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Review
. 2015 Apr;70(4):301-11.
doi: 10.6061/clinics/2015(04)14.

Cardiac troponin and C-reactive protein for predicting all-cause and cardiovascular mortality in patients with chronic kidney disease: a meta-analysis

Wei-Jie Li  1 , Xu-Miao Chen  1 , Xiao-Ying Nie  2 , Jing Zhang  1 , Yun-Jiu Cheng  1 , Xiao-Xiong Lin  1 , Su-Hua Wu  1
Affiliations
Review

Cardiac troponin and C-reactive protein for predicting all-cause and cardiovascular mortality in patients with chronic kidney disease: a meta-analysis

Wei-Jie Li et al. Clinics (Sao Paulo). 2015 Apr.

Abstract

Elevated serum levels of cardiac troponin and C-reactive protein are associated with all-cause and cardiovascular mortality in patients with end-stage renal disease. However, the relationship between these two biomarker levels and mortality in patients with chronic kidney disease remains unclear. We conducted a meta-analysis to quantify the association of cardiac troponin and C-reactive protein levels with all-cause and cardiovascular mortality in patients with chronic kidney disease. Relevant studies were identified by searching the MEDLINE database through November 2013. Studies were included in the meta-analysis if they reported the long-term all-cause or cardiovascular mortality of chronic kidney disease patients with abnormally elevated serum levels of cardiac troponin or C-reactive protein. Summary estimates of association were obtained using a random-effects model. Thirty-two studies met our inclusion criteria. From the pooled analysis, cardiac troponin and C-reactive protein were significantly associated with all-cause (HR 2.93, 95% CI 1.97-4.33 and HR 1.21, 95% CI 1.14-1.29, respectively) and cardiovascular (HR 3.27, 95% CI 1.67-6.41 and HR 1.19, 95% CI 1.10-1.28, respectively) mortality. In the subgroup analysis of cardiac troponin and C-reactive protein, significant heterogeneities were found among the subgroups of population for renal replacement therapy and for the proportion of smokers and the C-reactive protein analysis method. Elevated serum levels of cardiac troponin and C-reactive protein are significant associated with higher risks of all-cause and cardiovascular mortality in patients with chronic kidney disease. Further studies are warranted to explore the risk stratification in chronic kidney disease patients.

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Conflict of interest statement

No potential conflict of interest was reported.

Figures

Figure 1
Figure 1
Selection of included studies.
Figure 2
Figure 2
C-reactive protein and cardiac troponin for predicting all-cause mortality. Elevated serum levels of C-reactive protein and cardiac troponin were significantly associated with all-cause mortality in patients with chronic kidney disease. However, the pooled HR of cardiac troponin was higher than that of C-reactive protein. HR, hazard ratio; CI, confidence interval.
Figure 3
Figure 3
C-reactive protein and cardiac troponin for predicting cardiovascular mortality. Elevated serum levels of C-reactive protein and cardiac troponin were significantly associated with cardiovascular mortality in patients with chronic kidney disease. However, the pooled HR of cardiac troponin was higher than that of C-reactive protein. HR, hazard ratio; CI confidence interval.
Figure 4
Figure 4
Egger's funnel plots for C-reactive protein and cardiac troponin studies. Publication bias was found in this meta-analysis. CRP, C-reactive protein; CI confidence interval.
See this image and copyright information in PMC

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