Prognostic Significance of Serum Indoxyl Sulfate and Albumin for Patients with Cardiovascular Disease.
Int Heart J
; 60(1): 129-135, 2019 Jan 25.
Article
in En
| MEDLINE
| ID: mdl-30464134
ABSTRACT
The progression of renal dysfunction reduces serum albumin and deteriorates the binding capacity of protein-bound uremic toxins. We evaluated the prognostic implications of serum indoxyl sulfate (IS) and albumin levels in patients with cardiovascular disease.We prospectively enrolled 351 consecutive patients undergoing percutaneous revascularization for coronary artery disease or peripheral artery disease. The primary endpoint was all-cause mortality. Patients were assigned to four groups according to the median levels of serum IS (0.1 mg/dL) and albumin (3.9 g/dL).During the median follow-up time of 575 days, 16 patients died. The IS level was significantly higher in nonsurvivors (0.33 versus 0.85 mg/dL, P < 0.05). On the Kaplan-Meier curve, the high IS/low albumin group presented the highest mortality rate (log-rank test, P < 0.01). Cox proportional hazard analysis revealed that high IS/low albumin (hazard ratio (HR) 5.33; 95% confidence interval (CI) 1.71-16.5; P < 0.01), diastolic pressure (HR 0.94; 95% CI 0.91-0.98; P < 0.01), prior stroke (HR 4.54; 95% CI 1.33-15.4; P = 0.01), and left ventricular ejection fraction (LVEF) (HR 0.92; 95% CI 0.88-0.96; P < 0.001) were associated with increased mortality. Furthermore, the combination of IS and albumin levels significantly conferred an additive value to LVEF for predicting mortality (C-statistic 0.69 versus 0.80; P < 0.001; net reclassification improvement 0.83; P < 0.001; integrated discrimination improvement 0.02; P = 0.02).A lower albumin level adds potentiating effects on IS as a prognostic factor for cardiovascular disease.
Key words
Full text:
1
Database:
MEDLINE
Main subject:
Toxins, Biological
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Serum Albumin
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Cardiovascular Diseases
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Cardio-Renal Syndrome
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Indican
Type of study:
Etiology_studies
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Observational_studies
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Prognostic_studies
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Risk_factors_studies
Limits:
Aged
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Female
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Humans
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Male
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Middle aged
Language:
En
Year:
2019
Type:
Article