Cardiovascular risk stratification in hemodialysis patients in the era of highly sensitive troponins: should we choose between hs-troponin I and hs-troponin T?

被引：8

作者：

Bargnoux, Anne-Sophie ^{[1
]}

Kuster, Nils ^{[1
]}

Patrier, Laure ^{[3
]}

Dupuy, Anne-Marie ^{[4
]}

Tachon, Gaelle ^{[4
]}

Maurice, Francois ^{[5
,6
]}

Badaoui, Bouchra ^{[4
]}

Chalabi, Lotfi ^{[3
]}

Badiou, Stephanie ^{[1
]}

Deleuze, Sebastien ^{[6
]}

Leray-Moragues, Helene ^{[7
]}

Morena, Marion ^{[1
,2
]}

Canaud, Bernard ^{[8
]}

Cristol, Jean-Paul ^{[1
,2
]}

机构：

[1] Univ Montpellier, CHRU Montpellier, Lab Biochim, PhyMedExp,INSERM U1046,CNRS UMR 9214, 191 Ave Doyen Gaston Giraud, F-34295 Montpellier 5, France

[2] CHRU Montpellier, Inst Rech & Format Dialyse, Montpellier, France

[3] Assoc Installat Domicile Epurat Renales, Languedoc Roussillon, France

[4] Univ Montpellier I, CHRU Montpellier, Lab Biochim, Montpellier, France

[5] CHRU Montpellier, Inst Rech & Format Dialyse, Montpellier, France

[6] Ctr NephroCare, F-34000 Castelnau Le Lez, France

[7] Univ Montpellier I, CHRU Montpellier, Serv Nephrol, Montpellier, France

[8] Fresenius Med Care, Bad Homburg, Germany

来源：

CLINICAL CHEMISTRY AND LABORATORY MEDICINE | 2016年 / 54卷 / 04期

关键词：

conventional troponins; hemodialysis (HD); high-sensitivity troponins; mortality; CHRONIC KIDNEY-DISEASE; C-REACTIVE PROTEIN; CARDIAC TROPONIN; PROGNOSTIC VALUE; ASSAY; BIOMARKERS; MORTALITY; PERFORMANCE; ADJUSTMENT; TIME;

D O I：

10.1515/cclm-2015-0071

中图分类号：

R446 [实验室诊断]; R-33 [实验医学、医学实验];

学科分类号：

1001 ;

摘要：

Background: New highly sensitive (hs) assays have challenged the interpretation of cardiac troponins (cTn). The present study was designed to evaluate simultaneously conventional cTnT and cTnI together with their corresponding highly sensitive determinations in stable hemodialysis (HD) patients. Ability of cTn to stratify HD patient risk was assessed. Methods: A total of 224 stable HD patients was included in this observational study. cTnT and hs-cTnT were measured using Roche cTnT/hs-cTnT assays based on a Cobas e601 (R) analyzer. cTnI and hs-cTnI were measured using Beckman AccuTnI/hs-TnI IUO assays on Access II system. Patients were followed up prospectively during 9 years. Relationship between cTn level and mortality was assessed through Cox survival analysis. Results: The median cTnT and cTnI concentrations were 38.5 ng/L (IQR, 18.8-76) and 10 ng/L (IQR, 10-20), respectively. The median hs-cTnT and hs-cTnI concentrations were 62.5 ng/L (IQR, 38.8-96.3) and 13.9 ng/L (IQR, 8.4-23.6), respectively. The prevalence of values above the 99th percentile was significantly more marked with cTnT (85.3 and 97.8% for conventional and hs cTnT, respectively) than with cTnI (7.6 and 67.4% for -conventional and hs cTnI, respectively). During the follow-up, 167 patients died, mainly from cardiac cause (n = 77). The optimized cut-off values, determined by bootstrap method, predicting mortality were 38, 69, 20 and 11 ng/L for cTnT, hs-cTnT, cTnI and hs-cTnI, respectively. After full adjustment, elevated plasma concentrations of all troponin were significant predictors of mortality. Conclusions: A large proportion of patients free of acute coronary syndrome (ACS) has hs-cTn I or T higher than the 99th percentile which could be seen as a limiting factor for ACS screening. However, all generation and type of troponin assays could be reliable indicators of prognosis risk in HD patients.

引用

页码：673 / 682

页数：10

共 43 条

[1] Weekly and 90-Minute Biological Variations in Cardiac Troponin T and Cardiac Troponin I in Hemodialysis Patients and Healthy Controls [J].

Aakre, Kristin M. ;

Roraas, Thomas ;

Petersen, Per Hyltoft ;

Svarstad, Einar ;

Sellevoll, Hilde ;

Skadberg, Oyvind ;

Saele, Kristin ;

Sandberg, Sverre .

CLINICAL CHEMISTRY, 2014, 60 (06) :838-847

[2] Clinical Implications of a Recent Adjustment to the High-Sensitivity Cardiac Troponin T Assay: User Beware [J].

Apple, Fred S. ;

Jaffe, Allan S. .

CLINICAL CHEMISTRY, 2012, 58 (11) :1599-1600

[3] Determination of 19 Cardiac Troponin I and T Assay 99th Percentile Values from a Common Presumably Healthy Population [J].

Apple, Fred S. ;

Ler, Ranka ;

Murakami, MaryAnn M. .

CLINICAL CHEMISTRY, 2012, 58 (11) :1574-1581

[4] A New Season for Cardiac Troponin Assays: It's Time to Keep a Scorecard [J].

Apple, Fred S. .

CLINICAL CHEMISTRY, 2009, 55 (07) :1303-1306

[5] Predictive value of cardiac troponin I and T for subsequent death in end-stage renal disease [J].

Apple, FS ;

Murakami, MM ;

Pearce, LA ;

Herzog, CA .

CIRCULATION, 2002, 106 (23) :2941-2945

[6]

Armbruster David A, 2008, Clin Biochem Rev, V29 Suppl 1, pS49

[7] Sensitive Troponins - Which Suits Better for Hemodialysis Patients? Associated Factors and Prediction of Mortality [J].

Artunc, Ferruh ;

Mueller, Christian ;

Breidthardt, Tobias ;

Twerenbold, Raphael ;

Peter, Andreas ;

Thamer, Claus ;

Weyrich, Peter ;

Haering, Hans-Ulrich ;

Friedrich, Bjoern .

PLOS ONE, 2012, 7 (10)

[8] A combined index of cardiac biomarkers as a risk factor for early cardiovascular mortality in hemodialysis patients [J].

Bargnoux, Anne-Sophie ;

Morena, Marion ;

Jaussent, Isabelle ;

Maurice, Francois ;

Chalabi, Lotfi ;

Leray-Moragues, Helene ;

Terrier, Nathalie ;

Dupuy, Anne-Marie ;

Badiou, Stephanie ;

Canaud, Bernard ;

Cristol, Jean-Paul .

CLINICAL CHEMISTRY AND LABORATORY MEDICINE, 2013, 51 (09) :1865-1874

[9] The effect of freezing and long-term storage on the stability of cardiac troponin T [J].

Basit, Majid ;

Bakshi, Nasir ;

Hashem, Mustafa ;

Allebban, Zuhair ;

Lawson, Noel ;

Rosman, Howard S. ;

Maciejko, James J. .

AMERICAN JOURNAL OF CLINICAL PATHOLOGY, 2007, 128 (01) :164-167

[10] Measurement of circulating troponin Ic enhances the prognostic value of C-reactive protein in haemodialysis patients [J].

Boulier, A ;

Jaussent, I ;

Terrier, N ;

Maurice, F ;

Rivory, JP ;

Chalabi, L ;

Boularan, AM ;

Delcourt, C ;

Dupuy, AM ;

Canaud, B ;

Cristol, JP .

NEPHROLOGY DIALYSIS TRANSPLANTATION, 2004, 19 (09) :2313-2318

← 1 2 3 4 5 →