Abstract 14587: Multiple Biomarkers Improve the Prediction of Cardiovascular Mortality in Patients on Chronic Hemodialysis
Background: B-type natriuretic peptide (BNP), troponin T (TnT) and C-reactive protein (CRP) levels are individually established to be predictive biomarkers for cardiovascular (CV) mortality in patients on chronic hemodialysis (HD). We investigated whether combining these biomarkers improve the prediction of CV mortality in this population.
Methods: A total of 500 consecutive HD patients were examined by the measurement of BNP, TnT and CRP, and were followed up for 10 years. The cutoff 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 10-year follow-up period, 204 patients died including 95 CV deaths. BNP, TnT and CRP levels were individually independent predictors for CV mortality (p <0.01 for all). 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. After adjustment for other confounders, multi-marker score had strongly predictive power for CV mortality (HR 7.80, 95%CI 3.25-18.73, p <0.0001 for high vs. low risk group) and for all-cause mortality (HR 5.93, 95%CI 3.39-10.37, p <0.0001 for high vs. low risk group). Furthermore, C-index for both mortalities was greater in the predicting model with multi-marker score compared to that with BNP, TnT, CRP and alone (Table).
Conclusion: Multiple biomarkers could more accurately predict the mortality than these biomarkers alone in patients on HD.
- © 2013 by American Heart Association, Inc.