A risk stratification for systemic immunoglobulin light-chain amyloidosis with renal involvement
Ting Li
School of Medicine, Southeast University, Nanjing, China
These authors contributed equally to this work.
Search for more papers by this authorXianghua Huang
National Clinical Research Centre of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
These authors contributed equally to this work.
Search for more papers by this authorQingwen Wang
National Clinical Research Centre of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
Search for more papers by this authorLiang Zhao
National Clinical Research Centre of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
Search for more papers by this authorGuisheng Ren
National Clinical Research Centre of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
Search for more papers by this authorWencui Chen
National Clinical Research Centre of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
Search for more papers by this authorChunxia Zheng
National Clinical Research Centre of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
Search for more papers by this authorMinlin Zhou
National Clinical Research Centre of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
Search for more papers by this authorQi Jiang
National Clinical Research Centre of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
Search for more papers by this authorRu Yin
National Clinical Research Centre of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
Search for more papers by this authorCorresponding Author
Zhihong Liu
School of Medicine, Southeast University, Nanjing, China
National Clinical Research Centre of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
Correspondence: Professor Zhihong Liu, School of Medicine, Southeast University, NO. 87 Dingjiaqiao, Hunan Road, Nanjing 210009, Jiangsu, China.
E-mail: [email protected]
Search for more papers by this authorTing Li
School of Medicine, Southeast University, Nanjing, China
These authors contributed equally to this work.
Search for more papers by this authorXianghua Huang
National Clinical Research Centre of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
These authors contributed equally to this work.
Search for more papers by this authorQingwen Wang
National Clinical Research Centre of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
Search for more papers by this authorLiang Zhao
National Clinical Research Centre of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
Search for more papers by this authorGuisheng Ren
National Clinical Research Centre of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
Search for more papers by this authorWencui Chen
National Clinical Research Centre of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
Search for more papers by this authorChunxia Zheng
National Clinical Research Centre of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
Search for more papers by this authorMinlin Zhou
National Clinical Research Centre of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
Search for more papers by this authorQi Jiang
National Clinical Research Centre of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
Search for more papers by this authorRu Yin
National Clinical Research Centre of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
Search for more papers by this authorCorresponding Author
Zhihong Liu
School of Medicine, Southeast University, Nanjing, China
National Clinical Research Centre of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
Correspondence: Professor Zhihong Liu, School of Medicine, Southeast University, NO. 87 Dingjiaqiao, Hunan Road, Nanjing 210009, Jiangsu, China.
E-mail: [email protected]
Search for more papers by this authorSummary
Renal involvement is found in about 70% of patients with systemic immunoglobulin light-chain (AL) amyloidosis. However, there is no risk stratification system specialized for renal AL concerning patients’ survival. Galectin-3 (Gal-3) has been reported to portend poor prognosis in other renal diseases. We measured Gal-3 and several traditional risk biomarkers of AL in baseline samples from 253 consecutive patients diagnosed with renal AL. At baseline, Gal-3 [Hazard ratio (HR): 1·46; P = 0·033], high-sensitivity cardiac troponin T (hs-cTnT) (HR: 2·65; P < 0·001) and difference between involved and uninvolved free light chains (dFLC) (HR: 1·81; P = 0·001) were independent predictors of all-cause mortality. The cut-off points for Gal-3, hs-cTnT, and dFLC were 20·24 ng/ml, 0·026 ng/ml, and 75·89 mg/l, respectively. Patients were stratified into four stages by assigning a score of 1 for each of the three biomarkers above the cut-off point. The proportions of patients with disease stages 1, 2, 3 and 4 were 17·0%, 37·2%, 29·2% and 16·6%, and the median overall survival times from diagnosis were 100, 60, 29 and 15 months, respectively (P < 0·01). Higher level of Gal-3 is associated with increased risk for mortality, and the risk stratification based on Gal-3 is a reliable model for predicting mortality in AL amyloidosis with renal involvement.
Conflict of interest
The authors declare no conflict of interest.
Supporting Information
| Filename | Description |
|---|---|
| bjh16112-sup-0001-Supinfo.docxWord document, 168.8 KB | Table S1. Correlation of Gal-3 with other characteristics. Figure S1. Spearman correlations between the Gal-3 concentration and (A) the NT-proBNP concentration (r = 0.401, 95%CI 0·292–0·499), (B) the hs-cTnT concentration (r = 0·0·459, 95%CI 0·356–0·551), (C) and eGFR (r = −0·429, 95%CI −0·525 to −0·323); (D) Spearman correlation between the NT-proBNP concentration and the hs-cTnT concentration (r = 0·810, 95%CI 0·761 to 0·848; all P < 0·001). Figure S2. Receiving operating characteristic curve and corresponding area under the curve for estimating the optima cut-point for (A) Gal-3 (Cut-point 20·24 ng/ml, AUC 0·744, 95%CI 0·659–0·830), (B) hs-cTnT (Cut-point 0·026 ng/ml, AUC 0·779, 95%CI 0·704–0·855), (C) and NT-proBNP (Cut-point 434·7 pg/ml, AUC 0·735, 95%CI 0·656 to 0·815). |
Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
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