Related Experiment Videos
Increased mortality in hemodialyzed patients with elevated serum troponin T: a one-year outcome study
D S Ooi1, J P Veinot, G A Wells
1Department of Laboratory Medicine, Ottawa Hospital Civic Campus, Ontario, Canada. dsooi@civich.ottawa.on.ca
Insights
Elevated serum troponin T (cTnT) in hemodialysis patients predicts mortality from both coronary and noncoronary causes, even without acute ischemia. This finding highlights cTnT as a crucial prognostic marker in this vulnerable population.
Area of Science:
- Cardiology
- Nephrology
- Clinical Biomarkers
Background:
- Hemodialysis patients often exhibit elevated cardiac troponin T (cTnT) without acute coronary events.
- The prognostic significance of this elevation in hemodialysis patients remains incompletely understood.
Purpose of the Study:
- To investigate the association between elevated serum cTnT levels and mortality in hemodialysis patients.
- To determine if cTnT predicts mortality from both coronary and noncoronary causes in this population.
Main Methods:
- A 12-month follow-up study of 172 hemodialysis patients with recorded serum cTnT concentrations.
- Mortality was the primary outcome, with causes of death determined by autopsy in a subset of patients.
Main Results:
- Patients with cTnT > or =0.1 microg/L had significantly increased death rates (p<0.001).
- Elevated cTnT was a significant predictor of noncoronary deaths, particularly in nondiabetics, those without coronary or peripheral vascular disease, and hypertensives.
- A significant increase in coronary deaths was observed in patients without hypertension and those aged 50 years or older.
Conclusions:
- Serum cTnT is a valuable prognostic marker for overall mortality in hemodialysis patients.
- Elevated cTnT is associated with increased risk of death from both coronary and noncoronary causes in this population.
Objectives:
To determine the significance of elevated serum troponin T (cTnT) occurring in hemodialysis patients in the absence of clinical evidence of acute coronary ischemia.
Design And Methods:
Twelve-month follow-up of cohort of 172 hemodialyzed patients with known serum cTnT concentration. The cohort consisted of patients undergoing hemodialysis in a hospital unit over a 5-month period, with one to four measurements of cTnT. The main outcome measure was death. Cause of death was determined by autopsy in six patients.
Results:
Of the 31 deaths, 12 were due to acute coronary disease, 14 were noncoronary, and 5 were undefined. Death rates of patients with cTnT <0.1, 0.1-0.2, and >0.2 microg/L were 9.9% (11/111), 32.4% (12/37), and 33.3% (8/24), respectively. The increase in death rate with cTnT > or =0.1 microg/L was significant (p<0.001) for noncoronary deaths, but not for acute coronary deaths. The risk ratios for noncoronary deaths in the subgroups were: nondiabetics 6.6 (95% CI 1.9-23.6), patients with no coronary artery disease 7.3 (1.6-32.4), patients with no peripheral vascular disease 8.9 (2.0-39.7), and hypertensives 9.0 (1.1-76.5). Significant increase in coronary deaths was seen only in patients without hypertension and those aged > or =50 years. The risk ratios for these groups were 9.3 (1.2-74.3) and 3.3 (1.0-10.6), respectively.
Conclusions:
Serum cTnT is a potential prognostic marker of mortality in hemodialyzed patient, with increase in death from coronary and noncoronary causes.