title: Cardiac troponin and C-reactive protein for predicting all-cause and cardiovascular mortality in patients with chronic kidney disease: a meta-analysis.
abstract: Elevated serum levels of cardiac troponin and C-reactive protein are associated with all-cause and cardiovascular mortality in patients with end-stage renal disease. However, the relationship between these two biomarker levels and mortality in patients with chronic kidney disease remains unclear. We conducted a meta-analysis to quantify the association of cardiac troponin and C-reactive protein levels with all-cause and cardiovascular mortality in patients with chronic kidney disease. Relevant studies were identified by searching the MEDLINE database through November 2013. Studies were included in the meta-analysis if they reported the long-term all-cause or cardiovascular mortality of chronic kidney disease patients with abnormally elevated serum levels of cardiac troponin or C-reactive protein. Summary estimates of association were obtained using a random-effects model. Thirty-two studies met our inclusion criteria. From the pooled analysis, cardiac troponin and C-reactive protein were significantly associated with all-cause (HR 2.93, 95% CI 1.97-4.33 and HR 1.21, 95% CI 1.14-1.29, respectively) and cardiovascular (HR 3.27, 95% CI 1.67-6.41 and HR 1.19, 95% CI 1.10-1.28, respectively) mortality. In the subgroup analysis of cardiac troponin and C-reactive protein, significant heterogeneities were found among the subgroups of population for renal replacement therapy and for the proportion of smokers and the C-reactive protein analysis method. Elevated serum levels of cardiac troponin and C-reactive protein are significant associated with higher risks of all-cause and cardiovascular mortality in patients with chronic kidney disease. Further studies are warranted to explore the risk stratification in chronic kidney disease patients.
authors.affiliation: Department of Cardiology, First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.
authors.forename: Wei-Jie
authors.initials: WJ
authors.lastname: Li
authors.affiliation: Department of Cardiology, First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.
authors.forename: Xu-Miao
authors.initials: XM
authors.lastname: Chen
authors.affiliation: Outpatient Department, First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.
authors.forename: Xiao-Ying
authors.initials: XY
authors.lastname: Nie
authors.affiliation: Department of Cardiology, First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.
authors.forename: Jing
authors.initials: J
authors.lastname: Zhang
authors.affiliation: Department of Cardiology, First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.
authors.forename: Yun-Jiu
authors.initials: YJ
authors.lastname: Cheng
authors.affiliation: Department of Cardiology, First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.
authors.forename: Xiao-Xiong
authors.initials: XX
authors.lastname: Lin
authors.affiliation: Department of Cardiology, First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.
authors.forename: Su-Hua
authors.initials: SH
authors.lastname: Wu
mesh_terms: D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis*; D002318:Cardiovascular Diseases / Q000097:blood* / Q000209:etiology / Q000401:mortality*; D005260:Female; D006801:Humans; D008297:Male; D011237:Predictive Value of Tests; D051436:Renal Insufficiency, Chronic / Q000097:blood* / Q000150:complications / Q000401:mortality*; D012307:Risk Factors; D014336:Troponin / Q000097:blood*
chemical_list: D015415:Biomarkers; D014336:Troponin; D002097:C-Reactive Protein