Prooxidant–antioxidant balance, hsTnI and hsCRP: mortality prediction in haemodialysis patients, two-year follow-up

Figures & data

Table 1. Biomarkers studied in this paper.

Biomarker (abbreviation)	Biomarker (full name)	Biochemical significance	Summary of our findings
hsCRP	High-sensitive CRP	Inflammatory marker	Great predictor of mortality, all-cause and CVD
PAB	Prooxidant–antioxidant balance	Marker of both oxidative and antioxidative processes	Great predictor of all-cause mortality, in combination with CRP even better prediction possibility
TAS	Total antioxidative status	Measure of antioxidative protection	Significantly higher in survival group, no significance in mortality prediction
TOS	Total oxidative status	Marker of oxidative stress	No significance between survivors and non-survivors, no significance in mortality prediction
hsTnI	High-sensitive troponin I	Reflects ischemic damage of cardiomyocytes	Predictor of CVD mortality, the best prediction possibility when used with CRP
Resistin	Resistin	Inflammatory cytokine, link between inflammation with metabolic and vascular pathways	No significance between survivors and non-survivors, no significance in mortality prediction

Table 2. Characteristics of patients according to their survival status.

	Survivors n = 39	Non-survivors all-cause n = 23	p-Value survivors, non-survivors all-cause	Non-survivors CVD n = 10	p-Value survivors, non-survivors CVD
Age, years	57.5 (50.25–63.0)	60.0 (55.0–68.5)	.077	56.0 (55.0–67.5)	.709
Sex	53.8% males(21)	39.1% males (9)	.393	60%males (6)	1
BMI, kg/m^2	23.09 ± 3.27	23.48 ± 3.58	.631	23.86 ± 3.16	.363
Smokers	35.9%(14)	34.8% (8)	.862	20%(2)	.463
HD duration, days	1148 (471–2340.25)	1777.5 (425–3148)	.264	1656 (372.5–2401)	.778
Systolic before HD, mmHg	143.9 ± 21.8	139.5 ± 23.2	.465	148.3 ± 24.7	.385
Systolic after HD, mmHg	130.4 ± 20.4	127.7 ± 25.8	.661	135.6 ± 30.5	.511
Kt/V	1.16 (1.05–1.25)	1.10 (0.97–1.20)	.083	1.08 (1.01–1.14)	.281
URR	64.1 (58.8–68.4)	59.7 (53.2–67.1)	.124	57.8 (48.5–65.1)	.108
Urea before HD mmol/L	29.5 ± 5.9	30.9 ± 7.9	.433	34.8 ± 7.9	.012
Creatinine before HD, μmol/L	1038.8 ± 197.8	910.3 ± 198.4	.016	964.4 ± 208.8	.658
Uric before HD, μmol/L	412.1 (361.0–482.2)	411.5 (362.5–502.4)	.503	406.6 (369.3–479.3)	.826
Cholesterol, mmol/L	4.36 (3.67–4.72)	3.72 (3.06–4.36)	.041	4.03 (3.09–4.11)	.138
Triglycerides, mmol/L	1.43 ± 0.61	1.53 ± 0.68	.59	1.38 ± 0.42	.649
HDL cholesterol, mmol/L	0.86 (0.74–1.07)	0.73 (0.62–0.89)	.025	0.73 (0.61–0.81)	.065
LDL cholesterol, mmol/L	2.55 (2.12–3.02)	2.03 (1.92–2.65)	.008	2.03 (1.95–2.66)	.153
ApoAI, g/L	1.38 ± 0.23	1.27 ± 0.24	.089	1.24 ± 0.20	.135
ApoB, g/L	0.79 ± 0.17	0.80 ± 0.18	.742	0.83 ± 0.18	.443

Data are presented as Mean ± SD, Median (25–75 percentile) or percentage (count) and were compared by the Student?s t test or Mann-Whitney U nonparametric test, whereas categorical variables are presented as relative frequencies and were compared by the Chi-square test.

CVD: cardiovascular disease; BMI: body mass index; HD: hemodialysis; URR: urea reduction rate.

Bold values indicates statistically significant p-value < .05.

Table 3. Predictors of all-cause and CVD mortality: univariate logistic regression analysis (enter method).

	Mortality
	All-cause		CVD
Variables	HR (95% CI)^a	p	HR (95% CI)^a	p
Age, years	1.064 (1.012–1.118)	<.05^b	1.051 (0.974–1.135)	.198
Smoking	1.01 (0.424–2.408)	.982	2.013 (0.418–9.691)	.383
BMI, kg/m^2	1.017 (0.907–1.141)	.768	1.072 (0.893–1.286)	.457
TC, mmol/L	0.54 (0.319–0.917)	<.05^b	0.541 (0.239–1.221)	.139
TG, mmol/L	1.158 (0.632–2.12)	.636	0.817 (0.239–2.285)	.700
LDL-C, mmol/L	0.372 (0.176–0.783)	<.05^b	0.440 (0.140–1.389)	.162
HDL-C, mmol/L	0.341 (0.080–1.456)	.146	0.142 (0.015–1.327)	.087^b
hsCRP, mg/L	1.021 (1.010–1.033)	<.001^b	1.023 (1.005–1.048)	.054^b
Resistin, mg/L	0.691 (1.93–2.481)	.571	1.283 (0.226–7.280)	.779
hsTnI, ng/L	1.007 (1.004–1.011)	<.001^b	1.010 (1.004–1.016)	<.001^b
TAS, mmol/L	0.061 (0.006–0.653)	<.05^b	0.096 (0.003–1.746)	.171
TOS, μmol/L	1.006 (0.985–1.026)	.594	1.008 (0.981–1.036)	.551
PAB, HK units	1.035 (1.021–1.049)	<.05^b	1.003 (1.012–1.055)	<.05^b

^aHR: hazard ratios; 95% CI: 95% confidence interval.

^bVariables with p < .10 were entered in multivariate logistic regression analysis.

Table 4. Predictors of all-cause and CVD mortality: multivariate logistic analysis.

	Mortality
	All-cause		CVD
Variables	HR (95% CI)^a	p^b	HR (95% CI)	p^c
Age, years	1.014 (0.944–1.088)	.707	–
TC, mmol/L	2.046 (0.517–8.090)	.307	–
LDL-C, mmol/L	0.168 (0.019–1.496)	.110	–
HDL-C, mmol/L	–	–	0.029	.166
hsCRP, mg/L	1.085 (1.015–1.160)	<.05	1.076 (1.019–1.136)	<.05
hsTnI, ng/L	1.003 (0.997–1.009)	.340	1.013 (1.005–1.021)	<.001
TAS, mmol/L	0.027	.091	–	–
PAB, HK units	1.027 (1.001–1.054)	<.05	1.010 (0.976–1.045)	.566

^aHR: hazard ratios; 95% CI: 95% confidence interval.

^b,c Values are adjusted for other variables with p < .10 in univariate logistic regression analysis.

Bold values indicates statistically significant p-value < .05.

Table 5. Characteristics of patients according to their survival status.

	Survivors n = 39	Non-survivors all-cause n = 23	p-Value survivors, non-survivors all-cause	Non-survivors CVD n = 10	p-Value survivors, non-survivors CVD
hsCRP, mg/L	2.59 (1.03–4.47)	12.20 (2.39–17.8)	<.001	13.7 (8.79–17.1)	.001
Resistin, mg/L	0.71 (0.52–1.03)	0.61 (0.50–0.75)	.386	0.72 (0.59–0.95)	.275
hsTnI, ng/L	12 (7–26)	38 (21.0–69.0)	<.001	40 (17.5–229.75)	.039
TAS, mmol/L	2.25 (2.11–2.32)	2.11 (2.04–2.20)	.027	2.12 (1.99–2.25)	.289
TOS, μmol/L	44.51 ± 24.43	48.87 ± 21.98	.545	50.52 ± 24.83	.52
PAB, HK units	14.86 (7.63–25.71)	39.66 (28.99–58.81)	<.001	42.13 (28.39–58.81)	.013

Data are presented as Mean ± SD, Median (25–75 percentile) and were compared by the Student?s t test or Mann-Whitney U nonparametric test.

CVD: cardiovascular disease; TAS: total antioxidant status; TOS: total oxidant status; PAB: prooxidant-antioxidant balance.

Bold values indicates statistically significant p-value < .05.

Figure 1. Kaplan–Meier survival curves by hsCRP and PAB groups (all-cause mortality).

Figure 2. Kaplan–Meier survival curves by hsCRP and hsTnI groups (CVD mortality).