Document Detail


Elevated cardiac troponin T in predialysis patients is associated with inflammation and predicts mortality.
MedLine Citation:
PMID:  12542555     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: Cardiac troponin T (cTnT) is a highly sensitive and specific marker of myocardial damage. It has been shown that elevated serum concentrations of cTnT in haemodialysis (HD) patients are associated with poor prognostic outcome. The aim of the present study was to investigate the predictive value of cTnT in samples from predialysis patients and to investigate associations between cTnT and inflammatory markers, such as C-reactive protein (CRP) and interleukin-6 (IL-6). DESIGN: Cohort, follow-up study. SETTING: Huddinge University Hospital, Sweden. SUBJECTS: A total of 115 (62% males, 28% diabetic patients) end-stage renal disease (ESRD) patients (52 +/- 1 years), of which 29% had cardiovascular disease (CVD), were studied shortly before the onset of dialysis therapy. Sixty-four patients started peritoneal dialysis (PD) as renal replacement therapy, whilst 49 started HD during the follow-up. MAIN OUTCOME MEASURES: The cTnT was analysed with the third generation TnT assay on Elecsys 2010. The prognostic value was calculated for cTnT, IL-6, age, CVD, malnutrition, diabetes mellitus (DM) and gender. Survival analyses were made with Kaplan-Meier and Cox regression analyses, with all-cause mortality as the clinical end point (mean follow-up period 2.7 +/- 0.1 years). RESULTS: Significant correlations were found between cTnT and CKMB (rho = 0.52, P < 0.0001), IL-6 (rho = 0.23, P < 0.05), CRP (rho = 0.30, P < 0.05), and serum albumin (rho = -0.31, P < 0.001), respectively. Diabetic patients had higher median serum cTnT level (0.09 microg L-1; range <0.01-0.51 vs. 0.04 microg L-1; range <0.01-0.67 microg L-1; P < 0.005) compared with nondiabetic patients. Likewise, patients with CVD had a significantly higher median level (0.08 microg L-1; range <0.01-0.67 microg L-1 vs. 0.04 microg L-1; range <0.01-0.61 microg L-1; P < 0.01) of cTnT compared with patients without CVD. Patients with cTnT > or =0.10 microg L-1 had a higher cumulative mortality rate than patients with cTnT < 0.10 microg L-1 (chi2 = 7.04; P < 0.01). Whilst age, CVD, malnutrition, DM, IL-6, cTnT and male gender were associated with poor outcome in the univariate analysis, only DM (P < 0.05) and cTnT (P < 0.05) were independently associated with mortality in a multivariate analysis. CONCLUSIONS: The present study demonstrates that serum concentrations of cTnT > or =0.10 microg L-1 is a significant predictor of mortality in patients starting dialysis. Moreover, the positive correlations between cTnT and IL-6, and CRP, respectively, suggest an association between inflammation and cTnT levels. Finally, the results of the present study suggest that cTnT is an independent predictor of mortality in ESRD patients starting dialysis.
Authors:
C Löwbeer; P Stenvinkel; R Pecoits-Filho; O Heimbürger; B Lindholm; S A Gustafsson; A Seeberger
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of internal medicine     Volume:  253     ISSN:  0954-6820     ISO Abbreviation:  J. Intern. Med.     Publication Date:  2003 Feb 
Date Detail:
Created Date:  2003-01-24     Completed Date:  2003-03-24     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  8904841     Medline TA:  J Intern Med     Country:  England    
Other Details:
Languages:  eng     Pagination:  153-60     Citation Subset:  IM    
Affiliation:
Division of Clinical Chemistry, Department of Medical Laboratory Sciences and Technology, Karolinska Institutet at Huddinge University Hospital, Stockholm, Sweden. christian.lowbeer@medilab.se
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MeSH Terms
Descriptor/Qualifier:
Biological Markers / blood
C-Reactive Protein / analysis
Cardiomyopathies / blood,  mortality
Cohort Studies
Diabetic Nephropathies / blood,  mortality
Female
Follow-Up Studies
Humans
Interleukin-6 / blood
Kidney Failure, Chronic / blood,  mortality*,  therapy
Male
Middle Aged
Prognosis
Renal Dialysis / mortality*
Survival Rate
Troponin T / blood*
Chemical
Reg. No./Substance:
0/Biological Markers; 0/Interleukin-6; 0/Troponin T; 9007-41-4/C-Reactive Protein

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