Cargando…
Association of NTproBNP and cTnI with outpatient sudden cardiac death in hemodialysis patients: the Choices for Healthy Outcomes in Caring for ESRD (CHOICE) study
BACKGROUND: Sudden cardiac death (SCD) is the most common etiology of death in hemodialysis patients but not much is known about its risk factors. The goal of our study was to determine the association and risk prediction of SCD by serum N-terminal prohormone of brain natriuretic peptide (NTproBNP)...
Autores principales: | , , , , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2016
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4761195/ https://www.ncbi.nlm.nih.gov/pubmed/26897129 http://dx.doi.org/10.1186/s12882-016-0230-x |
_version_ | 1782416948059963392 |
---|---|
author | Kruzan, Rachel M. Herzog, Charles A. Wu, Aozhou Sang, Yingying Parekh, Rulan S. Matsushita, Kunihiro Hwang, Seungyoung Cheng, Alan Coresh, Josef Powe, Neil R. Shafi, Tariq |
author_facet | Kruzan, Rachel M. Herzog, Charles A. Wu, Aozhou Sang, Yingying Parekh, Rulan S. Matsushita, Kunihiro Hwang, Seungyoung Cheng, Alan Coresh, Josef Powe, Neil R. Shafi, Tariq |
author_sort | Kruzan, Rachel M. |
collection | PubMed |
description | BACKGROUND: Sudden cardiac death (SCD) is the most common etiology of death in hemodialysis patients but not much is known about its risk factors. The goal of our study was to determine the association and risk prediction of SCD by serum N-terminal prohormone of brain natriuretic peptide (NTproBNP) troponin I (cTnI) in hemodialysis patients. METHODS: We measured NTproBNP and cTnI in 503 hemodialysis patients of a national prospective cohort study. We determined their association with SCD using Cox regression, adjusting for demographics, co-morbidities, and clinical factors and risk prediction using C-statistic and Net Reclassification Improvement (NRI). RESULTS: Patients’ mean age was 58 years and 54 % were male. During follow-up (median 3.5 years), there were 75 outpatient SCD events. In unadjusted and fully-adjusted models, NTproBNP had a significant association with the risk of SCD. Analyzed as a continuous variable, the risk of SCD increased 27 % with each 2-fold increase in NTproBNP (HR, 1.27 per doubling; 95 % CI, 1.13–1.43; p < 0.001). In categorical models, the risk of SCD was 3-fold higher in the highest tertile of NTproBNP (>7,350 pg/mL) compared with the lowest tertile (<1,710 pg/mL; HR for the highest tertile, 3.03; 95 % CI, 1.56–5.89; p = 0.001). Higher cTnI showed a trend towards increased risk of SCD in fully adjusted models, but was not statistically significant (HR, 1.17 per doubling; 95 % CI, 0.98–1.40; p = 0.08). Sensitivity analyses using competing risk models showed similar results. Improvement in risk prediction by adding cardiac biomarkers to conventional risk factors was greater with NTproBNP (C-statistic for 3-year risk: 0.810; 95 % CI, 0.757 to 0.864; and continuous NRI: 0.270; 95 % CI, 0.046 to 0.495) than with cTnI. CONCLUSIONS: NTproBNP is associated with the risk of SCD in hemodialysis patients. Further research is needed to determine if biomarkers measurement can guide SCD risk prevention strategies in dialysis patients. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12882-016-0230-x) contains supplementary material, which is available to authorized users. |
format | Online Article Text |
id | pubmed-4761195 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2016 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-47611952016-02-21 Association of NTproBNP and cTnI with outpatient sudden cardiac death in hemodialysis patients: the Choices for Healthy Outcomes in Caring for ESRD (CHOICE) study Kruzan, Rachel M. Herzog, Charles A. Wu, Aozhou Sang, Yingying Parekh, Rulan S. Matsushita, Kunihiro Hwang, Seungyoung Cheng, Alan Coresh, Josef Powe, Neil R. Shafi, Tariq BMC Nephrol Research Article BACKGROUND: Sudden cardiac death (SCD) is the most common etiology of death in hemodialysis patients but not much is known about its risk factors. The goal of our study was to determine the association and risk prediction of SCD by serum N-terminal prohormone of brain natriuretic peptide (NTproBNP) troponin I (cTnI) in hemodialysis patients. METHODS: We measured NTproBNP and cTnI in 503 hemodialysis patients of a national prospective cohort study. We determined their association with SCD using Cox regression, adjusting for demographics, co-morbidities, and clinical factors and risk prediction using C-statistic and Net Reclassification Improvement (NRI). RESULTS: Patients’ mean age was 58 years and 54 % were male. During follow-up (median 3.5 years), there were 75 outpatient SCD events. In unadjusted and fully-adjusted models, NTproBNP had a significant association with the risk of SCD. Analyzed as a continuous variable, the risk of SCD increased 27 % with each 2-fold increase in NTproBNP (HR, 1.27 per doubling; 95 % CI, 1.13–1.43; p < 0.001). In categorical models, the risk of SCD was 3-fold higher in the highest tertile of NTproBNP (>7,350 pg/mL) compared with the lowest tertile (<1,710 pg/mL; HR for the highest tertile, 3.03; 95 % CI, 1.56–5.89; p = 0.001). Higher cTnI showed a trend towards increased risk of SCD in fully adjusted models, but was not statistically significant (HR, 1.17 per doubling; 95 % CI, 0.98–1.40; p = 0.08). Sensitivity analyses using competing risk models showed similar results. Improvement in risk prediction by adding cardiac biomarkers to conventional risk factors was greater with NTproBNP (C-statistic for 3-year risk: 0.810; 95 % CI, 0.757 to 0.864; and continuous NRI: 0.270; 95 % CI, 0.046 to 0.495) than with cTnI. CONCLUSIONS: NTproBNP is associated with the risk of SCD in hemodialysis patients. Further research is needed to determine if biomarkers measurement can guide SCD risk prevention strategies in dialysis patients. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12882-016-0230-x) contains supplementary material, which is available to authorized users. BioMed Central 2016-02-20 /pmc/articles/PMC4761195/ /pubmed/26897129 http://dx.doi.org/10.1186/s12882-016-0230-x Text en © Kruzan et al. 2016 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. |
spellingShingle | Research Article Kruzan, Rachel M. Herzog, Charles A. Wu, Aozhou Sang, Yingying Parekh, Rulan S. Matsushita, Kunihiro Hwang, Seungyoung Cheng, Alan Coresh, Josef Powe, Neil R. Shafi, Tariq Association of NTproBNP and cTnI with outpatient sudden cardiac death in hemodialysis patients: the Choices for Healthy Outcomes in Caring for ESRD (CHOICE) study |
title | Association of NTproBNP and cTnI with outpatient sudden cardiac death in hemodialysis patients: the Choices for Healthy Outcomes in Caring for ESRD (CHOICE) study |
title_full | Association of NTproBNP and cTnI with outpatient sudden cardiac death in hemodialysis patients: the Choices for Healthy Outcomes in Caring for ESRD (CHOICE) study |
title_fullStr | Association of NTproBNP and cTnI with outpatient sudden cardiac death in hemodialysis patients: the Choices for Healthy Outcomes in Caring for ESRD (CHOICE) study |
title_full_unstemmed | Association of NTproBNP and cTnI with outpatient sudden cardiac death in hemodialysis patients: the Choices for Healthy Outcomes in Caring for ESRD (CHOICE) study |
title_short | Association of NTproBNP and cTnI with outpatient sudden cardiac death in hemodialysis patients: the Choices for Healthy Outcomes in Caring for ESRD (CHOICE) study |
title_sort | association of ntprobnp and ctni with outpatient sudden cardiac death in hemodialysis patients: the choices for healthy outcomes in caring for esrd (choice) study |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4761195/ https://www.ncbi.nlm.nih.gov/pubmed/26897129 http://dx.doi.org/10.1186/s12882-016-0230-x |
work_keys_str_mv | AT kruzanrachelm associationofntprobnpandctniwithoutpatientsuddencardiacdeathinhemodialysispatientsthechoicesforhealthyoutcomesincaringforesrdchoicestudy AT herzogcharlesa associationofntprobnpandctniwithoutpatientsuddencardiacdeathinhemodialysispatientsthechoicesforhealthyoutcomesincaringforesrdchoicestudy AT wuaozhou associationofntprobnpandctniwithoutpatientsuddencardiacdeathinhemodialysispatientsthechoicesforhealthyoutcomesincaringforesrdchoicestudy AT sangyingying associationofntprobnpandctniwithoutpatientsuddencardiacdeathinhemodialysispatientsthechoicesforhealthyoutcomesincaringforesrdchoicestudy AT parekhrulans associationofntprobnpandctniwithoutpatientsuddencardiacdeathinhemodialysispatientsthechoicesforhealthyoutcomesincaringforesrdchoicestudy AT matsushitakunihiro associationofntprobnpandctniwithoutpatientsuddencardiacdeathinhemodialysispatientsthechoicesforhealthyoutcomesincaringforesrdchoicestudy AT hwangseungyoung associationofntprobnpandctniwithoutpatientsuddencardiacdeathinhemodialysispatientsthechoicesforhealthyoutcomesincaringforesrdchoicestudy AT chengalan associationofntprobnpandctniwithoutpatientsuddencardiacdeathinhemodialysispatientsthechoicesforhealthyoutcomesincaringforesrdchoicestudy AT coreshjosef associationofntprobnpandctniwithoutpatientsuddencardiacdeathinhemodialysispatientsthechoicesforhealthyoutcomesincaringforesrdchoicestudy AT poweneilr associationofntprobnpandctniwithoutpatientsuddencardiacdeathinhemodialysispatientsthechoicesforhealthyoutcomesincaringforesrdchoicestudy AT shafitariq associationofntprobnpandctniwithoutpatientsuddencardiacdeathinhemodialysispatientsthechoicesforhealthyoutcomesincaringforesrdchoicestudy |