Abstract 11538: Multiple Biomarkers Improve the Prediction of Cardiovascular Mortality in Patients on Chronic Hemodialysis
Background: Patients on chronic hemodialysis (HD) are widely recognized to be at high risk for cardiovascular (CV) mortality, thus the more accurate prediction of CV mortality is clinically important. Serum brain natriuretic peptide (BNP), Troponin T (TnT) and C-reactive protein (CRP) are individually established to be predictive biomarkers for CV mortality in this population. We investigated whether combining of these biomarkers improve the prediction of CV mortality.
Methods: A total of 500 consecutive HD patients were examined by the measurement of serum BNP, TnT and CRP, and were followed up for 10 years. The cut-off values were based on the tertiles of the individual biomarkers, and a multivariate Cox analysis including three biomarkers for CV mortality was performed. From the analyzed model, a simplified score was obtained by putting weight to individual biomarkers based on the adjusted hazard ratio (HR). Finally, the multi-marker score was defined as the sum of these points, with higher points indicating a higher mortality risk.
Results: During follow-up period (80±41 months), 204 patients died including 95 CV deaths. Serum BNP, TnT and CRP were individually independent predictors for CV mortality (p<0.01 for all). However, by receiver operating characteristic (ROC) analysis, area under curve (AUC) for CV mortality was larger in the multi-marker score (0.76) compared to BNP (0.64), TnT (0.70) and CRP (0.65) alone. Similarly, AUC for all-cause mortality was 0.80, 0.68, 0.74 and 0.73 in the multi-marker score, BNP, TnT and CRP. Among low-risk group (multi-marker score < 3), middle-risk group (multi-marker score 4-6) and high-risk group (multi-marker score > 7), 10-year survival rate was 93.5%, 73.3% and 54.0% for CV mortality and 83.1%, 52.6% and 26.6% for all-cause mortality (p<0.0001 for both), respectively. Even after adjustment, multi-marker score had strongly predictive power (Table).
Conclusion: Multiple biomarkers could more accurately predict the mortality than these biomarkers alone in patients on HD.
- © 2011 by American Heart Association, Inc.