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Published on: January 28, 2020
Serum uromodulin is a predictive biomarker for cardiovascular events and overall mortality in coronary patients
Andreas Leiherer1, Axel Muendlein2, Christoph H Saely3
1Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Feldkirch, Austria; Private University of the Principality of Liechtenstein, Triesen, Liechtenstein; Medical Central Laboratories, Feldkirch, Austria.
Insights
Serum uromodulin is a protective biomarker for mortality and cardiovascular events in patients with stable coronary artery disease. Lower levels indicate higher risk, highlighting its predictive value.
Area of Science:
- Nephrology
- Cardiology
- Biomarker Discovery
Background:
- Uromodulin, a kidney-produced protein, shows promise as a serum biomarker for kidney disease.
- Previous studies on urinary uromodulin were inconclusive, but serum analysis is emerging as superior.
- The role of serum uromodulin in cardiovascular event risk and mortality prediction remains unexplored.
Purpose of the Study:
- To evaluate the association between serum uromodulin levels and cardiovascular event risk.
- To determine if serum uromodulin can predict overall mortality in patients with stable coronary artery disease.
- To investigate the relationship between serum uromodulin, kidney function, and cardiovascular outcomes.
Main Methods:
- Serum uromodulin was measured in 529 patients undergoing coronary angiography for stable coronary artery disease (CAD).
- Mortality and cardiovascular events were prospectively recorded over an 8-year follow-up period.
- Statistical analyses, including hazard ratios and multivariable adjustments, were performed to assess predictive values.
Main Results:
- Serum uromodulin demonstrated a protective effect against overall mortality (HR=0.56, p<0.001), even after adjustment.
- Patients with the lowest serum uromodulin tertile exhibited significantly higher cardiovascular event risk (HR=1.45, p=0.027).
- The creatinine-to-uromodulin ratio correlated with kidney function and predicted cardiovascular events (HR=1.26, p<0.001).
Conclusions:
- Serum uromodulin is a valuable biomarker for predicting overall mortality.
- Serum uromodulin also serves as a significant predictor of cardiovascular events.
- The findings support the clinical utility of serum uromodulin in risk stratification for cardiovascular disease.
Background:
Uromodulin is a protein produced exclusively by the kidneys and present in urine and blood. In contrast to weak and in part contradictory study data on uromodulin in urine samples, the analysis of serum samples recently proved uromodulin's value as superior biomarker for ongoing kidney disease. Whether serum uromodulin is associated with cardiovascular event risk and whether it has predictive power for overall mortality is still unknown and has been evaluated in the present study.
Methods:
We measured uromodulin in a series of 529 patients without acute coronary syndrome undergoing coronary angiography for the evaluation of established or suspected stable coronary artery disease (CAD) and prospectively recorded mortality as well as cardiovascular events in our patients during a follow-up of up to 8years.
Results:
We recorded 95 deaths and 145 cardiovascular events over 8years. Serum uromodulin proved protective for overall mortality (HR=0.56 [95%CI 0.43-0.72]; p<0.001), even after full adjustment including eGFR, current smoking, diabetes, and CAD status (adj. HR=0.57 [95%CI 0.37-0.89]; p=0.014). Patients in the lowest tertile of serum uromodulin had a significantly higher cardiovascular event risk compared to patients in the medium and highest tertile (HR=of 1.45 (95%CI 1.04-2.02, p=0.027). The ratio between creatinine and uromodulin was significantly associated with kidney function (r=-0.322; p<0.001) and significantly predicted the incidence of cardiovascular events (HR of 1.26 [95%CI 1.12-1.41], p<0.001) and major cardiovascular events (HR of 1.37 [95%CI 1.21-1.56], p<0.001).
Conclusion:
We conclude that serum uromodulin is a valuable biomarker to predict overall mortality and cardiovascular events.
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