title: Multiple biomarkers including cardiac troponins T and I measured by high-sensitivity assays, as predictors of long-term mortality in patients with chronic renal failure who underwent dialysis.
abstract: There is a high cardiac mortality in patients on long-term renal dialysis. No studies have reported long-term outcomes relating to both high-sensitivity cardiac troponin T (hs-cTnT) and high-sensitivity cardiac troponin I (hs-cTnI) in these patients. Patients who underwent long-term dialysis at the Canberra Hospital had blood samples collected for both cardiac and other biomarkers. Samples were stored at -80°C until analysis. Mortality data were collected at 5 years, and univariate and multivariate analyses were performed to identify which biomarkers were predictive of mortality at 5 years. After multivariate analysis, albumin, C-reactive protein (CRP), and hs-cTnT remained independently predictive of all-cause mortality, with hs-cTnT having the highest hazard ratio. If hs-cTnT was excluded from the analysis, then hs-cTnI was independently predictive of mortality. For hs-cTnT, for both genders, the ninety-ninth percentile, derived from a population with subjects with subclinical disease excluded, served as an excellent partition between survivors and nonsurvivors. Receiver-operating characteristic curve analysis for hs-cTnT had area under the curve of 0.798 and for hs-cTnI of 0.774. Kaplan-Meier curves for the aggregation of albumin, CRP, and hs-cTnT showed a stronger predictive power with receiver-operating characteristic area under the curve of 0.805. The addition of echocardiographic data in an analysis of all patients who had an echocardiogram for clinical reasons (n = 105) did not alter the final observations in this subgroup. In conclusion, hs-cTnT retains a superior predictive power in a dialysis-dependent population for identifying those at risk for death and when aggregated with albumin and CRP also has substantial additive value for identifying mortality risk in a renal-dialysis population.
authors: ACT Pathology, Canberra Hospital, Garran, Australia; Australian National University Medical School, Canberra, Australia. Electronic address: peter.hickman@act.gov.au.
authors: Peter E
authors: PE
authors: Hickman
authors: Australian National University Medical School, Canberra, Australia; Department of Cardiology, Canberra Hospital, Garran, Australia.
authors: Darryl
authors: D
authors: McGill
authors: ACT Pathology, Canberra Hospital, Garran, Australia; Australian National University Medical School, Canberra, Australia.
authors: Julia M
authors: JM
authors: Potter
authors: ACT Pathology, Canberra Hospital, Garran, Australia.
authors: Gus
authors: G
authors: Koerbin
authors: Department of Laboratory Medicine and Pathology, Hennepin County Medical Center, Minneapolis, Minnesota; University of Minnesota School of Medicine, Minneapolis, Minnesota.
authors: Fred S
authors: FS
authors: Apple
authors: Australian National University Medical School, Canberra, Australia; Department of Nephrology, Canberra Hospital, Garran, Australia.
authors: Girish
authors: G
authors: Talaulikar
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D003430:Cross-Sectional Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood* / Q000401:mortality* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D006435:Renal Dialysis; D012680:Sensitivity and Specificity; D013997:Time Factors; D019210:Troponin I / Q000097:blood*; D020107:Troponin T / Q000097:blood*; D055815:Young Adult
chemical_list: D015415:Biomarkers; D019210:Troponin I; D020107:Troponin T