title: Association of Urinary Cadmium with Mortality in Patients at a Coronary Care Unit.
abstract: BACKGROUND
  Determine the effect of the day 1 urinary excretion of cadmium (D1-UE-Cd) on mortality of patients admitted to a coronary care unit (CCU).
  
  
  METHODS
  A total of 323 patients were enrolled in this 6-month study. Urine and blood samples were taken within 24 h after CCU admission. Demographic data, clinical diagnoses, and hospital mortality were recorded. The scores of established systems for prediction of mortality in critically ill patients were calculated.
  
  
  RESULTS
  Compared with survivors (n = 289), non-survivors (n = 34) had higher levels of D1-UE-Cd. Stepwise multiple linear regression analysis indicated that D1-UE-Cd was positively associated with pulse rate and level of aspartate aminotransferase, but negatively associated with serum albumin level. Multivariate Cox analysis, with adjustment for other significant variables and measurements from mortality scoring systems, indicated that respiratory rate and D1-UE-Cd were independent and significant predictors of mortality. For each 1 μg/day increase of D1-UE-Cd, the hazard ratio for CCU mortality was 3.160 (95% confidence interval: 1.944-5.136, p < 0.001). The chi-square value of Hosmer-Lemeshow goodness-of-fit test for D1-UE-Cd was 10.869 (p = 0.213). The area under the receiver operating characteristic curve for D1-UE-Cd was 0.87 (95% confidence interval: 0.81-0.93).
  
  
  CONCLUSIONS
  The D1-UE-Cd, an objective variable with no inter-observer variability, accurately predicted hospital mortality of CCU patients and outperformed other established scoring systems. Further studies are needed to determine the physiological mechanism of the effect of cadmium on mortality in CCU patients.
authors.affiliation: Department of Nephrology, Division of Clinical Toxicology, Chang Gung Memorial Hospital, Taipei, Taiwan.|Department of Nephrology, Division of Clinical Toxicology, Lin-Kou Medical Center, Taoyuan, Taiwan.|Chang Gung University and School of Medicine, Taoyuan, Taiwan.
authors.forename: Ching-Wei
authors.initials: CW
authors.lastname: Hsu
authors.affiliation: Department of Nephrology, Division of Clinical Toxicology, Chang Gung Memorial Hospital, Taipei, Taiwan.|Department of Nephrology, Division of Clinical Toxicology, Lin-Kou Medical Center, Taoyuan, Taiwan.|Chang Gung University and School of Medicine, Taoyuan, Taiwan.
authors.forename: Cheng-Hao
authors.initials: CH
authors.lastname: Weng
authors.affiliation: Department of Nephrology, Division of Clinical Toxicology, Chang Gung Memorial Hospital, Taipei, Taiwan.|Department of Nephrology, Division of Clinical Toxicology, Lin-Kou Medical Center, Taoyuan, Taiwan.|Chang Gung University and School of Medicine, Taoyuan, Taiwan.
authors.forename: Dan-Tzu
authors.initials: DT
authors.lastname: Lin-Tan
authors.affiliation: Chang Gung University and School of Medicine, Taoyuan, Taiwan.|Division of Cardiology, Chang Gung Memorial Hospital, Lin-Kou Medical Center, Taoyuan, Taiwan.
authors.forename: Pao-Hsien
authors.initials: PH
authors.lastname: Chu
authors.affiliation: Department of Nephrology, Division of Clinical Toxicology, Chang Gung Memorial Hospital, Taipei, Taiwan.|Department of Nephrology, Division of Clinical Toxicology, Lin-Kou Medical Center, Taoyuan, Taiwan.|Chang Gung University and School of Medicine, Taoyuan, Taiwan.
authors.forename: Tzung-Hai
authors.initials: TH
authors.lastname: Yen
authors.affiliation: Department of Nephrology, Division of Clinical Toxicology, Chang Gung Memorial Hospital, Taipei, Taiwan.|Department of Nephrology, Division of Clinical Toxicology, Lin-Kou Medical Center, Taoyuan, Taiwan.|Chang Gung University and School of Medicine, Taoyuan, Taiwan.
authors.forename: Kuan-Hsing
authors.initials: KH
authors.lastname: Chen
authors.affiliation: Department of Nephrology, Division of Clinical Toxicology, Chang Gung Memorial Hospital, Taipei, Taiwan.|Department of Nephrology, Division of Clinical Toxicology, Lin-Kou Medical Center, Taoyuan, Taiwan.|Chang Gung University and School of Medicine, Taoyuan, Taiwan.
authors.forename: Chung-Yin
authors.initials: CY
authors.lastname: Lin
authors.affiliation: Department of Nephrology, Division of Clinical Toxicology, Chang Gung Memorial Hospital, Taipei, Taiwan.|Department of Nephrology, Division of Clinical Toxicology, Lin-Kou Medical Center, Taoyuan, Taiwan.|Chang Gung University and School of Medicine, Taoyuan, Taiwan.
authors.forename: Wen-Hung
authors.initials: WH
authors.lastname: Huang
mesh_terms: D018806:APACHE; D000368:Aged; D000369:Aged, 80 and over; D001219:Aspartate Aminotransferases / Q000097:blood; D002104:Cadmium / Q000652:urine*; D002318:Cardiovascular Diseases / Q000175:diagnosis* / Q000401:mortality* / Q000473:pathology / Q000652:urine; D002413:Cations, Divalent; D003325:Coronary Care Units; D005260:Female; D006339:Heart Rate; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D015203:Reproducibility of Results; D012709:Serum Albumin / Q000378:metabolism; D012720:Severity of Illness Index; D016019:Survival Analysis
chemical_list: D002413:Cations, Divalent; D012709:Serum Albumin; D002104:Cadmium; D001219:Aspartate Aminotransferases