title: Measurement of circulating troponin Ic enhances the prognostic value of C-reactive protein in haemodialysis patients.
abstract: BACKGROUND
  Cardiac Troponin I (cTnI) levels are considered an important diagnostic tool in acute coronary events. They could be of predictive value in haemodialysis (HD) patients. However, the relationship between cTnI and the HD-induced inflammatory state remains unclear. The aim of this study was to explore the prognostic relevance to all-cause and cardiovascular mortalities in HD patients of cTnI, in combination with highly sensitive C-reactive protein (hs-CRP) levels.
  
  
  METHODS
  We measured cTnI and hs-CRP at baseline (March 10 to November 16, 2001) in 191 HD patients without clinical signs of acute coronary artery disease [median age 66.7 years (range 22.3-93.5), 94 females, 97 males]. We used a cTnI concentration with a total imprecision of 10% (0.03 microg/l), determined in the laboratory, as the analytical threshold value. Patients were followed for mortality until 1 January, 2003 (median follow-up 418 days). The adjusted relative risks (RRs) of death and 95% confidence intervals (CIs) were estimated using Cox proportional hazard models.
  
  
  RESULTS
  A significant proportion (25.1%) of patients had elevated CTnl, > or =0.03 microg/l; 40.3% of patients had CRP concentrations > or =10 mg/l. During follow-up, 29 patients died, 44.8% due to cardiac causes. Elevated cTnI or CRP levels were associated with increased mortality [RR adjusted for age, sex and duration of dialysis 4.2 (1.9-9.0) for cTnI > or =0.03 microg/l and 3.6 (1.6-8.1) for CRP > or =10 mg/l], cTnI being particularly predictive of cardiovascular death. Moreover, the combination of elevated hs-CRP (> or =10 mg/l) and circulating cTnI (> or =0.03 microg/l) dramatically impaired the HD survival rate [adjusted RR for all-cause mortality 16.9 (4.5-63.8)].
  
  
  CONCLUSIONS
  Circulating cTnI was associated with poor prognosis, especially when combined with elevated CRP, strongly supporting the adoption of regular cTnI testing in HD patients.
authors.affiliation: Biochemistry Laboratory, Hôpital Lapeyronie, 371 Av. Doyen Gaston Giraud, 34295 Montpellier cedex 5, France. jp-cristol@chu-montpellier.fr
authors.forename: Alexandre
authors.initials: A
authors.lastname: Boulier
authors.forename: Isabelle
authors.initials: I
authors.lastname: Jaussent
authors.forename: Nathalie
authors.initials: N
authors.lastname: Terrier
authors.forename: François
authors.initials: F
authors.lastname: Maurice
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Rivory
authors.forename: Lotfi
authors.initials: L
authors.lastname: Chalabi
authors.forename: Anne-Marie
authors.initials: AM
authors.lastname: Boularan
authors.forename: Cécile
authors.initials: C
authors.lastname: Delcourt
authors.forename: Anne-Marie
authors.initials: AM
authors.lastname: Dupuy
authors.forename: Bernard
authors.initials: B
authors.lastname: Canaud
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Cristol
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002097:C-Reactive Protein / Q000032:analysis*; D002318:Cardiovascular Diseases / Q000097:blood / Q000150:complications / Q000175:diagnosis* / Q000401:mortality*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood / Q000150:complications / Q000401:mortality* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D006435:Renal Dialysis; D019210:Troponin I / Q000097:blood*
chemical_list: D019210:Troponin I; D002097:C-Reactive Protein