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Published on: May 10, 2021
Association between microinflammatory state and cardiac valvular calcification in patients undergoing maintenance
Meiyu Liu1, Peishan Peng1, Jie Chen2
1Department of Nephrology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200092, China.
Insights
The CALLY index, a novel marker, is linked to cardiac valvular calcification severity in maintenance hemodialysis patients. It offers improved prediction of multi-valvular involvement compared to other biomarkers.
Area of Science:
- Nephrology
- Cardiology
- Biomarker Research
Background:
- Microinflammation is prevalent in maintenance hemodialysis (MHD) patients.
- Cardiac valvular calcification (CVC) is a common complication in MHD patients.
- Predictive markers for CVC severity in MHD are needed.
Purpose of the Study:
- To investigate the association between microinflammation and CVC in MHD patients.
- To compare the C-reactive protein-albumin-lymphocyte (CALLY) index with other biomarkers for predicting CVC severity.
Main Methods:
- A cross-sectional study of 203 MHD patients categorized by CVC severity.
- Serum inflammatory markers (hs-CRP, IL-6, TNF-α) and routine biochemical parameters were measured.
- Calculated CALLY index, NLR, CAR, PNI, GNRI; utilized logistic regression, ROC curves, NRI/IDI analyses.
Main Results:
- CVC prevalence was 67.0% in the study population.
- The CALLY index was independently associated with single and double valve calcification.
- CALLY index showed superior predictive performance (C-statistic 0.869) and incremental value for multi-valvular involvement.
Conclusions:
- The CALLY index is an independent predictor of CVC severity in MHD patients.
- The CALLY index significantly enhances the prediction of multi-valvular calcification.
- This index offers valuable insights for managing CVC in MHD patients.
Objective:
To investigate the association between microinflammatory state and cardiac valvular calcification (CVC) in maintenance hemodialysis (MHD) patients, and to compare the predictive value of the C-reactive protein-albumin-lymphocyte (CALLY) index with conventional inflammatory and nutritional biomarkers for CVC severity.
Methods:
This single-center cross-sectional study enrolled 203 MHD patients. Patients were categorized by echocardiography into no CVC (n = 67), single valve calcification (n = 69), and double valve calcification (n = 67) groups. Serum levels of hs-CRP, IL-6, TNF-α, and routine biochemical parameters were measured. The CALLY index, neutrophil-to-lymphocyte ratio (NLR), C-reactive protein-to-albumin ratio (CAR), prognostic nutritional index (PNI), and geriatric nutritional risk index (GNRI) were calculated. Multinomial logistic regression, model fit indices, net reclassification improvement (NRI), integrated discrimination improvement (IDI), receiver operating characteristic (ROC) curves, and bootstrap internal validation were utilized to evaluate the comparative and incremental performance of the biomarkers.
Results:
The prevalence of CVC in the study population was 67.0%. Multinomial logistic regression analysis demonstrated that after adjusting for the six clinical covariates (age, gender, dialysis vintage, serum phosphorus, active vitamin D dosage, and phosphate binders), the CALLY index was independently associated with both single valve calcification (OR = 0.680, P = 0.005) and double valve calcification (OR = 0.527, P < 0.001). The CALLY index also exhibited the highest C-statistic for CVC (0.869). In NRI/IDI analyses, the CALLY index significantly improved both continuous NRI (0.435, P = 0.001) and IDI (0.034, P = 0.004) for double valve calcification and CVC, whereas NLR, IL-6, and hs-CRP did not.
Conclusion:
The CALLY index is independently associated with CVC severity in MHD patients. Incorporating the CALLY index into standard clinical parameters provides significant incremental predictive value for identifying multi-valvular involvement.
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