Multimarker Approach to Risk Stratification for Long-Term Mortality in Patients on Chronic Hemodialysis
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- Ishii Junnichi
- Department of Joint Research Laboratory of Clinical Medicine, Fujita Health University School of Medicine
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- Takahashi Hiroshi
- Division of Statistics, Fujita Health University School of Medicine
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- Kitagawa Fumihiko
- Department of Joint Research Laboratory of Clinical Medicine, Fujita Health University School of Medicine
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- Kuno Atsuhiro
- Department of Joint Research Laboratory of Clinical Medicine, Fujita Health University School of Medicine
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- Okuyama Ryuunosuke
- Department of Cardiology, Fujita Health University School of Medicine
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- Kawai Hideki
- Department of Cardiology, Fujita Health University School of Medicine
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- Muramatsu Takashi
- Department of Cardiology, Fujita Health University School of Medicine
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- Naruse Hiroyuki
- Department of Joint Research Laboratory of Clinical Medicine, Fujita Health University School of Medicine
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- Motoyama Sadako
- Department of Cardiology, Fujita Health University School of Medicine
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- Matsui Shigeru
- Department of Cardiology, Fujita Health University School of Medicine
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- Hasegawa Midori
- Department of Nephrology, Fujita Health University School of Medicine
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- Aoyama Toru
- Cardiovascular Center, Nagoya Kyoritsu Hospital
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- Kamoi Daisuke
- Cardiovascular Center, Nagoya Kyoritsu Hospital
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- Kasuga Hirotake
- Department of Nephrology, Nagoya Kyoritsu Hospital
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- Izawa Hideo
- Department of Cardiology, Banbuntane Houtokukai Hospital
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- Ozaki Yukio
- Department of Cardiology, Fujita Health University School of Medicine
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- Yuzawa Yukio
- Department of Nephrology, Fujita Health University School of Medicine
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Background:We prospectively investigated the prognostic value of the combined use of cardiac troponin T (TnT), B-type natriuretic peptide (BNP), and high-sensitivity C-reactive protein (CRP) for long-term mortality in hemodialysis (HD) patients.Methods and Results:Baseline measurements of TnT, BNP, and CRP were performed in 516 patients on chronic HD. Patients were followed up for 10 years. Using the Cox multivariate model with these 3 biomarkers as variables categorized into tertiles for mortality, a simplified score was obtained by underscoring individual biomarkers based on the adjusted hazard ratio (HR). The multimarker score was defined as the sum of these points. TnT, BNP, and CRP levels were individually independent predictors for mortality (P<0.05). Among low-risk (multimarker score <4), intermediate-risk (multimarker score 4–7), and high-risk (multimarker score ≥7) groups, 10-year survival rates were 83.3%, 54.3%, and 27.2% (P<0.0001), respectively. After adjusting for other confounders, the multimarker score had strong predictive power for mortality (HR: 4.26; P<0.0001 for high-risk vs. low-risk group). Furthermore, adding the multimarker score to a baseline model with established risk factors improved the C-index (P<0.01), net reclassification improvement (P<0.0001), and integrated discrimination improvement (P<0.0001) greater than that of any single biomarker or baseline model alone.Conclusions:The multimarker approach (ie, simultaneous assessment of TnT, BNP, and CRP, which individually independently predict prognosis) may improve the prediction of long-term mortality in HD patients. (Circ J 2015; 79: 656–663)
収録刊行物
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- Circulation Journal
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Circulation Journal 79 (3), 656-663, 2015
一般社団法人 日本循環器学会
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詳細情報 詳細情報について
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- CRID
- 1390282680083758464
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- NII論文ID
- 130004927120
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- NII書誌ID
- AA11591968
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- ISSN
- 13474820
- 13469843
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- NDL書誌ID
- 026187240
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- PubMed
- 25746551
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- 本文言語コード
- en
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- データソース種別
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- PubMed
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