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Predictive value of circulating endothelial microparticles for cardiovascular mortality in end-stage renal failure: a
Nicolas Amabile1, Alain P Guérin, Alain Tedgui
1INSERM, U970, Paris Cardiovascular Research Center–PARCC, Paris, France.
Background:
Endothelial dysfunction in cardiovascular (CV) diseases is closely associated with increases in plasma level of shed membrane microparticles (MPs) of endothelial origin. As arterial damage is a major contributor to CV mortality, we examined whether or not increases in endothelial microparticles (EMPs) circulating levels could predict outcome in patients with end-stage renal disease (ESRD).
Methods:
This prospective pilot study conducted in a community hospital (median follow-up: 50.5 months), included 81 stable haemodialysed ESRD patients (59 ± 14 years; 63% male). Platelet-free plasma obtained 72 h after last dialysis was analysed by flow cytometry, and MPs cellular origin identified as endothelial (CD31+CD41-MPs; EMPs), platelets (CD31+CD41+MPs) or erythrocyte (CD235a+MPs). The main outcome measures were global and CV mortality (fatal myocardial infarction, stroke, acute pulmonary oedema and sudden cardiac death).
Results:
Non-survivors (n = 24) were older (P < 0.001) and characterized by higher levels of EMPs (P < 0.01) and high-sensitivity C-reactive protein (P < 0.05) and lower diastolic blood pressure (P < 0.001). Kaplan-Meier analysis demonstrated significantly higher probability of all-cause (P < 0.001) and CV mortality (P < 0.0001) between the lower and upper EMPs tertiles. Multivariate Cox regression analysis demonstrated that baseline EMP levels independently predicted all-cause [hazard ratio (HR) = 21.7, 95% confidence interval (CI): 4.23-111.18 per log EMPs/μL; P = 0.0002] and CV mortality (HR = 20.0, 95% CI: 3.86-103.5) per log EMPs/μL; P < 0.0004) after adjustment for confounding factors. EMPs baseline level was a stronger predictor of poor outcome than classical risk factors.
Conclusion:
This study demonstrates that increased plasma levels of EMPs is a robust independent predictor of severe CV outcome in end-stage renal failure patients.
Insights
Elevated levels of endothelial microparticles (EMPs) in end-stage renal disease (ESRD) patients predict a higher risk of death. This finding highlights EMPs as a crucial biomarker for cardiovascular outcomes in ESRD.
Area of Science:
- Nephrology
- Cardiology
- Biomarkers
Background:
- Endothelial dysfunction is linked to increased circulating microparticles (MPs) in cardiovascular diseases.
- Arterial damage significantly contributes to cardiovascular mortality.
- This study investigates if elevated endothelial microparticles (EMPs) predict outcomes in end-stage renal disease (ESRD) patients.
Purpose of the Study:
- To determine if increased circulating EMP levels predict mortality in haemodialysed ESRD patients.
- To assess EMPs as a prognostic marker for cardiovascular outcomes in ESRD.
Main Methods:
- Prospective pilot study of 81 haemodialysed ESRD patients with a median follow-up of 50.5 months.
- Plasma EMP levels analyzed by flow cytometry.
- Global and cardiovascular mortality were the primary outcome measures.
Main Results:
- Non-survivors had higher EMP levels, C-reactive protein, and were older.
- Kaplan-Meier analysis showed significantly higher all-cause and cardiovascular mortality in the upper EMP tertiles.
- Multivariate Cox regression revealed EMP levels as an independent predictor of mortality (all-cause HR=21.7, CV HR=20.0).
Conclusions:
- Increased plasma EMP levels are a robust, independent predictor of severe cardiovascular outcomes in ESRD patients.
- EMPs serve as a stronger predictor of poor outcomes than traditional risk factors in this population.
