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C-reactive protein and B-type natriuretic peptide yield either a non-significant or a modest incremental value to traditional risk factors in predicting long-term overall mortality in older adults.

Beleigoli AM, Boersma E, Diniz Mde F, Vidigal PG, Lima-Costa MF, Ribeiro AL - PLoS ONE (2013)

Bottom Line: Subsequently, we compared c-statistic of each of the new models to the old one, and calculated integrated discriminative improvement (IDI) and net reclassification improvement (NRI). 544 (37.0%) participants died in a mean follow-up time of 9.0 years.Discrimination was similar among the old (c-statistic 0.78 [0.78-0.81]) and new models (p=0.43 for CRP; p=0.57 for BNP; and p=0.31 for CRP plus BNP).Despite being independent predictors of long-term risk of death, compared to traditional risk factors CRP and/or BNP led to either a modest or non-significant improvement in the ability of predicting all-cause mortality in older adults.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Faculty of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil ; Post-Graduation Department, Faculty of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.

ABSTRACT

Background: New biomarkers may aid in preventive and end-of-life decisions in older adults if they enhance the prognostic ability of traditional risk factors. We investigated whether C-reactive protein (CRP) and/or B-type natriuretic peptide (BNP) improve the ability to predict overall mortality among the elderly of the Bambuí, Brazil Study of Aging when added to traditional risk factors.

Methods: From 1997 to 2007, 1,470 community-dwelling individuals (≥60 years) were followed-up. Death was ascertained by continuous verification of death certificates. We calculated hazard ratios per 1 standard deviation change (HR) of death for traditional risk factors only (old model), and traditional risk factors plus CRP and/or BNP (new models) and assessed calibration of the models. Subsequently, we compared c-statistic of each of the new models to the old one, and calculated integrated discriminative improvement (IDI) and net reclassification improvement (NRI).

Results: 544 (37.0%) participants died in a mean follow-up time of 9.0 years. CRP (HR 1.28, 95% CI 1.17-1.40), BNP (HR 1.31 95% CI 1.19-1.45), and CRP plus BNP (HR 1.26, 95% CI 1.15-1.38, and HR 1.29, 95% CI 1.16-1.42, respectively) were independent determinants of mortality. All models were well-calibrated. Discrimination was similar among the old (c-statistic 0.78 [0.78-0.81]) and new models (p=0.43 for CRP; p=0.57 for BNP; and p=0.31 for CRP plus BNP). Compared to the old model, CRP, BNP, and CRP plus BNP models led to an IDI of 0.009 (p<0.001), -0.005 (p<0.001) and -0.003 (p=0.84), and a NRI of 0.04 (p=0.24), 0.07 (p=0.08) and 0.06 (p=0.10), respectively.

Conclusions: Despite being independent predictors of long-term risk of death, compared to traditional risk factors CRP and/or BNP led to either a modest or non-significant improvement in the ability of predicting all-cause mortality in older adults.

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Estimated 11-year risk of mortality by the models with traditional risk factors only and after addition of CRP.
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pone-0075809-g003: Estimated 11-year risk of mortality by the models with traditional risk factors only and after addition of CRP.

Mentions: IDI was modest for the addition of CRP (IDI=0.009; p=<0.001), BNP (IDI=-0.005; p=<0.001) and both of the biomarkes (IDI=-0.003; p=0.84) to the model with traditional risk factors only. Moreover, the addition of CRP led to small non-significant changes in the prediction of death (NRI=0.04; 95% CI -0.02 to 0.09; p=0.24) by the model. Changes in the risk of death estimated by the model were also non-significant when BNP was added to traditional risk factors (NRI=0.07; 95% CI -0.01 to 0.14; p=0.08) and when BNP and CRP were simultaneously added to the model (NRI=0.06; 95% CI -0.01 to 0.12; p=0.10) Figures 3-5 display the estimated risk of death for both subjects who died and survived during the follow-up time for each of the new models compared to the model based on traditional risk factors only.


C-reactive protein and B-type natriuretic peptide yield either a non-significant or a modest incremental value to traditional risk factors in predicting long-term overall mortality in older adults.

Beleigoli AM, Boersma E, Diniz Mde F, Vidigal PG, Lima-Costa MF, Ribeiro AL - PLoS ONE (2013)

Estimated 11-year risk of mortality by the models with traditional risk factors only and after addition of CRP.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3815403&req=5

pone-0075809-g003: Estimated 11-year risk of mortality by the models with traditional risk factors only and after addition of CRP.
Mentions: IDI was modest for the addition of CRP (IDI=0.009; p=<0.001), BNP (IDI=-0.005; p=<0.001) and both of the biomarkes (IDI=-0.003; p=0.84) to the model with traditional risk factors only. Moreover, the addition of CRP led to small non-significant changes in the prediction of death (NRI=0.04; 95% CI -0.02 to 0.09; p=0.24) by the model. Changes in the risk of death estimated by the model were also non-significant when BNP was added to traditional risk factors (NRI=0.07; 95% CI -0.01 to 0.14; p=0.08) and when BNP and CRP were simultaneously added to the model (NRI=0.06; 95% CI -0.01 to 0.12; p=0.10) Figures 3-5 display the estimated risk of death for both subjects who died and survived during the follow-up time for each of the new models compared to the model based on traditional risk factors only.

Bottom Line: Subsequently, we compared c-statistic of each of the new models to the old one, and calculated integrated discriminative improvement (IDI) and net reclassification improvement (NRI). 544 (37.0%) participants died in a mean follow-up time of 9.0 years.Discrimination was similar among the old (c-statistic 0.78 [0.78-0.81]) and new models (p=0.43 for CRP; p=0.57 for BNP; and p=0.31 for CRP plus BNP).Despite being independent predictors of long-term risk of death, compared to traditional risk factors CRP and/or BNP led to either a modest or non-significant improvement in the ability of predicting all-cause mortality in older adults.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Faculty of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil ; Post-Graduation Department, Faculty of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.

ABSTRACT

Background: New biomarkers may aid in preventive and end-of-life decisions in older adults if they enhance the prognostic ability of traditional risk factors. We investigated whether C-reactive protein (CRP) and/or B-type natriuretic peptide (BNP) improve the ability to predict overall mortality among the elderly of the Bambuí, Brazil Study of Aging when added to traditional risk factors.

Methods: From 1997 to 2007, 1,470 community-dwelling individuals (≥60 years) were followed-up. Death was ascertained by continuous verification of death certificates. We calculated hazard ratios per 1 standard deviation change (HR) of death for traditional risk factors only (old model), and traditional risk factors plus CRP and/or BNP (new models) and assessed calibration of the models. Subsequently, we compared c-statistic of each of the new models to the old one, and calculated integrated discriminative improvement (IDI) and net reclassification improvement (NRI).

Results: 544 (37.0%) participants died in a mean follow-up time of 9.0 years. CRP (HR 1.28, 95% CI 1.17-1.40), BNP (HR 1.31 95% CI 1.19-1.45), and CRP plus BNP (HR 1.26, 95% CI 1.15-1.38, and HR 1.29, 95% CI 1.16-1.42, respectively) were independent determinants of mortality. All models were well-calibrated. Discrimination was similar among the old (c-statistic 0.78 [0.78-0.81]) and new models (p=0.43 for CRP; p=0.57 for BNP; and p=0.31 for CRP plus BNP). Compared to the old model, CRP, BNP, and CRP plus BNP models led to an IDI of 0.009 (p<0.001), -0.005 (p<0.001) and -0.003 (p=0.84), and a NRI of 0.04 (p=0.24), 0.07 (p=0.08) and 0.06 (p=0.10), respectively.

Conclusions: Despite being independent predictors of long-term risk of death, compared to traditional risk factors CRP and/or BNP led to either a modest or non-significant improvement in the ability of predicting all-cause mortality in older adults.

Show MeSH