Prediction model of coronary heart disease in patients with chronic kidney disease: role of plasma fibrinogen as a new prognostic variable.
BACKGROUND
The Framingham-Anderson (FA) risk equation can predict coronary heart disease (CHD) risk in the general population. However, this formula's validity in predicting CHD risk in chronic kidney disease (CKD) patients is not extensively evaluated.


METHODS
In a group of 96 patients with CKD stage 2 to 4, free of CHD at the time of the start of follow-up, and prospectively followed for 4 to 12 years (7.4 +/- 2.2 years, mean +/- SD), we calculated the FA index.


RESULTS
During the follow-up period, twenty-one patients experienced fatal and non-fatal myocardial infarction (CHDobs+), and 75 remain free of CHD (CHDobs-). The median FA index was 7.1% for CHDobs - patients and 10.3% for CHDobs+ patients. The specificity of the model was acceptable (89%), but the sensitivity was low (24%). Sensitivity analysis by adding fibrinogen led to an improvement in the CHD risk index and the sensitivity of the model (48%) as well. However, despite the addition of fibrinogen to the FA risk factors, full CHD risk in CKD patients remains underestimated.


CONCLUSIONS
Our results show that the FA index is a weak predictor of CHD in CKD stage 2 to 4 patients, and emphasized the role of inflammation in predicting the CHD risk.
Massy
Ziad A
ZA
Divisions of Clinical Pharmacology and Nephrology, INSERM ERI-12, University of Picardie and Amiens University Hospital, Amiens, France. massy@u-picardie.fr
Taupin
Pierre
P
Jungers
Paul
P
Landais
Paul
P
D000368:Aged; D015415:Biomarkers / Q000032:analysis; D002908:Chronic Disease; D003327:Coronary Disease / Q000175:diagnosis* / Q000209:etiology; D005260:Female; D005340:Fibrinogen / Q000032:analysis*; D006801:Humans; D007674:Kidney Diseases / Q000097:blood / Q000150:complications*; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D011379:Prognosis; D012307:Risk Factors; D012680:Sensitivity and Specificity
D015415:Biomarkers; D005340:Fibrinogen