10 mg/l (n = 128) and group 2 of CRP greater than or equal to 10 mg/l (n = 135), and then followed up until the end of 1997. Survival curves were calculated using the Kaplan-Meier method. The statistical significance of the relationship between CRP levels and the risk of death was evaluated by multiple logistic analysis with covariables such as age, sex, diabetes mellitus, serum albumin, and blood pressure.Results. The mean (SD) level of serum albumin was 38 (3) g/l in group 1 and 36 (3) g/l in group 2 (P < 0.00001). The 5-year survival rate was significantly poorer in group 2 (44.4%) than in group 1 (82.5%) (P < 0.0001). Furthermore, the risk of death was significantly higher in group 2 (relative risk 3.48 (95% confidence interval 1.76-6.89), P < 0.0003) by multivariate Cox proportional hazard analysis.Conclusions, CRP is a significant predictor of death in chronic dialysis patients, independent of serum albumin and other possible confounders. Dialysis patients with high CRP levels should be carefully evaluated and monitored regardless of serum albumin concentrations in the normal range.