Upper Reference Limits for High-Sensitivity Cardiac Troponin T and N-Terminal Fragment of the Prohormone Brain Natriuretic Peptide in Patients With CKD.
Upper Reference Limits for High-Sensitivity Cardiac Troponin T and N-Terminal Fragment of the Prohormone Brain Natriuretic Peptide in Patients With CKD.
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DOI：
10.1053/j.ajkd.2021.06.017
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发表时间：
2022-03
期刊：
影响因子：
--
通讯作者：
CRIC Study Investigators
中科院分区：
文献类型：
--
作者：
Bansal N;Zelnick LR;Ballantyne CM;Chaves PHM;Christenson RH;Coresh J;deFilippi CR;de Lemos JA;Daniels LB;Go AS;He J;Hedayati SS;Matsushita K;Nambi V;Shlipak MG;Taliercio JJ;Seliger SL;CRIC Study Investigators
N-末端脑钠肽前体（NT-proBNP）和高敏心肌肌钙蛋白T（hsTnT）的常规参考上限（URL）在慢性肾脏疾病（CKD）中的效用仍有争议。我们分析了门诊CKD患者hsTnT和NT-proBNP的分布，以检查常规URL在该人群中的诊断价值。观察性研究。我们研究了慢性肾功能不全队列的参与者，他们患有CKD，没有自我报告的心血管疾病（CVD）史。估计肾小球滤过率（eGFR）。基线时的NT-proBNP和hsTnT。我们描述了NT-proBNP（125 pg/ml）和hsTnT（14 ng/L）总体和eGFR高于常规URL的受试者比例。然后我们估计NT-proBNP和hsTnT的第99百分位数URL。使用第99百分位数的分位数回归，我们对eGFR与NT-proBNP和hsTnT的相关性进行建模。在2，312名CKD参与者中，40%和43%的NT-proBNP和hsTnT水平分别高于传统URL。在eGFR<30 ml/min/1.73 m2的受试者中，分别有71%和68%的受试者的NT-proBNP和hsTnT浓度高于常规URL。在所有CKD受试者中，NT-proBNP的第99百分位数为3，592（95% CI：2，470，4，849）pg/mL，hsTnT为126（95% CI：100，144）ng/L。eGFR每降低15 ml/min/1.73 m2，NT-proBNP [1.43（1.21，1.69）]和hsTnT [1.45（1.31，1.60）]第99百分位数的阈值升高约40%。研究包括非卧床患者;我们无法在急性护理环境中测试NT-proBNP和hsTnT参考上限的准确性。在无自报CVD病史的非卧床CKD人群中，根据eGFR分层，40-88%的受试者的NT-proBNP和hsTnT浓度高于常规URL。在CKD背景下为这些常用的心脏生物标志物开发eGFR特异性阈值可能会提高其用于评估疑似心力衰竭和心肌梗死的效用。心脏生物标志物N-末端脑钠肽前体（NT-proBNP）和高敏心肌肌钙蛋白T（hsTnT）在临床上常用于评估疑似急性心力衰竭或心肌梗死患者。然而，NT-proBNP和hsTnT的常规参考上限（URL）在慢性肾病（CKD）中的效用仍有争议。我们分析了hsTnT和NT-proBNP在非卧床CKD受试者中的分布，以研究传统URL如何适用于这一人群。在这个没有自报CVD病史的非卧床CKD人群中，我们发现大多数参与者的NT-proBNP和hsTnT浓度高于常规URL。开发这些常用心脏生物标志物在CKD背景下使用时的阈值可能会提高其评估疑似心力衰竭和心肌梗死的效用。
The utility of conventional upper reference limits (URL) for N-terminal pro brain natriuretic peptide (NT-proBNP) and high-sensitivity cardiac troponin T (hsTnT) in chronic kidney disease (CKD) remains debated. We analyzed the distribution of hsTnT and NT-proBNP in people with CKD in ambulatory settings to examine the diagnostic value of conventional URL in this population. Observational study. We studied participants of the Chronic Renal Insufficiency Cohort with CKD and no self-reported history of cardiovascular disease (CVD). Estimated glomerular filtration rate (eGFR). NT-proBNP and hsTnT at baseline. We described the proportion of participants above the conventional URL for NT-proBNP (125 pg/ml) and hsTnT (14 ng/L) overall, and by eGFR. We then estimated 99th percentile URL for NT-proBNP and hsTnT. Using quantile regression of the 99th percentile, we modeled the association of eGFR with NT-proBNP and hsTnT. Among 2,312 CKD participants, 40% and 43% had levels of NT-proBNP and hsTnT above conventional URL, respectively. In those with eGFR<30 ml/min/1.73 m2, 71% and 68% of participants had concentrations of NT-proBNP and hsTnT above conventional URL, respectively. Amongst all CKD participants, the 99th percentile for NT-proBNP was 3,592(95% CI: 2,470, 4,849) pg/mL and for hsTnT was 126(95% CI: 100, 144) ng/L. Each 15 ml/min/1.73 m2 decrement in eGFR was associated with a ~40% higher threshold for the 99th percentile of NT-proBNP [1.43 (1.21, 1.69)] and hsTnT [1.45 (1.31, 1.60)]. Study included ambulatory patients; we could not test the accuracy of upper reference limits of NT-proBNP and hsTnT in the acute care setting. In this ambulatory CKD population with no self-reported history of CVD, a range of 40–88% of participants had concentrations of NT-proBNP and hsTnT above conventional URL, depending on eGFR strata. Developing eGFR-specific thresholds for these commonly-used cardiac biomarkers in the setting of CKD may improve their utility for evaluation of suspected heart failure and myocardial infarction. The cardiac biomarkers N-terminal pro brain natriuretic peptide (NT-proBNP) and high-sensitivity cardiac troponin T (hsTnT) are frequently used clinically to evaluate patients for suspected acute heart failure or myocardial infarction. However, the utility of conventional upper reference limits (URL) for NT-proBNP) and hsTnT in chronic kidney disease (CKD) remains debated. We analyzed the distribution of hsTnT and NT-proBNP in ambulatory CKD participants to examine how conventional URL apply to this population. In this ambulatory CKD population with no self-reported history of CVD, we found that the majority of participants had concentrations of NT-proBNP and hsTnT above conventional URL. Developing thresholds for these commonly-used cardiac biomarkers when used in the setting of CKD may improve their utility for evaluation of suspected heart failure and myocardial infarction.
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影响因子：
24
作者：
Bansal N;Katz R;Robinson-Cohen C;Odden MC;Dalrymple L;Shlipak MG;Sarnak MJ;Siscovick DS;Zelnick L;Psaty BM;Kestenbaum B;Correa A;Afkarian M;Young B;de Boer IH
通讯作者：
de Boer IH
影响因子：
5.4
作者：
Bansal, Nisha;Zelnick, Leila;Townsend, Raymond R.
通讯作者：
Townsend, Raymond R.
影响因子：
4.2
作者：
Joffe, Marshall;Hsu, Chi-Yuan;Hamm, L. Lee
通讯作者：
Hamm, L. Lee
DOI：
10.1161/circinterventions.111.963876
发表时间：
2012-04-01
影响因子：
5.6
作者：
Acharji, Subasit;Baber, Usman;Stone, Gregg W.
通讯作者：
Stone, Gregg W.
影响因子：
5.4
作者：
Lamprea-Montealegre, Julio A.;Zelnick, Leila R.;Townsend, Raymond R.
通讯作者：
Townsend, Raymond R.