An evidence-based cutoff or change-from-baseline measure for the diagnosis of ACS in patients with CKD might allow clinicians to better diagnose and treat ACS in this population. Key Question 2: Collection and assembly of data: For a title to be eliminated at this level, both reviewers will need to indicate that the study was ineligible. Additionally, asymptomatic multi-vessel coronary artery stenosis is frequently present at the start of dialysis in patients with detectable cTnT, 14 although this association has not been a consistent finding.
Grading the Strength of Evidence for Individual Comparisons and Outcomes At the completion of our review, at least two reviewers will independently assign evidence grades.
The grade incorporated risk-of-bias assessments, consistency of direction of the effect across studies for a given comparison and outcome, relevance to the question of interest, and precision based on the width of the CIs.
Nephrol Dial Transplant 2008;23: For all articles, we will pay attention to the troponin assay used and the troponin cutoff value used. View More.
For continuous outcomes, we will calculate a weighted mean difference by using a random-effects model with the DerSimonian and Laird formula. In this small study of 26 ESRD subjects, one-half of whom had an elevated cTnT level, no significant association was found between cTnT level and presence of delayed enhancement gadolinium.
Two reviewers independently evaluated titles, abstracts, and full-text articles to identify studies evaluating troponin assays for the determination of diagnosis, treatment, or prognosis in patients with CKD and suspected ACS.
Short-term outcomes all-cause mortality and MACE during the initial hospitalization or within 1 year of followup? Ability of troponins to predict adverse outcomes in patients with renal insufficiency and suspected acute coronary syndromes: In one study looking at the half-life of troponin I following AMI, found no difference between patients with ESRD and patients with normal renal function.
We found insufficient evidence from 1 study 21 for the diagnostic accuracy of a change in troponin level. Operating characteristics of a rank correlation test for publication bias.Chronic Kidney Disease (CKD) Pathophysiology
Does a troponin elevation modify the comparative effectiveness of interventions or management strategies for ACS e. JC Primer.
Musical chairs, except, everyone gets a seat. For all studies, the overall study quality will be assessed as indicated below, and differences between reviewers will be resolved through consensus adjudication. AHRQ series paper 5: Without evidence-based guidelines, clinicians will be uncertain about the role of screening asymptomatic individuals, the interpretation of elevated cTn results, and how that affects patient management and outcomes in the context of kidney disease.
Predictive cardiovascular risk factors in patients with chronic kidney disease CKD. No study addressed harms associated with a false-positive diagnosis.
Twenty-three studies met inclusion criteria. The outcomes of interest are sensitivity, specificity, and positive and negative predictive value against a clinical diagnosis of ACS as the reference standard. Related Topics.