We determined levels of the inflammatory marker YKL-40 in a population of patients with type 2 diabetes (T2D) and investigated the association with mortality.
In a prospective observational follow-up study, 290 patients with T2D, normoalbuminuria (n = 177), microalbuminuria (n = 71) and macroalbuminuria (n = 42) were followed for a median (range) of 17.2 (0.2–23.0) years. Serum YKL-40 concentration was determined at baseline.
Baseline median (IQR) YKL-40 level was 46 ng/ml (36–67) in patients with normoalbuminuria, 61 ng/ml (43–114) in microalbuminuric patients, and 81.5 ng/ml (60–157) in patients with macroalbuminuria, p < 0.001. During follow-up 189 patients (65.2%) died, 119 (41.0%) from cardiovascular causes. All-cause mortality was increased in patients with YKL-40 levels in the second and third tertile (hazard ratios (95% CI) compared with the first tertile, (1.50 (1.03–2.19), p = 0.034, and 2.88 (2.01–4.12), p < 0.001). This association persisted after adjustment for cardiovascular risk factors but was attenuated after additional adjustment for urinary albumin excretion rate and glomerular filtration rate.
Cardiovascular mortality was increased with YKL-40 levels in the third tertile compared with the first tertile, (2.70 (1.78–4.08)), p < 0.001. This association was diminished after adjustment for covariates.
In patients with T2D and increasing albuminuria high YKL-40 levels predict all-cause mortality.
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Published online: January 04, 2012
Accepted: December 5, 2011
Received in revised form: October 24, 2011
Received: September 6, 2011
© 2011 Elsevier Ireland Ltd. Published by Elsevier Inc. All rights reserved.