title: C-reactive protein and procalcitonin as markers of mortality in hemodialysis patients: a 2-year prospective study.
abstract: OBJECTIVE
  We have previously shown in a transversal study that PCT combined to CRP is associated to an altered nutritional status in hemodialysis patients. In a 2-year prospective study, we have assessed the relationship between markers of inflammation or nutrition and mortality.
  
  
  METHODS
  Two-year prospective study, in 61 patients dialyzed in our unit (29 M/32 F, age 63 +/- 15 years, on dialysis for 76 +/- 94 months, 12 hrs/wk, on high-flux (HF) membrane for 25 patients and low-flux (LF) for 36 patients, without reuse). Kt/V was 1.53 +/- 0.30.
  
  
  METHODS
  Hospital-based dialysis unit.
  
  
  METHODS
  CRP, PCT, ferritin, albumin, and prealbumin, were measured in 04/99 (T0) and every 6 months thereafter. Interleukin-6 (IL6) and fibrinogen were measured at the start of study. The outcome and the causes of death of patients were noted in 58 patients, 3 patients were lost of follow-up.
  
  
  RESULTS
  The mortality (24 deaths) was 42% at 2 years in this hospital based unit. The main causes of mortality were cardiovascular diseases (71%) and infection (17%). Patients were classified according to their CRP (CRP+ if CRP > or = 5 mg/L; n = 40), and PCT values (PCT + if PCT > or = 0.5 ng/mL; n = 25). IL6 level was > or = 10 pg/mL for 95% of the patients. Mortality was higher in the CRP+ group (Kaplan-Meier test P < .01) but not in the PCT or IL6 positive patients. All patients of the CRP+ group at T0 remained CRP+. Only 56% of patients of PCT+ remained positive at 6 months. When patients were grouped according to CRP quartile the difference on survival remained significant (P = .03), patients who were classified in the third and fourth quartile (upper than 9.9 mg/L), exhibited a higher rate of mortality than the lower quartile. The concomitant presence of a high level of PCT and CRP was associated with a worsened nutritional status at T0 but PCT level had no influence on 2-year mortality.
  
  
  CONCLUSIONS
  In this 2-year prospective study in a hospital-based cohort of high-risk hemodialysis patients, elevated CRP, but not raised PCT, was associated with increased mortality. Inflammation remained present throughout a 2-year follow-up in patients with an initial CRP higher than 5 mg/L. An upper value of CRP above 9.9 mg/L is independly predictive of mortality, mainly from cardiovascular causes. The association of high PCT and CRP was no more predictive of mortality than high CRP.
authors.affiliation: Service de Néphrologie et Hémodialyse, Hôpital Saint André, Bordeaux, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Chauveau
authors.forename: Claude
authors.initials: C
authors.lastname: Level
authors.forename: Catherine
authors.initials: C
authors.lastname: Lasseur
authors.forename: Hervé
authors.initials: H
authors.lastname: Bonarek
authors.forename: Evelyne
authors.initials: E
authors.lastname: Peuchant
authors.forename: Danièle
authors.initials: D
authors.lastname: Montaudon
authors.forename: Benoît
authors.initials: B
authors.lastname: Vendrely
authors.forename: Christian
authors.initials: C
authors.lastname: Combe
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood*; D002097:C-Reactive Protein / Q000032:analysis*; D002116:Calcitonin / Q000097:blood*; D015740:Calcitonin Gene-Related Peptide; D002318:Cardiovascular Diseases / Q000401:mortality; D005260:Female; D006801:Humans; D007239:Infections / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009752:Nutritional Status; D011446:Prospective Studies; D011498:Protein Precursors / Q000097:blood*; D006435:Renal Dialysis / Q000401:mortality*
chemical_list: D015415:Biomarkers; C000606589:CALCA protein, human; D011498:Protein Precursors; D002116:Calcitonin; D002097:C-Reactive Protein; D015740:Calcitonin Gene-Related Peptide