Optimal cut-off value of high-sensitivity troponin I in diagnosing myocardial infarction in patients with end-stage renal disease

Abstract

End-stage renal disease (ESRD) is a major risk factor for cardiovascular disease and the prognosis after myocardial infarction (MI) is dismal. Although cardiac troponin is a key diagnostic test, troponin levels are often elevated in ESRD patients without evidence of MI. Thus, this study attempted to determine the optimal diagnostic value of high-sensitivity troponin I (hsTnI) by dialysis modality in ESRD patients. Medical records of adult dialysis patients who visited tertiary emergency department (ED) were collected retrospectively. Diagnosis of MI was made according to the fourth universal definition of MI. The cut-off values were calculated using a receiver operating characteristic (ROC) curve. Medical records of 1144 patients were analyzed and MI was diagnosed in 82 patients (75 on hemodialysis and 7 on peritoneal dialysis). The optimal cut-off value of hsTnI in hemodialysis patients was 75 ng/L, with 93.33% sensitivity and 60.76% specificity. Area under the curve (AUC) was .870 (95% confidence interval (CI) .833–.906). The optimal cut-off value of hsTnI in peritoneal dialysis patients was 144 ng/L, with 100.00% sensitivity and 83.10% specificity. AUC was .943 (95% CI .893–.992). The dialysis modality should also be considered when diagnosing MI using hsTnI in ESRD patients.

Troponin Cut-Offs for Acute Myocardial Infarction in Patients with Impaired Renal Function—A Systematic Review and Meta-Analysis

“…The remaining 46 publications were again assessed for eligibility according to inclusion and exclusion criteria. A total of 15 articles published from 2007 [ 14 ]–2019 [ 15 ], were preliminarily included. A total of six studies, which were considered to be adequate in terms of AMI and renal impairment definition, were selected for the meta-analysis.…”

“…The 15 studies included for review featured four retrospective studies [ 15 , 16 , 17 , 18 ], eight prospective studies [ 14 , 19 , 20 , 21 , 22 , 23 , 24 , 25 ], and three post hoc analyses [ 26 , 27 , 28 ].…”

“…Two of the post hoc analyses were based on a multicenter study [ 27 , 28 ]. The other studies were single-center studies [ 14 , 15 , 16 , 17 , 19 , 20 , 21 , 22 , 26 ].…”

“…This cohort study was designed to predict death, hence the lower eGFR. Two publications included only ESRD patients on dialysis [ 15 , 26 ].…”

Evaluation of the Correlation Between Cardiac Troponin I Versus Causes of Admission and In-Hospital Mortality in End-Stage Renal Disease Patients

“…Cardiac troponins (cTn) can be used to diagnose CAD (5). However, the troponin level is thought to be increased in ESRD patients without coronary events (6). There is little evidence about the relationship between ESRD and cTn level; hence, more evidence is needed to clarify this correspondence.…”