Document Detail


Prognostic value of troponin T and I among asymptomatic patients with end-stage renal disease: a meta-analysis.
MedLine Citation:
PMID:  16286604     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: The prognostic usefulness of troponin enzymes in end-stage renal disease (ESRD) patients is controversial. To resolve this uncertainty of troponin as a prognostic tool, we conducted a systematic review to quantify the association between elevated troponin I or T and long-term total mortality among ESRD patients not suspected of having acute coronary syndrome. METHODS AND RESULTS: We conducted an unrestricted search from the MEDLINE, EMBASE, and DARE bibliographic databases to December 2004 using the terms troponin.mp. or exp troponin and exp kidney, exp renal, exp kidney disease exp renal replacement therapy. We also manually searched review articles and bibliographies to supplement the search. Studies were included if they were prospective observational studies, used cardiac-specific troponin assays, and evaluated long-term risk of death or cardiac events for asymptomatic ESRD patients. Two authors independently abstracted data on study and patient characteristics. Studies findings were stratified according to troponin T or I levels. We used a random-effects model to pool study results and tested for heterogeneity using chi2 testing and used funnel-plot inspection to evaluate the presence of publication bias. Data from 28 studies (3931 patients) published between 1999 and December 2004 were included in this review. Patients received dialysis for a median duration of 4 years, with a mean follow-up of 23 months. From the pooled analysis, elevated troponin T (>0.1 ng/mL) was significantly associated with increased all-cause mortality (relative risk, 2.64; 95% CI, 2.17 to 3.20). Although the prognostic effect sizes were all consistent with a positive relationship between troponin T and mortality, there was significant heterogeneity in the magnitude of these effect sizes (P=0.015). The funnel plot showed evidence of publication bias. Elevated troponin T was also strongly associated with increased cardiac death. Studies evaluating troponin I included a wide variety of assays and differing cut points, rendering synthesis of the study findings difficult. CONCLUSIONS: Elevated troponin T (>0.1 ng/mL) identifies a subgroup of ESRD patients who have poor survival and a high risk of cardiac death despite being asymptomatic. These findings suggest that troponin T is a promising risk stratification tool and may help frame therapeutic decisions. The clinical interpretation of elevated troponin I levels, however, remain unclear, largely because of the lack of standardization of assays.
Authors:
Nadia A Khan; Brenda R Hemmelgarn; Marcello Tonelli; Christopher R Thompson; Adeera Levin
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Publication Detail:
Type:  Journal Article; Meta-Analysis; Research Support, Non-U.S. Gov't; Review    
Journal Detail:
Title:  Circulation     Volume:  112     ISSN:  1524-4539     ISO Abbreviation:  Circulation     Publication Date:  2005 Nov 
Date Detail:
Created Date:  2005-11-15     Completed Date:  2006-03-07     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  United States    
Other Details:
Languages:  eng     Pagination:  3088-96     Citation Subset:  AIM; IM    
Affiliation:
Division of Internal Medicine, University of British Columbia, Canada. nakhan@shaw.ca
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MeSH Terms
Descriptor/Qualifier:
Biological Markers / blood
Humans
Kidney Failure, Chronic / blood*,  mortality
Predictive Value of Tests
Prognosis
Troponin I / blood*
Troponin T / blood*
Chemical
Reg. No./Substance:
0/Biological Markers; 0/Troponin I; 0/Troponin T
Comments/Corrections
Comment In:
Circulation. 2006 May 23;113(20):e775; author reply e776   [PMID:  16717158 ]
Circulation. 2005 Nov 15;112(20):3036-7   [PMID:  16286601 ]
Erratum In:
Circulation. 2006 May 2;113(17):e742

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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