title: A combined index of cardiac biomarkers as a risk factor for early cardiovascular mortality in hemodialysis patients.
abstract: BACKGROUND
  Cardiac biomarkers, including cardiac troponin-I (cTn-I) and N-terminal pro brain natriuretic peptide (NT-proBNP) have been associated with poor outcome in hemodialysis (HD) patients. The present study was designed to evaluate these biomarkers as biological risk factors for early and late mortality in HD patients. In addition, a multimarker approach including inflammatory index was performed in order to improve the cardiovascular risk assessment of these patients.
  
  
  METHODS
  cTnI, NT-proBNP and C-reactive protein (CRP) were measured at baseline (October through November 2002) in 130 HD patients [median age 69.0 (23.4-87.7) years old, 76 females, 54 males]. Patients were followed during 8 years. Adjusted hazard ratios (HRs) of death and 95% confidence intervals (CIs) were estimated using Cox proportional hazard models.
  
  
  RESULTS
  During the follow-up, 82 patients died, mainly from cardiac cause (63.4%). Elevated cTnI, NT-proBNP or CRP were all associated with increased early (death within 2 years of follow-up) but not late mortality. Moreover, the combination of all parameters (CRP ≥10.51 mg/L and cTnI ≥0.037 µg/L and NT-proBNP ≥10,204 pg/mL) dramatically increased the short-term mortality especially the cardiovascular mortality (HR 8.58, 95% CI 1.59-46.2; p=0.0007).
  
  
  CONCLUSIONS
  A combined index of cardiovascular risk factors could provide supplementary risk stratification in HD patients for early cardiovascular mortality, strongly supporting the annual routine determination of these biomarkers.
authors: Anne-Sophie
authors: AS
authors: Bargnoux
authors: Marion
authors: M
authors: Morena
authors: Isabelle
authors: I
authors: Jaussent
authors: Francois
authors: F
authors: Maurice
authors: Lotfi
authors: L
authors: Chalabi
authors: Hélène
authors: H
authors: Leray-Moragues
authors: Nathalie
authors: N
authors: Terrier
authors: Anne-Marie
authors: AM
authors: Dupuy
authors: Stéphanie
authors: S
authors: Badiou
authors: Bernard
authors: B
authors: Canaud
authors: Jean-Paul
authors: JP
authors: Cristol
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism*; D002318:Cardiovascular Diseases / Q000097:blood* / Q000401:mortality*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D011379:Prognosis; D006435:Renal Dialysis / Q000379:methods* / Q000401:mortality*; D012307:Risk Factors; D055815:Young Adult
chemical_list: D015415:Biomarkers; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain; D002097:C-Reactive Protein