Predictive Factor for COVID-19 Worsening: Insights for High-Sensitivity Troponin and D-Dimer and Correlation With Right Ventricular Afterload

Background: Coronavirus disease 2019 (COVID-19) has been associated with cardiovascular complications and coagulation disorders.Objectives: To explore clinical and biological parameters of COVID-19 patients with hospitalization criteria that could predict referral to intensive care unit (ICU).Methods: Analyzing the clinical and biological profiles of COVID-19 patients at admission.Results: Among 99 consecutive patients that fulfilled criteria for hospitalization, 48 were hospitalized in the medicine department, 21 were first admitted to the medicine ward department and referred later to ICU, and 30 were directly admitted to ICU from the emergency department. At admission, patients requiring ICU were more likely to have lymphopenia, decreased SpO2, a D-dimer level above 1,000 ng/mL, and a higher high-sensitivity cardiac troponin (Hs-cTnI) level. A receiver operating characteristic curve analysis identified Hs-cTnI above 9.75 pg/mL as the best predictive criteria for ICU referral [area under the curve (AUC), 86.4; 95% CI, 76.6–96.2]. This cutoff for Hs-cTnI was confirmed in univariate [odds ratio (OR), 22.8; 95% CI, 6.0–116.2] and multivariate analysis after adjustment for D-dimer level (adjusted OR, 20.85; 95% CI, 4.76–128.4). Transthoracic echocardiography parameters subsequently measured in 72 patients showed an increased right ventricular (RV) afterload correlated with Hs-cTnI (r = 0.42, p = 0.010) and D-dimer (r = 0.18, p = 0.047).Conclusion: Hs-cTnI appears to be the best relevant predictive factor for referring COVID-19 patients to ICU. This result associated with the correlation of D-dimer with RV dilatation probably reflects a myocardial injury due to an increased RV wall tension. This reinforces the hypothesis of a COVID-19-associated microvascular thrombosis inducing a higher RV afterload.

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Utility of recombinant human TSH stimulation test in the follow-up of patients with differentiated thyroid cancer depending on basal thyroglobulin results

Advances in Laboratory Medicine / Avances en Medicina de Laboratorio ◽

10.1515/almed-2019-0017 ◽

2020 ◽

Vol 1 (1) ◽

Author(s):

Amaia Sandúa ◽

Monica Macias ◽

Carolina Perdomo ◽

Juan Carlos Galofre ◽

Roser Ferrer ◽

...

Keyword(s):

Thyroid Cancer ◽

Differentiated Thyroid Cancer ◽

Characteristic Curve ◽

Area Under The Curve ◽

High Sensitivity ◽

Thyroid Stimulating Hormone ◽

Stimulation Test ◽

Human Thyroid ◽

Antithyroglobulin Antibodies ◽

Structural Disease

AbstractBackgroundThyroglobulin (Tg) is fundamental for differentiated thyroid cancer (DTC) monitoring. Tg detection can be enhanced using recombinant human thyroid-stimulating hormone (TSH) (rhTSH). This study is aimed to evaluate the use of the rhTSH stimulation test when using a high-sensitivity Tg assay.MethodsWe retrospectively studied 181 rhTSH tests from 114 patients with DTC and negative for antithyroglobulin antibodies (anti-TgAb). Image studies were performed in all cases. Serum Tg and anti-TgAb were measured using specific immunoassays.ResultsrhTSH stimulation in patients with basal serum Tg (b-Tg) concentrations lower than 0.2 ng/mL always resulted in rhTSH-stimulated serum Tg (s-Tg) concentrations lower than 1.0 ng/mL and negative structural disease. In patients with b-Tg concentration between 0.2 and 1.0 ng/mL, s-Tg detected one patient (1/30) who showed biochemical incomplete response. Patients with negative images had lower s-Tg than those with nonspecific or abnormal findings (p<0.05). Receiver operating characteristic curve analysis of the s-Tg to detect altered images showed an area under the curve of 0.763 (p<0.05). With an s-Tg cutoff of 0.85 ng/mL, the sensitivity was 100%, decreasing to 96.15% with an s-Tg cutoff of 2 ng/mL.ConclusionsPatients with DTC with b-Tg concentrations equal or higher than 0.2 ng/mL can benefit from the rhTSH stimulation test.

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Analytical assessment of ortho clinical diagnostics high-sensitivity cardiac troponin I assay

Clinical Chemistry and Laboratory Medicine (CCLM) ◽

10.1515/cclm-2020-1115 ◽

2020 ◽

Vol 0 (0) ◽

Author(s):

Peter A. Kavsak ◽

Tara Edge ◽

Chantele Roy ◽

Paul Malinowski ◽

Karen Bamford ◽

...

Keyword(s):

Cardiac Troponin ◽

Troponin I ◽

Limit Of Detection ◽

Clinical Performance ◽

Characteristic Curve ◽

Area Under The Curve ◽

High Sensitivity ◽

Cardiac Troponin I ◽

Clinical Diagnostics ◽

Ortho Clinical Diagnostics

AbstractObjectivesTo analytically evaluate Ortho Clinical Diagnostics VITROS high-sensitivity cardiac troponin I (hs-cTnI) assay in specific matrices with comparison to other hs-cTn assays.MethodsThe limit of detection (LoD), imprecision, interference and stability testing for both serum and lithium heparin (Li-Hep) plasma for the VITROS hs-cTnI assay was determined. We performed Passing-Bablok regression analyses between sample types for the VITROS hs-cTnI assay and compared them to the Abbott ARCHITECT, Beckman Access and the Siemens ADVIA Centaur hs-cTnI assays. We also performed Receiver-operating characteristic curve analyses with the area under the curve (AUC) determined in an emergency department (ED)-study population (n=131) for myocardial infarction (MI).ResultsThe VITROS hs-cTnI LoD was 0.73 ng/L (serum) and 1.4 ng/L (Li-Hep). Stability up to five freeze-thaws was observed for the Ortho hs-cTnI assay, with the analyte stability at room temperature in serum superior to Li-Hep with gross hemolysis also affecting Li-Hep plasma hs-cTnI results. Comparison of Li-Hep to serum concentrations (n=202), yielded proportionally lower concentrations in plasma with the VITROS hs-cTnI assay (slope=0.85; 95% confidence interval [CI]:0.83–0.88). In serum, the VITROS hs-cTnI concentrations were proportionally lower compared to other hs-cTnI assays, with similar slopes observed between assays in samples frozen <−70 °C for 17 years (ED-study) or in 2020. In the ED-study, the VITROS hs-cTnI assay had an AUC of 0.974 (95%CI:0.929–0.994) for MI, similar to the AUCs of other hs-cTn assays.ConclusionsLack of standardization of hs-cTnI assays across manufacturers is evident. The VITROS hs-cTnI assay yields lower concentrations compared to other hs-cTnI assays. Important differences exist between Li-Hep plasma and serum, with evidence of stability and excellent clinical performance comparable to other hs-cTn assays.

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D-dimer as a biomarker for assessment of COVID-19 prognosis: D-dimer levels on admission and its role in predicting disease outcome in hospitalized patients with COVID-19

PLoS ONE ◽

10.1371/journal.pone.0256744 ◽

2021 ◽

Vol 16 (8) ◽

pp. e0256744

Author(s):

Ayusha Poudel ◽

Yashasa Poudel ◽

Anurag Adhikari ◽

Barun Babu Aryal ◽

Debika Dangol ◽

...

Keyword(s):

Proportional Hazards ◽

Characteristic Curve ◽

Area Under The Curve ◽

Respiratory Illness ◽

Immunofluorescence Assay ◽

Cox Proportional Hazards ◽

Optimal Cutoff ◽

Cutoff Value ◽

Potential Biomarker ◽

D Dimer

Introduction Coronavirus Disease 2019 is a primarily respiratory illness that can cause thrombotic disorders. Elevation of D-dimer is a potential biomarker for poor prognosis in COVID-19, though optimal cutoff value for D-dimer to predict mortality has not yet been established. This study aims to assess the accuracy of admission D-dimer in the prognosis of COVID-19 and to establish the optimal cutoff D-dimer value to predict hospital mortality. Methods Clinical and laboratory parameters and outcomes of confirmed COVID-19 cases admitted to four hospitals in Kathmandu were retrospectively analyzed. Admitted COVID-19 cases with recorded D-dimer and definitive outcomes were included consecutively. D-dimer was measured using immunofluorescence assay and reported in Fibrinogen Equivalent Unit (μg/ml). The receiver operating characteristic curve was used to determine the accuracy of D-dimer in predicting mortality, and to calculate the optimal cutoff value, based on which patients were divided into two groups and predictive value of D-dimer for mortality was measured. Results 182 patients were included in the study out of which 34(18.7%) died during the hospital stay. The mean admission D-dimer among surviving patients was 1.067 μg/ml (±1.705 μg/ml), whereas that among patients who died was 3.208 μg/ml (±2.613 μg/ml). ROC curve for D-dimer and mortality gave an area under the curve of 0.807 (95% CI 0.728–0.886, p<0.001). Optimal cutoff value for D-dimer was 1.5 μg/ml (sensitivity 70.6%, specificity 78.4%). On Cox proportional hazards regression analysis, the unadjusted hazard ratio for high D-dimer was 6.809 (95% CI 3.249–14.268, p<0.001), and 5.862 (95% CI 2.751–12.489, p<0.001) when adjusted for age. Conclusion D-dimer value on admission is an accurate biomarker for predicting mortality in patients with COVID-19. 1.5 μg/ml is the optimal cutoff value of admission D-dimer for predicting mortality in COVID-19 patients.

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The Optimal Cutoff Value of D-dimer Levels to Predict in Hospital Mortality in Severe Cases of Coronavirus Disease 2019

Open Access Macedonian Journal of Medical Sciences ◽

10.3889/oamjms.2021.7600 ◽

2021 ◽

Vol 9 (B) ◽

pp. 1561-1564

Author(s):

Ngakan Ketut Wira Suastika ◽

Ketut Suega

Keyword(s):

Hospital Mortality ◽

Receiver Operating Characteristic Curve ◽

Receiver Operating Characteristic ◽

Operating Characteristic ◽

Characteristic Curve ◽

Area Under The Curve ◽

Optimal Cutoff ◽

Cutoff Value ◽

Operating Characteristic Curve ◽

D Dimer

Introduction: Coronavirus disease 2019 (Covid-19) can cause coagulation parameters abnormalities such as an increase of D-dimer levels especially in severe cases. The purpose of this study is to determine the differences of D-dimer levels in severe cases of Covid-19 who survived and non-survived and determine the optimal cut-off value of D-dimer levels to predict in-hospital mortality. Method: Data were obtained from confirmed Covid-19 patients who were treated from June to September 2020. The Mann-Whitney U test was used to determine differences of D-dimer levels in surviving and non-surviving patients. The optimal cut-off value and area under the curve (AUC) of the D-dimer level in predicting mortality were obtained by the receiver operating characteristic curve (ROC) method. Results: A total of 80 patients were recruited in this study. Levels of D-dimer were significantly higher in non-surviving patients (median 3.346 mg/ml; minimum – maximum: 0.939 – 50.000 mg/ml) compared to surviving patients (median 1.201 mg/ml; minimum – maximum: 0.302 – 29.425 mg/ml), p = 0.012. D-dimer levels higher than 1.500 mg/ml are the optimal cut-off value for predicting mortality in severe cases of Covid-19 with a sensitivity of 80.0%; specificity of 64.3%; and area under the curve of 0.754 (95% CI 0.586 - 0.921; p = 0.010). Conclusions: D-dimer levels can be used as a predictor of mortality in severe cases of Covid-19.

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Homocysteine as a potential predictive factor for high major adverse cardiovascular events risk in female patients with premature acute coronary syndrome

10.21203/rs.2.13695/v1 ◽

2019 ◽

Author(s):

Mei Wei ◽

Le Wang ◽

Yongsheng Liu ◽

Mingqi Zheng ◽

Fangfang Ma ◽

...

Keyword(s):

Acute Coronary Syndrome ◽

Predictive Factor ◽

Cardiovascular Events ◽

Characteristic Curve ◽

Area Under The Curve ◽

Major Adverse Cardiovascular Events ◽

Free Survival ◽

Female Patients ◽

Coronary Syndrome ◽

Kaplan Meier

Abstract Background We aimed to investigate correlation of homocysteine (Hcy) level with clinical characteristics, and explore its predictive value for major adverse cardiovascular events (MACE) risk in female patients with premature acute coronary syndrome (ACS).Methods Serum Hcy level was detected from 1,299 female patients with premature ACS. According to the tertile of Hcy level, patients were divided into three groups: lowest tertile group (≤9.1 µmol/L), middle tertile group (9.2~11.6 µmol/L) and highest tertile group (>11.6 µmol/L). MACE incidence was recorded and MACE-free survival was caculated with the median follow-up duration of 28.3 months.Results Increased Hcy correlated with older age ( P <0.001), higher creatinine level ( P <0.001) and enhanced uric acid level ( P =0.001), while reduced fasting glucose concentration ( P <0.001). MACE incidence was 10.7% and it was highest in highest tertile group (22.1%), followed by middle tertile group (7.7%) and lowest tertile group (2.4%) ( P <0.001). Receiver operating characteristic curve showed that Hcy distinguished MACE patients from non-MACE patients with the area under the curve of 0.789 (95% CI: 0.742-0.835). Kaplan-Meier curves revealed that MACE-free survival was shortest in Hcy highest tertile group, followed by middle tertile group and lowest tertile group ( P <0.001). Multivariate Cox’s analyses further showed that higher Hcy level was an independently predictive factor for poor MACE-free survival (middle tertile vs. lowest tertile ( P =0.001, HR: 3.615, 95% CI: 1.661-7.864); highest tertile vs. lowest tertile ( P <0.001, HR: 11.023, 95% CI: 5.356-22.684)).Conclusion Hcy serves as a potential predictive factor for increased MACE risk in female patients with premature ACS.

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Monitoring DOACs with a Novel Dielectric Microsensor: A Clinical Study

Thrombosis and Haemostasis ◽

10.1055/s-0040-1715589 ◽

2020 ◽

Cited By ~ 1

Author(s):

Debnath Maji ◽

Aman Opneja ◽

Michael A. Suster ◽

Kara L. Bane ◽

Brigid M. Wilson ◽

...

Keyword(s):

Whole Blood ◽

Point Of Care ◽

Oral Anticoagulants ◽

Characteristic Curve ◽

Direct Oral Anticoagulants ◽

Unmet Need ◽

Area Under The Curve ◽

High Sensitivity ◽

Diagnostic Study ◽

Coagulation Tests

Abstract Background There are acute settings where assessing the anticoagulant effect of direct oral anticoagulants (DOACs) can be useful. Due to variability among routine coagulation tests, there is an unmet need for an assay that detects DOAC effects within minutes in the laboratory or at the point of care. Methods We developed a novel dielectric microsensor, termed ClotChip, and previously showed that the time to reach peak permittivity (T peak) is a sensitive parameter of coagulation function. We conducted a prospective, single-center, pilot study to determine its clinical utility at detecting DOAC anticoagulant effects in whole blood. Results We accrued 154 individuals: 50 healthy volunteers, 49 rivaroxaban patients, 47 apixaban, and 8 dabigatran patients. Blood samples underwent ClotChip measurements and plasma coagulation tests. Control mean T peak was 428 seconds (95% confidence interval [CI]: 401–455 seconds). For rivaroxaban, mean T peak was 592 seconds (95% CI: 550–634 seconds). A receiver operating characteristic curve showed that the area under the curve (AUC) predicting rivaroxaban using T peak was 0.83 (95% CI: 0.75–0.91, p < 0.01). For apixaban, mean T peak was 594 seconds (95% CI: 548–639 seconds); AUC was 0.82 (95% CI: 0.73–0.91, p < 0.01). For dabigatran, mean T peak was 894 seconds (95% CI: 701–1,086 seconds); AUC was 1 (p < 0.01). Specificity for all DOACs was 88%; sensitivity ranged from 72 to 100%. Conclusion This diagnostic study using samples from “real-world” DOAC patients supports that ClotChip exhibits high sensitivity at detecting DOAC anticoagulant effects in a disposable portable platform, using a miniscule amount of whole blood (<10 µL).

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Clinical suspicion of spondylodiscitis with equivocal MRI findings: does diffusion-weighted imaging prove helpful here?

Acta Radiologica ◽

10.1177/0284185120927905 ◽

2020 ◽

pp. 028418512092790

Author(s):

Jeanette Henkelmann ◽

Kristina Bremicker ◽

Timm Denecke ◽

Karl-Titus Hoffmann ◽

Ralf Henkelmann ◽

...

Keyword(s):

Diffusion Weighted Imaging ◽

Characteristic Curve ◽

Area Under The Curve ◽

Region Of Interest ◽

High Sensitivity ◽

Diagnostic Value ◽

Mri Findings ◽

Adc Value ◽

Diffusion Weighted ◽

Adc Values

Background Despite the high sensitivity of magnetic resonance imaging (MRI), early detection of spondylodiscitis (SpD) remains challenging due to its low specificity. Purpose To assess the diagnostic value of diffusion-weighted imaging (DWI) in suspected cases of SpD with ambiguous early MRI findings in the differentiation of degenerative disorders (DD). Material and Methods In this prospective study, 52 patients suspected of having SpD underwent a whole-spine 3-T MRI scan comprising sagittal DWI. Of 58 conspicuous, T2-weighted, signal increased discs, 39 were successfully evaluated using DWI. Apparent diffusion coefficient (ADC) values and ADC maps were blindly analyzed using the region of interest of the conspicuous disc and a normal adjacent reference disc. Intraindividual ratios (conspicuous disc: reference disc) were calculated. Results All conspicuous discs showed increased absolute ADC values, which did not differ significantly between SpD (n = 22) and DD (n = 17). However, ADC ratio was significantly higher in SpD vs. DD ( P < 0.05). In receiver operating characteristic curve analysis, an ADC ratio threshold of 1.6 resulted in 45% sensitivity and 88% specificity (area under the curve = 0.69) for SpD diagnosis. Conclusion The absolute ADC value does not provide a reliable diagnosis of SpD. Increased diffusivity can be an indication of infection but should always be discussed in the context of existing disc degeneration.

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Laboratory predictors of clinical outcomes in patients with atrial fibrillation

Rational Pharmacotherapy in Cardiology ◽

10.20996/1819-6446-2021-04-14 ◽

2021 ◽

Vol 17 (2) ◽

pp. 332-340

Author(s):

A. A. Sokolova ◽

I. V. Goncharova ◽

A. A. Vedernikov ◽

N. S. Morozova ◽

D. A. Napalkov

Keyword(s):

Atrial Fibrillation ◽

Troponin I ◽

Troponin T ◽

High Sensitivity ◽

Cardiovascular Complications ◽

Cardioembolic Stroke ◽

Published Data ◽

Thromboembolic Complications ◽

Abc Scale ◽

D Dimer

Atrial fibrillation (AF) is the most common cardiac arrhythmia in clinical practice that affects intracardiac hemodynamics and is accompanied by increased mortality due to the risk of stroke and systemic thromboembolism. In recent years, numerous studies, evaluating the use of biomarkers in AF patients, have been conducted to expand the possibility of stratification the complications risks.The aim of the review is to evaluate the possible isolated and combined predictive significance of NT-proBNP, troponin T (TnT) and D-dimer levels in the development and progression of AF and its thromboembolic complications according to published data. Determining the level of NT-proBNP can be used to diagnose cardioembolic stroke in latent forms of AF. Patients with a cardioembolic stroke have been shown to have higher BNP/NT-proBNP levels than patients with an atherothrombotic stroke and venous thromboembolism. Elevated TnT level is independently associated with AF detection as a cause of stroke. The assessment on the CHADS2 scale significantly correlates with the level of troponin I (TnI). However, it is equally important to take into account TnI level even with a low score of CHADS2. Patients with the level of TnI ≥ 0.040 pg/L are considered to be prescribed anticoagulants in the same way as the patients with high CHADS2 score. Similar results were obtained analyzing high-sensitivity cardiac troponin T (hs-cTnT) data. The level of D-dimer 0.315 mg/L was determined to be the optimal limit level for predicting the adverse functional outcome of stroke owing to AF. Patients with a high level of D-dimer have shown a high risk of developing thromboembolic and cardiovascular complications despite their taking anticoagulant drugs. D-dimer levels positively correlate with the CHA2DS2 and CHA2DS2-VASC scales of stroke risk stratification. The analysis of the biomarkers combination has revealed the increase of hs-cTnT and BNP associated with stroke in AF patients (p<0.05). However, ABC scale, including hs-cTnT and NT- pro BNP, hasn't given more accurate result in stroke predicting than CHA2DS2-VASc scale. The integration of biomarkers in predicting the risk of AF occurrence, progression and appearance of thromboembolic complications is a promising direction. An isolated level of biomarkers (hs-cTnT, NT-proBNP, D-dimer) and their combination with clinical risk factors can improve the quality of cardioembolic strokes prognosis.

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Right Ventricular Dysfunction in Ventilated Patients with COVID-19 (COVID-RV)

10.1101/2021.07.29.21261190 ◽

2021 ◽

Author(s):

Philip McCall ◽

Jennifer Willder ◽

Bethany Stanley ◽

Claudia-Martina Messow ◽

John Allan ◽

...

Keyword(s):

Right Ventricular ◽

Myocardial Injury ◽

Ventricular Dysfunction ◽

Right Ventricular Dysfunction ◽

High Sensitivity ◽

Dynamic Compliance ◽

Plateau Pressure ◽

Cardiovascular Complications ◽

Ventilated Patients

Purpose COVID-19 is associated with cardiovascular complications, with right ventricular dysfunction (RVD) commonly reported. The combination of acute respiratory distress syndrome (ARDS), injurious invasive ventilation, micro/macro thrombi and the potential for direct myocardial injury create conditions where RVD is likely to occur. No study has prospectively explored the prevalence of RVD, and its association with mortality, in a cohort requiring mechanical ventilation. Methods Prospective, multi-centre, trans-thoracic echocardiographic, cohort study of ventilated patients with COVID-19 in Scottish intensive care units. RVD was defined as the presence of severe RV dilatation and interventricular septal flattening. To explore role of myocardial injury, high sensitivity troponin and N-terminal pro B-type natriuretic peptide (NT-proBNP) were measured in all patients. Results One hundred and twenty-one patients were recruited to COVID-RV, 118 underwent imaging and it was possible to determine the primary outcome in 112. RVD was present in seven (6.2% [95%CI; 2.5%, 12.5%]) patients. Thirty-day mortality was 85.7% in those with RVD, compared to 44.8% in those without (p=0.051). Patients with RVD were more likely to have; pulmonary thromboembolism (p<0.001), higher plateau pressure (p=0.048), lower dynamic compliance (p=0.031), higher NT-proBNP (p<0.006) and more frequent abnormal troponin (p=0.048). Abnormal NT-proBNP (OR 4.77 [1.22, 21.32], p=0.03) and abnormal Troponin (16.54 [4.98, 67.12], p<0.001) independently predicted 30-day mortality. Conclusion COVID-RV demonstrates a prevalence of RVD in ventilated patients with COVID-19 of 6.2% and is associated with a mortality of 85.7%. Association is observed between RVD and each of the aetiological domains of; ARDS, ventilation, micro/macro thrombi and myocardial injury.

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Diagnostic value of the Hs-cTnT/CysC ratio in patients with stage ≥3 CKD and acute myocardial infarction

10.21203/rs.3.rs-59606/v1 ◽

2020 ◽

Author(s):

Lihua Yang ◽

Cudan Cai ◽

Hanfei Lin ◽

Jianwei Peng ◽

Yanqiang Peng ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Troponin T ◽

Characteristic Curve ◽

Area Under The Curve ◽

High Sensitivity ◽

Diagnostic Value ◽

Epidermal Growth Factor Receptors ◽

Pain Center ◽

Epidermal Growth

Abstract Background: We investigated the diagnostic value of the ratio of high sensitivity troponin to cystatin C in CKD patients with stage ≥ 3 chronic kidney disease (CKD) and acute myocardial infarction. Methods: We retrospectively analyzed 401 patients with suspected acute myocardial infarction (AMI) who underwent coronary angiography in the chest pain center at our hospital during 2013–2019. Among the 196 patients studied, 113 were placed in an AMI group and 83 in a non-AMI group. Results: There were no significant differences in age, sex, or the presence of hypertension, diabetes, gout/hyperuricemia, stroke, tumor, or epidermal growth factor receptors between the two groups (P > 0.05). A correlation analysis showed that there was a positive correlation between CysC and Cr, with a correlation coefficient of 0.872 (P < 0.001). A receiver operating characteristic curve for the high-sensitivity cardiac troponin T (hs-cTnT)/CysC ratio showed an area under the curve value of 0.925 (P < 0.001), with sensitivity of 78.4% and specificity of 94.0%. Conclusion: The hs-TnT/CysC ratio can thus be used as an index to predict AMI in patients with stage≥ 3 CKD.

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