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Serum albumin, C-reactive protein, interleukin 6, and fetuin a as predictors of malnutrition, cardiovascular disease, and mortality in patients with ESRD.
Am J Kidney Dis. 2006 Jan; 47(1):139-48.AJ

Abstract

BACKGROUND

Serum albumin (S-Alb), C-reactive protein (CRP), and interleukin 6 (IL-6) predict malnutrition, atherosclerotic cardiovascular disease (CVD), and mortality in patients with end-stage renal disease (ESRD). Fetuin A, an inhibitor of vascular calcification, also is associated strongly with clinical outcome in patients with ESRD. In this study, multivariate analyses were performed to assess these 4 biomarkers as predictors of malnutrition, CVD, and mortality in patients with ESRD.

METHODS

One hundred seventy-six patients with ESRD (54 +/- 12 years) underwent measurements of S-Alb, high-sensitivity CRP (hs-CRP), plasma IL-6, and fetuin A close to the start of dialysis therapy and were followed up for a median of 26 months (range, 1 to 66 months). Nutritional status was evaluated by means of subjective global assessment. CVD was defined based on medical history. Associations between biomarker levels and malnutrition, CVD, and mortality were evaluated by means of receiver operating characteristic curve, logistic regression analysis, and Cox proportional hazards model.

RESULTS

All 4 biomarkers predicted malnutrition, CVD, and mortality. Multivariate analysis, according to receiver operating characteristic analysis, showed that malnutrition was predicted best by hs-CRP and IL-6 levels; CVD, by IL-6 level; and mortality, by albumin and IL-6 levels. When using the cutoff levels derived from receiver operating characteristics, logistic regression analysis showed that only hs-CRP level (odds ratio [OR], 3.6) was associated with malnutrition, and only IL-6 level (OR, 3.7) was associated with CVD. Levels of S-Alb, IL-6, and fetuin A, but not hs-CRP, were associated with increased relative risk for mortality as assessed by Cox in a model adjusting for age, sex, and diabetes mellitus.

CONCLUSION

Multivariate analyses show that in patients with ESRD, malnutrition is predicted best by hs-CRP and IL-6 levels; CVD, by IL-6 level; and mortality, by S-Alb, IL-6, and fetuin A levels, but not by hs-CRP level. This comparative analysis indicates that of these biomarkers, IL-6 level may be the most reliable predictor of CVD and mortality in patients with ESRD.

Authors+Show Affiliations

Division of Renal Medicine, Department of Clinical Science, Interventions and Technology, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

16377395

Citation

Honda, Hirokazu, et al. "Serum Albumin, C-reactive Protein, Interleukin 6, and Fetuin a as Predictors of Malnutrition, Cardiovascular Disease, and Mortality in Patients With ESRD." American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, vol. 47, no. 1, 2006, pp. 139-48.
Honda H, Qureshi AR, Heimbürger O, et al. Serum albumin, C-reactive protein, interleukin 6, and fetuin a as predictors of malnutrition, cardiovascular disease, and mortality in patients with ESRD. Am J Kidney Dis. 2006;47(1):139-48.
Honda, H., Qureshi, A. R., Heimbürger, O., Barany, P., Wang, K., Pecoits-Filho, R., Stenvinkel, P., & Lindholm, B. (2006). Serum albumin, C-reactive protein, interleukin 6, and fetuin a as predictors of malnutrition, cardiovascular disease, and mortality in patients with ESRD. American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, 47(1), 139-48.
Honda H, et al. Serum Albumin, C-reactive Protein, Interleukin 6, and Fetuin a as Predictors of Malnutrition, Cardiovascular Disease, and Mortality in Patients With ESRD. Am J Kidney Dis. 2006;47(1):139-48. PubMed PMID: 16377395.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Serum albumin, C-reactive protein, interleukin 6, and fetuin a as predictors of malnutrition, cardiovascular disease, and mortality in patients with ESRD. AU - Honda,Hirokazu, AU - Qureshi,Abdul Rashid, AU - Heimbürger,Olof, AU - Barany,Peter, AU - Wang,Kai, AU - Pecoits-Filho,Roberto, AU - Stenvinkel,Peter, AU - Lindholm,Bengt, PY - 2005/03/30/received PY - 2005/09/19/accepted PY - 2005/12/27/pubmed PY - 2006/2/10/medline PY - 2005/12/27/entrez SP - 139 EP - 48 JF - American journal of kidney diseases : the official journal of the National Kidney Foundation JO - Am J Kidney Dis VL - 47 IS - 1 N2 - BACKGROUND: Serum albumin (S-Alb), C-reactive protein (CRP), and interleukin 6 (IL-6) predict malnutrition, atherosclerotic cardiovascular disease (CVD), and mortality in patients with end-stage renal disease (ESRD). Fetuin A, an inhibitor of vascular calcification, also is associated strongly with clinical outcome in patients with ESRD. In this study, multivariate analyses were performed to assess these 4 biomarkers as predictors of malnutrition, CVD, and mortality in patients with ESRD. METHODS: One hundred seventy-six patients with ESRD (54 +/- 12 years) underwent measurements of S-Alb, high-sensitivity CRP (hs-CRP), plasma IL-6, and fetuin A close to the start of dialysis therapy and were followed up for a median of 26 months (range, 1 to 66 months). Nutritional status was evaluated by means of subjective global assessment. CVD was defined based on medical history. Associations between biomarker levels and malnutrition, CVD, and mortality were evaluated by means of receiver operating characteristic curve, logistic regression analysis, and Cox proportional hazards model. RESULTS: All 4 biomarkers predicted malnutrition, CVD, and mortality. Multivariate analysis, according to receiver operating characteristic analysis, showed that malnutrition was predicted best by hs-CRP and IL-6 levels; CVD, by IL-6 level; and mortality, by albumin and IL-6 levels. When using the cutoff levels derived from receiver operating characteristics, logistic regression analysis showed that only hs-CRP level (odds ratio [OR], 3.6) was associated with malnutrition, and only IL-6 level (OR, 3.7) was associated with CVD. Levels of S-Alb, IL-6, and fetuin A, but not hs-CRP, were associated with increased relative risk for mortality as assessed by Cox in a model adjusting for age, sex, and diabetes mellitus. CONCLUSION: Multivariate analyses show that in patients with ESRD, malnutrition is predicted best by hs-CRP and IL-6 levels; CVD, by IL-6 level; and mortality, by S-Alb, IL-6, and fetuin A levels, but not by hs-CRP level. This comparative analysis indicates that of these biomarkers, IL-6 level may be the most reliable predictor of CVD and mortality in patients with ESRD. SN - 1523-6838 UR - https://www.unboundmedicine.com/medline/citation/16377395/Serum_albumin_C_reactive_protein_interleukin_6_and_fetuin_a_as_predictors_of_malnutrition_cardiovascular_disease_and_mortality_in_patients_with_ESRD_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0272-6386(05)01444-7 DB - PRIME DP - Unbound Medicine ER -