C-Reactive Protein and Prediction of 1-Year Mortality in Prevalent Hemodialysis Patients
Identifieur interne : 001692 ( Pmc/Curation ); précédent : 001691; suivant : 001693C-Reactive Protein and Prediction of 1-Year Mortality in Prevalent Hemodialysis Patients
Auteurs : Jonathan Bazeley [États-Unis] ; Brian Bieber [États-Unis] ; Yun Li [États-Unis] ; Hal Morgenstern [États-Unis] ; Patricia De Sequera [Espagne] ; Christian Combe [France] ; Hiroyasu Yamamoto [Japon] ; Martin Gallagher [Australie] ; Friedrich K. Port [États-Unis] ; Bruce M. Robinson [États-Unis]Source :
- Clinical Journal of the American Society of Nephrology : CJASN [ 1555-9041 ] ; 2011.
Abstract
Measurement of C-reactive protein (CRP) levels remains uncommon in North America, although it is now routine in many countries. Using Dialysis Outcomes and Practice Patterns Study data, our primary aim was to evaluate the value of CRP for predicting mortality when measured along with other common inflammatory biomarkers.
We studied 5061 prevalent hemodialysis patients from 2005 to 2008 in 140 facilities routinely measuring CRP in 10 countries. The association of CRP with mortality was evaluated using Cox regression. Prediction of 1-year mortality was assessed in logistic regression models with differing adjustment variables.
Median baseline CRP was lower in Japan (1.0 mg/L) than other countries (6.0 mg/L). CRP was positively, monotonically associated with mortality. No threshold below which mortality rate leveled off was identified. In prediction models, CRP performance was comparable with albumin and exceeded ferritin and white blood cell (WBC) count based on measures of model discrimination (c-statistics, net reclassification improvement [NRI]) and global model fit (generalized
These findings demonstrate the value of measuring CRP in addition to standard inflammatory biomarkers to improve mortality prediction in hemodialysis patients. Future studies are indicated to identify interventions that lower CRP and to identify whether they improve clinical outcomes.
Url:
DOI: 10.2215/CJN.00710111
PubMed: 21868617
PubMed Central: 3186454
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<affiliation wicri:level="1"><nlm:aff wicri:cut="; and" id="aff7">Division of Kidney and Hypertension, Jikei University School of Medicine, Tokyo, Japan</nlm:aff>
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<author><name sortKey="Gallagher, Martin" sort="Gallagher, Martin" uniqKey="Gallagher M" first="Martin" last="Gallagher">Martin Gallagher</name>
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<author><name sortKey="Port, Friedrich K" sort="Port, Friedrich K" uniqKey="Port F" first="Friedrich K." last="Port">Friedrich K. Port</name>
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<placeName><region type="state">Michigan</region>
</placeName>
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<author><name sortKey="Robinson, Bruce M" sort="Robinson, Bruce M" uniqKey="Robinson B" first="Bruce M." last="Robinson">Bruce M. Robinson</name>
<affiliation wicri:level="2"><nlm:aff id="aff1">Arbor Research Collaborative for Health, Ann Arbor, Michigan;</nlm:aff>
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<placeName><region type="state">Michigan</region>
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<country xml:lang="fr">États-Unis</country>
<placeName><region type="state">Michigan</region>
</placeName>
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<series><title level="j">Clinical Journal of the American Society of Nephrology : CJASN</title>
<idno type="ISSN">1555-9041</idno>
<idno type="eISSN">1555-905X</idno>
<imprint><date when="2011">2011</date>
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<front><div type="abstract" xml:lang="en"><sec><title>Summary</title>
<sec><title>Background and objectives</title>
<p>Measurement of C-reactive protein (CRP) levels remains uncommon in North America, although it is now routine in many countries. Using Dialysis Outcomes and Practice Patterns Study data, our primary aim was to evaluate the value of CRP for predicting mortality when measured along with other common inflammatory biomarkers.</p>
</sec>
<sec><title>Design, setting, participants, & measurements</title>
<p>We studied 5061 prevalent hemodialysis patients from 2005 to 2008 in 140 facilities routinely measuring CRP in 10 countries. The association of CRP with mortality was evaluated using Cox regression. Prediction of 1-year mortality was assessed in logistic regression models with differing adjustment variables.</p>
</sec>
<sec><title>Results</title>
<p>Median baseline CRP was lower in Japan (1.0 mg/L) than other countries (6.0 mg/L). CRP was positively, monotonically associated with mortality. No threshold below which mortality rate leveled off was identified. In prediction models, CRP performance was comparable with albumin and exceeded ferritin and white blood cell (WBC) count based on measures of model discrimination (c-statistics, net reclassification improvement [NRI]) and global model fit (generalized <italic>R</italic>
<sup>2</sup>
). The primary analysis included age, gender, diabetes, catheter use, and the four inflammatory markers (omitting one at a time). Specifying NRI ≥5% as appropriate reclassification of predicted mortality risk, NRI for CRP was 12.8% compared with 10.3% for albumin, 0.8% for ferritin, and <0.1% for WBC.</p>
</sec>
<sec><title>Conclusions</title>
<p>These findings demonstrate the value of measuring CRP in addition to standard inflammatory biomarkers to improve mortality prediction in hemodialysis patients. Future studies are indicated to identify interventions that lower CRP and to identify whether they improve clinical outcomes.</p>
</sec>
</sec>
</div>
</front>
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<pmc article-type="research-article"><pmc-comment>The publisher of this article does not allow downloading of the full text in XML form.</pmc-comment>
<front><journal-meta><journal-id journal-id-type="nlm-ta">Clin J Am Soc Nephrol</journal-id>
<journal-id journal-id-type="iso-abbrev">Clin J Am Soc Nephrol</journal-id>
<journal-id journal-id-type="hwp">clinjasn</journal-id>
<journal-id journal-id-type="pmc">cjn</journal-id>
<journal-id journal-id-type="publisher-id">CJASN</journal-id>
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<issn pub-type="epub">1555-905X</issn>
<publisher><publisher-name>American Society of Nephrology</publisher-name>
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<article-id pub-id-type="pmc">3186454</article-id>
<article-id pub-id-type="publisher-id">00710111</article-id>
<article-id pub-id-type="doi">10.2215/CJN.00710111</article-id>
<article-categories><subj-group subj-group-type="heading"><subject>Original Articles</subject>
<subj-group><subject>Epidemiology and Outcomes</subject>
</subj-group>
</subj-group>
<series-title>Original Articles</series-title>
</article-categories>
<title-group><article-title>C-Reactive Protein and Prediction of 1-Year Mortality in Prevalent Hemodialysis Patients</article-title>
</title-group>
<contrib-group><contrib contrib-type="author"><name><surname>Bazeley</surname>
<given-names>Jonathan</given-names>
</name>
<xref ref-type="aff" rid="aff1">*</xref>
<xref ref-type="aff" rid="aff2"><sup>†</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Bieber</surname>
<given-names>Brian</given-names>
</name>
<xref ref-type="aff" rid="aff1">*</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Li</surname>
<given-names>Yun</given-names>
</name>
<xref ref-type="aff" rid="aff1">*</xref>
<xref ref-type="aff" rid="aff3"><sup>‡</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Morgenstern</surname>
<given-names>Hal</given-names>
</name>
<xref ref-type="aff" rid="aff4"><sup>§</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>de Sequera</surname>
<given-names>Patricia</given-names>
</name>
<xref ref-type="aff" rid="aff5"><sup>‖</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Combe</surname>
<given-names>Christian</given-names>
</name>
<xref ref-type="aff" rid="aff6"><sup>¶</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Yamamoto</surname>
<given-names>Hiroyasu</given-names>
</name>
<xref ref-type="aff" rid="aff7">**</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Gallagher</surname>
<given-names>Martin</given-names>
</name>
<xref ref-type="aff" rid="aff8"><sup>††</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Port</surname>
<given-names>Friedrich K.</given-names>
</name>
<xref ref-type="aff" rid="aff1">*</xref>
<xref ref-type="aff" rid="aff2"><sup>†</sup>
</xref>
</contrib>
<contrib contrib-type="author" corresp="yes"><name><surname>Robinson</surname>
<given-names>Bruce M.</given-names>
</name>
<xref ref-type="aff" rid="aff1">*</xref>
<xref ref-type="aff" rid="aff2"><sup>†</sup>
</xref>
</contrib>
<aff id="aff1"><label>*</label>
Arbor Research Collaborative for Health, Ann Arbor, Michigan;</aff>
<aff id="aff2"><label>†</label>
Department of Medicine, Division of Nephrology, University of Michigan Health System, Ann Arbor, Michigan;</aff>
<aff id="aff3"><label>‡</label>
Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, Michigan;</aff>
<aff id="aff4"><label>§</label>
Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan;</aff>
<aff id="aff5"><label>‖</label>
Seccion de Nefrología, Hospital Infanta Leonor, Madrid, Spain;</aff>
<aff id="aff6"><label>¶</label>
Hôpital Pellegrin, Département de Néphrologie, Centre Hospitalier Universitaire & Université de Bordeaux, Bordeaux, France;</aff>
<aff id="aff7"><label>**</label>
Division of Kidney and Hypertension, Jikei University School of Medicine, Tokyo, Japan; and</aff>
<aff id="aff8"><label>††</label>
Renal Unit, Concord Repatriation & General Hospital, Sydney, Australia</aff>
</contrib-group>
<author-notes><corresp><bold>Correspondence:</bold>
Bruce Robinson, MD, MS, <addr-line>FACP Arbor Research Collaborative for Health 340 East Huron Street, Suite 300 Ann Arbor, MI 48104</addr-line>
<phone>734-665-4108</phone>
(phone) <fax>734-665-2103</fax>
(fax) <email>bruce.robinson@arborresearch.org</email>
</corresp>
</author-notes>
<pub-date pub-type="ppub"><month>10</month>
<year>2011</year>
</pub-date>
<pub-date pub-type="pmc-release"><day>1</day>
<month>10</month>
<year>2012</year>
</pub-date>
<pmc-comment> PMC Release delay is 12 months and 0 days and was based on the
. </pmc-comment>
<volume>6</volume>
<issue>10</issue>
<fpage>2452</fpage>
<lpage>2461</lpage>
<history><date date-type="received"><day>25</day>
<month>1</month>
<year>2011</year>
</date>
<date date-type="accepted"><day>2</day>
<month>7</month>
<year>2011</year>
</date>
</history>
<permissions><copyright-statement>Copyright © 2011 by the American Society of Nephrology</copyright-statement>
<copyright-year>2011</copyright-year>
</permissions>
<self-uri xlink:title="pdf" xlink:type="simple" xlink:href="cjn01011002452.pdf"></self-uri>
<abstract><sec><title>Summary</title>
<sec><title>Background and objectives</title>
<p>Measurement of C-reactive protein (CRP) levels remains uncommon in North America, although it is now routine in many countries. Using Dialysis Outcomes and Practice Patterns Study data, our primary aim was to evaluate the value of CRP for predicting mortality when measured along with other common inflammatory biomarkers.</p>
</sec>
<sec><title>Design, setting, participants, & measurements</title>
<p>We studied 5061 prevalent hemodialysis patients from 2005 to 2008 in 140 facilities routinely measuring CRP in 10 countries. The association of CRP with mortality was evaluated using Cox regression. Prediction of 1-year mortality was assessed in logistic regression models with differing adjustment variables.</p>
</sec>
<sec><title>Results</title>
<p>Median baseline CRP was lower in Japan (1.0 mg/L) than other countries (6.0 mg/L). CRP was positively, monotonically associated with mortality. No threshold below which mortality rate leveled off was identified. In prediction models, CRP performance was comparable with albumin and exceeded ferritin and white blood cell (WBC) count based on measures of model discrimination (c-statistics, net reclassification improvement [NRI]) and global model fit (generalized <italic>R</italic>
<sup>2</sup>
). The primary analysis included age, gender, diabetes, catheter use, and the four inflammatory markers (omitting one at a time). Specifying NRI ≥5% as appropriate reclassification of predicted mortality risk, NRI for CRP was 12.8% compared with 10.3% for albumin, 0.8% for ferritin, and <0.1% for WBC.</p>
</sec>
<sec><title>Conclusions</title>
<p>These findings demonstrate the value of measuring CRP in addition to standard inflammatory biomarkers to improve mortality prediction in hemodialysis patients. Future studies are indicated to identify interventions that lower CRP and to identify whether they improve clinical outcomes.</p>
</sec>
</sec>
</abstract>
</article-meta>
</front>
</pmc>
</record>
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