B-Type Natriuretic Peptide and Cardiac Troponin I Are Associated With Adverse Outcomes in Stable Kidney Transplant Recipients
B-Type Natriuretic Peptide and Cardiac Troponin I Are Associated With Adverse Outcomes in Stable Kidney Transplant Recipients
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DOI：
10.1097/tp.0000000000001080
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发表时间：
2017-01-01
期刊：
影响因子：
6.2
通讯作者：
Pfeffer, Marc A.
中科院分区：
文献类型：
--
作者：
Jarolim, Petr;Claggett, Brian L.;Pfeffer, Marc A.
背景资料。大约有20万肾移植受者生活在美国；他们患心血管疾病和其他不良后果的风险增加。预测这些结果的生物标志物是必要的。利用在叶酸降低移植血管结局试验期间收集的样本，我们确定了血浆B型利钠肽(BNP)和心肌肌钙蛋白I水平是否与稳定肾移植受者的不良结局有关。方法：研究方法。从4110种叶酸中随机挑选了510名受试者，用于降低移植参与者的血管结局。然后，对所有其他有不良后果(死亡、透析依赖性肾功能衰竭(DDKF)和心血管后果)的受试者进行了充实，共1131名参与者参与了研究。调整后的模型包括BNP和高敏感性心肌肌钙蛋白I(hs-cTnI)的四分位数。正常和升高的hs-cTnI(>；26.2 ng/L)和BNP(>；100pg/mL)的组合也被研究。结果。Hs-cTnI和BNP的中位浓度(四分位数范围)分别为5.6(3.3-10.5)ng/L和39(15，94)pg/mL。调整后BNP的四分位数越高，每个不良结局的风险比越高，在模型中加入hs-cTnI后，风险比仍然具有统计学意义。DDKF的最高四分位数风险比为2.47(95%可信区间[95%CI]，1.21-5.05)。BNP和hs-cTnI同时升高超过临床临界值与不良结局密切相关，DDKF的危险比为8.8(95%可信区间，3.4-23.1)，心血管结局的危险比为6.3(95%可信区间，2.7-15.0)。结论。在稳定的肾移植受者中，较高的BNP水平与死亡率、心血管和肾脏预后相关。升高的BNP和hs-cTnI确定有针对性地降低风险的候选对象。
Background. Approximately 200 000 kidney transplant recipients are living in the United States; they are at increased risk for cardiovascular and other adverse outcomes. Biomarkers predicting these outcomes are needed. Using specimens collected during the Folic Acid for Vascular Outcome Reduction in Transplantation trial, we determined whether plasma levels of B-type natriuretic peptide (BNP) and cardiac troponin I are associated with adverse outcomes in stable kidney transplant recipients. Methods. Five hundred ten subjects were selected randomly from the 4110 Folic Acid for Vascular Outcome Reduction in Transplantation participants. This cohort was then enriched for all additional subjects with adverse outcomes (death, dialysis-dependent kidney failure (DDKF), and cardiovascular outcomes) for a total of 1131 participants studied. Quartiles of BNP and high-sensitivity cardiac troponin I (hs-cTnI) were included in adjusted models. Combinations of normal and elevated hs-cTnI (>26.2 ng/L) and BNP (>100 pg/mL) were also studied. Results. Median concentrations (interquartile ranges) were 5.6 (3.3-10.5) ng/L for hs-cTnI and 39 (15, 94) pg/mL for BNP. Hazard ratios for each adverse outcome were higher with higher quartiles of BNP after adjustment and remained statistically significant after adding hs-cTnI to the model. The highest quartile hazard ratio for DDKF was 2.47 (95% confidence interval [95% CI], 1.21-5.05). Simultaneous elevations of BNP and hs-cTnI over clinical cutoffs were strongly associated with adverse outcomes with hazard ratios 8.8 (95% CI, 3.4-23.1) for DDKF and 6.3 (95% CI, 2.7-15.0) for cardiovascular outcomes. Conclusions. Higher BNP is associated with mortality and cardiovascular and kidney outcomes in stable kidney transplant recipients. Elevated BNP and hs-cTnI identify candidates for targeted risk reduction.