title: Pregnancy-associated plasma protein A as an independent mortality predictor in long-term hemodialysis patients.
abstract: OBJECTIVE
  Pregnancy-associated plasma protein A (PAPP-A) is a biomarker related to vascular damage. The aim of the study was to focus on PAPP-A and related parameters and their relationship to the prognosis of long-term hemodialysis (HD) patients.
  
  
  METHODS
  This is a prospective observational cohort study which included 261 long-term HD patients followed up for 5 years and 66 healthy subjects. PAPP-A, placental growth factor (PlGF), matrix metalloproteinase 2 and 9 (MMP-2, MMP-9), insulin-like growth factor 1 (IGF-1), insulin-like growth factor binding protein-4 (IGFBP-4), and cardiac, nutritional and inflammatory parameters were measured at the beginning of the study and tested as predictors of mortality.
  
  
  RESULTS
  PAPP-A, PlGF, IGF-1, IGFBP-4 and MMP-2 were significantly increased in HD patients compared to controls (PAPP-A 27.6 ± 15.5 mIU/l in HD vs. 9.4 ± 2.5 mIU/l in controls, p < 0.001). Increased PAPP-A was a significant independent predictor of overall mortality and mortality due to infection in the multivariate Cox analysis [HR (95% CI): 1.237 (1.060-1.444), p = 0.007, and 1.416 (1.115-1.798), p = 0.004, per standard deviation, respectively]. PAPP-A was not related to cardiovascular mortality.
  
  
  CONCLUSIONS
  Increased PAPP-A is a significant independent predictor of overall mortality and mortality due to infection but it was not related to cardiovascular mortality in this study.
authors: Institute of Clinical Biochemistry and Laboratory Diagnostics, Charles University and General University Hospital, Prague, Czech Republic. marta.kalousova@seznam.cz
authors: Marta
authors: M
authors: Kalousová
authors: Hana
authors: H
authors: Benáková
authors: Aleš Antonín
authors: AA
authors: Kuběna
authors: Sylvie
authors: S
authors: Dusilová-Sulková
authors: Vladimír
authors: V
authors: Tesař
authors: Tomáš
authors: T
authors: Zima
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011266:Pregnancy-Associated Plasma Protein-A / Q000378:metabolism*; D011446:Prospective Studies; D006435:Renal Dialysis / Q000401:mortality* / Q000639:trends; D015996:Survival Rate / Q000639:trends; D013997:Time Factors
chemical_list: D015415:Biomarkers; D011266:Pregnancy-Associated Plasma Protein-A