The association of sudden cardiac death with inflammation and other traditional risk factors
The association of sudden cardiac death with inflammation and other traditional risk factors
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DOI：
10.1038/ki.2008.449
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发表时间：
2008-11-01
影响因子：
19.6
通讯作者：
Klag, Michael J.
中科院分区：
文献类型：
--
作者：
Parekh, Rulan S.;Plantinga, Laura C.;Klag, Michael J.
尽管透析患者心血管死亡的频率很高，但很少有研究前瞻性地测量这些个体的心源性猝死。在这里，我们试图确定 CHOICE（ESRD 护理健康结果选择）队列中 1,041 名透析患者的心源性猝死频率及其与炎症和其他危险因素的关系。根据死亡证明数据，心源性猝死被定义为在医院外发生的、具有潜在心脏原因的死亡。在中位 2.5 年的随访中，该队列中所有死亡率的 22% 是由于心源性猝死。使用 Cox 比例风险，我们发现，在根据人口统计、合并症和实验室因素进行调整后，高敏 C 反应蛋白和 IL-6 的最高三分位与心源性猝死风险的相关性是其最低三分位的两倍。与最低三分位数相比，血清白蛋白的减少与最高三分位数的心源性猝死风险增加 1.35 倍相关。在考虑其他原因导致的死亡竞争风险时，这些发现是稳健且一致的。因此，我们发现心源性猝死在终末期肾病患者中很常见，并且炎症和营养不良显着增加其发生率，而与传统的心血管危险因素无关。
Despite the frequency of cardiovascular death in dialysis patients, few studies have prospectively measured sudden cardiac death in these individuals. Here, we sought to determine the frequency of sudden cardiac death and its association with inflammation and other risk factors among the CHOICE (Choices for Healthy Outcomes In Caring for ESRD) cohort of 1,041 incident dialysis patients. Sudden cardiac death was defined as that occurring outside of the hospital with an underlying cardiac cause from death certificate data. Over a median 2.5 years of follow-up, 22% of all mortality in this cohort was due to sudden cardiac death. Using Cox proportional hazards, we found that the highest tertiles of high-sensitivity C-reactive protein and of IL-6 were each associated with twice the risk of sudden cardiac death compared to their lowest tertiles when adjusted for demographics, comorbidities and laboratory factors. A decrement in serum albumin was associated with a 1.35 times increased risk for sudden cardiac death in the highest compared to the lowest tertile. These findings were robust and consistent when accounting for competing risks of death from other causes. Hence, we found that sudden cardiac death is common among patients with end stage renal disease and that inflammation and malnutrition significantly increased its occurrence independent of traditional cardiovascular risk factors.