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Urinary cadmium levels predict mortality of patients with acute heart failure
Ching-Wei Hsu1, Cheng-Hao Weng1, Cheng-Chia Lee1
1Department of Nephrology, Division of Clinical Toxicology, Chang Gung Memorial Hospital, Taipei, Taiwan, ROC; Department of Nephrology, Division of Clinical Toxicology, Linkou Medical Center, Taoyuan, Taiwan, ROC; Chang Gung University and School of Medicine, Taoyuan, Taiwan, ROC.
Insights
Urinary cadmium levels on ICU admission predict mortality in acute heart failure (AHF) patients. Higher cadmium levels correlate with increased AHF mortality risk, outperforming existing scoring systems.
Area of Science:
- Environmental toxicology
- Cardiovascular medicine
- Critical care medicine
Background:
- Acute heart failure (AHF) is a critical condition with high mortality in intensive care units (ICUs).
- Environmental cadmium exposure is linked to general population mortality, but its role in AHF patients is not well-defined.
Purpose of the Study:
- To investigate the relationship between urinary cadmium levels and mortality in patients with AHF.
- To evaluate urinary cadmium as a predictor of mortality in AHF patients.
Main Methods:
- A cohort of 153 AHF patients in ICUs was followed for 6 months.
- Urinary cadmium levels on day 1 of ICU admission (D1UCd) were measured.
- Demographic, clinical, and laboratory data, including SOFA and APACHE II scores, were collected.
Main Results:
- The overall mortality rate was 24.8%.
- Survivors had higher D1UCd levels than non-survivors.
- D1UCd was positively correlated with acute kidney injury and negatively with serum albumin.
- Multivariate Cox analysis identified D1UCd as an independent predictor of mortality (HR 1.20 per 1 μg increment, P<0.001).
- The area under the ROC curve for D1UCd (0.84) was superior to SOFA and APACHE II scores.
Conclusions:
- Urinary cadmium levels on ICU admission may serve as a standalone predictor of hospital mortality in AHF patients.
- Further research is needed to confirm these findings and explore underlying mechanisms due to the study's limitations.
Background:
Acute heart failure (AHF) is a serious condition that is associated with increased mortality in critically ill patients. Previous studies indicated that environmental exposure to cadmium increases mortality of general populations. However, the relationship of cadmium exposure and mortality is unclear for AHF patients.
Materials And Methods:
A total of 153 patients with AHF in intensive care units (ICUs) met the inclusion criteria and were followed up for 6 months. Demographic data, AHF etiology, hematological and biochemical data, and hospital mortality were recorded. The scores of two predictive systems (Sequential Organ Failure Assessment [SOFA], Acute Physiology and Chronic Health Evaluation II [APACHE II]) for mortality in critically ill patients were calculated, and urinary cadmium levels were recorded.
Results:
At the end of the follow-up period, the mortality rate was 24.8%. The survivors (n=115) had higher urinary cadmium levels on day 1 (D1UCd) of ICU admission than non-survivors (n=38). A multiple linear regression analysis revealed a positive correlation between D1UCd and acute kidney injury, but a negative correlation between D1UCd and the level of serum albumin. A multivariate Cox analysis indicated that D1UCd was an independent predictor of mortality in AHF patients. For each increment of 1 μg of D1UCd, the hazard ratio for ICU mortality was 1.20 (95% confidence interval [CI]: 1.09-1.32, P<0.001). The area under the receiver operating characteristic curve for D1UCd was 0.84 (95% CI: 0.78-0.91), better than the values for the SOFA and APACHE II systems.
Conclusion:
The D1UCd may serve as a single predictor of hospital mortality for AHF patients in the ICU. Because of the high mortality and smaller sample size, more investigations are required to confirm these observations and elucidate the underlying mechanisms.