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American Journal of the Medical Sciences:
doi: 10.1097/MAJ.0b013e31819bbec1
Clinical Investigation

Cardiothoracic Ratio, Inflammation, Malnutrition, and Mortality in Diabetes Patients on Maintenance Hemodialysis

Yen, Tzung-Hai MD, PhD; Lin, Ja-Liang MD; Lin-Tan, Dan-Tzu RN; Hsu, Kuang-Hung PhD

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Abstract

Background: This study investigates diabetic patients on maintenance hemodialysis (HD), and examines whether cardiothoracic ratio (CTR), malnutrition, and inflammation are closely interrelated, and whether CTR predicts short-term mortality in this population.

Methods: A 2-year longitudinal study that enrolls 179 patients-73 without cardiomegaly (CTR <50%), 81 with mild cardiomegaly (CTR 50%-60%), and 25 with moderate-to-severe cardiomegaly (CTR >60%).

Results: Spearman analysis established that CTR was positively correlated with age (P < 0.001) and high sensitivity C reactive protein (HsCRP) (P < 0.05), but negatively correlated with albumin (P < 0.05) and creatinine (P < 0.001). Multivariate logistic analyses identified age (P = 0.0027), creatinine (P = 0.0484), intact-PTH (P = 0.0197) and HsCRP (P = 0.0247) were independent determinants of cardiomegaly. After 2 years, 31 of 179 (17.32%) patients died including 9 of 25 (36%) with CTR >60%, 14 of 81 (17.28%) with CTR 50%-60%, and 8 of 73 (10.96%) with CTR <50%. The primary causes of death were infection (61.29%) and cardiovascular disease (CVD) (32.26%). Cox multivariable regression analysis revealed CTR >50% was the only independent variable for the development of all-cause and infection-cause mortality in 2 years. Kaplan-Meier analysis confirmed that patients with CTR >60% suffered higher cumulative mortality than patients with CTR <50% (P = 0.0003).

Conclusions: CTR does not only correlate with inflammation and nutritional status in diabetic patients on maintenance HD, but also predict the all-cause and infection-cause 2-year mortality.

© Copyright 2009 Southern Society for Clinical Investigation

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