Inflammation biomarkers and mortality prediction in patients with type 2 diabetes (ZODIAC-27)Landman, G. W. D., Kleefstra, N., Groenier, K. H., Bakker, S. J. L., Groeneveld, G. H., Bilo, H. J. G. & van Hateren, K. J. J., Jul-2016, In : ATHEROSCLEROSIS. 250, p. 46-51 6 p.
Research output: Contribution to journal › Article › Academic › peer-review
Background: C-reactive protein (CRP), procalcitonin (PCT) and pro-adrenomedullin (MR-proADM) are inflammation markers associated with long-term mortality risk. We compared the associations and predictive capacities of CRP, PCT and MR-proADM with cardiovascular and all-cause mortality in patients with type 2 diabetes.
Methods: This study included primary care treated patients with type 2 diabetes participating in the ZODIAC cohort study. A total of 1005 out of 1688 patients (60%) had complete baseline variables. Baseline CRP, PCT and MR-proADM were assessed in relation to cardiovascular and all-cause mortality with Cox proportional hazard analyses. Hazard Ratios (HR) were adjusted for age, gender, BMI, smoking, systolic blood pressure, cholesterol-HDL ratio, duration of diabetes, HbA(1c), history of cardiovascular diseases, albumin-creatinine ratio and creatinine. Risk prediction capabilities were assessed with Harrell's C statistics and proportion of explained variance (R-2).
Results: After a median follow-up of 11 years, 472 (47%) of 1005 patients had died. The likelihood ratio test showed that CRP and MR-proADM significantly improved prediction in cardiovascular mortality [HRs 1.20 (95% CI 1.09-1.33) and 1.56 (95% CI 1.06-2.30)] and in all-cause mortality [HRs 1.10 (95% CI: 1.03-1.18) and 1.31 (95% CI 1.02-1.69)]. Harrell's C values and R-2 measures showed slightly improved discrimination for cardiovascular mortality in patients without macrovascular disease (C: 0.80 to 0.81; R-2: 0.50 to 0.52) and MR-proADM (C: 0.80 to 0.82; R-2: 0.50 to 0.52).
Conclusions: CRP and MR-proADM, but not PCT, were independently associated with cardiovascular and all-cause mortality. In patients without macrovascular diseases, CRP and MR-proADM slightly improved discrimination, in absolute sense, of patients at risk for cardiovascular mortality. (C) 2016 Published by Elsevier Ireland Ltd.
|Number of pages||6|
|Publication status||Published - Jul-2016|
- Biomarker, Inflammation, Type 2 diabetes, Mortality, Prediction, C-REACTIVE PROTEIN, REGIONAL PRO-ADRENOMEDULLIN, CORONARY-HEART-DISEASE, APPARENTLY HEALTHY-MEN, CARDIOVASCULAR EVENTS, MIDREGIONAL PROADRENOMEDULLIN, IMMUNOLUMINOMETRIC ASSAY, MYOCARDIAL-INFARCTION, PLASMA PROCALCITONIN, PROGNOSTIC VALUE