AI Article Synopsis
- Type 2 diabetes is linked to higher death rates, prompting the need for new biomarkers to identify patients at risk for more aggressive treatment.
- The study analyzed 2,499 diabetes patients and evaluated the role of inflammation proteins hs-CRP and SAP in predicting mortality using established models.
- Results showed that hs-CRP and SAP independently influenced mortality risk, and combining these markers significantly enhanced the predictive accuracy of mortality models for diabetes patients.
Article Abstract
Objective: Type 2 diabetes is characterized by increased death rate. In order to tackle this dramatic event, it becomes essential to discover novel biomarkers capable of identifying high-risk patients to be exposed to more aggressive preventive and treatment strategies. hs-CRP and serum amyloid P component (SAP) are two acute-phase inflammation proteins, which interact physically and share structural and functional features. We investigated their combined role in associating with and improving prediction of mortality in type 2 diabetes.
Research Design And Methods: Four cohorts comprising 2,499 patients with diabetes (643 all-cause deaths) were analyzed. The improvement of mortality prediction was addressed using two well-established prediction models, namely, EstimatioN oF mORtality risk in type 2 diabetiC patiEnts (ENFORCE) and Risk Equations for Complications of Type 2 Diabetes (RECODe).
Results: Both hs-CRP and SAP were independently associated with all-cause mortality (hazard ratios [HRs] [95% CIs]: 1.46 [1.34-1.58] [ < 0.001] and 0.82 [0.76-0.89] [ < 0.001], respectively). Patients with SAP ≤33 mg/L were at increased risk of death versus those with SAP >33 mg/L only if hs-CRP was relatively high (>2 mg/L) (HR 1.96 [95% CI 1.52-2.54] [ < 0.001] and 1.20 [0.91-1.57] [ = 0.20] in hs-CRP >2 and ≤2 mg/L subgroups, respectively; hs-CRP-by-SAP strata interaction < 0.001). The addition of hs-CRP and SAP significantly (all < 0.05) improved several discrimination and reclassification measures of both ENFORCE and RECODe all-cause mortality prediction models.
Conclusions: In type 2 diabetes, hs-CRP and SAP show opposite and synergic associations with all-cause mortality. The use of both markers, possibly in combination with others yet to be unraveled, might improve the ability to predict the risk of death in the real-life setting.
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| http://dx.doi.org/10.2337/dc19-2489 | DOI Listing |
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