Kynurenine as a Predictor of Long-Term Mortality: A 10-Year Follow-Up from the KORONEF Registry

<b>Background</b>: The kynurenine (KYN) pathway of tryptophan metabolism has been linked to inflammation and cardiovascular risk, but its long-term prognostic value remains unclear. <b>Methods</b>: We analyzed 492 patients from the KORONEF registry who underwent coronary and...

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Main Authors: Adam Kern, Tomasz Stompór, Krystian Bojko, Ewa Sienkiewicz, Sebastian Pawlak, Krystyna Pawlak, Dariusz Pawlak, Grzegorz Poskrobko, Ewa Andrasz, Leszek Gromadziński, Rakesh Jalali, Dariusz Onichimowski, Grażyna Piwko, Artur Zalewski, Jacek Bil
Format: Article
Language:English
Published: MDPI AG 2025-05-01
Series:Biomedicines
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Online Access:https://www.mdpi.com/2227-9059/13/5/1123
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Summary:<b>Background</b>: The kynurenine (KYN) pathway of tryptophan metabolism has been linked to inflammation and cardiovascular risk, but its long-term prognostic value remains unclear. <b>Methods</b>: We analyzed 492 patients from the KORONEF registry who underwent coronary and renal angiography and were followed for a median of 10.2 years. Plasma levels of tryptophan (TRP), KYN, and downstream metabolites were measured. The primary endpoint was all-cause mortality. <b>Results</b>: The mean age was 64.4 ± 9.9 years, and 37.2% of patients were female. Common comorbidities included hypertension (74.8%), dyslipidemia (46.0%), and diabetes (25.8%). Overall mortality reached 29.5% and increased across KYN tertiles: 17.6% (T1), 28.2% (T2), and 42.9% (T3) (<i>p</i> < 0.001). In a multivariable Cox analysis, KYN independently predicted mortality (HR: 1.79; 95% CI: 1.15–2.44; <i>p</i> < 0.001), alongside age, diabetes, prior myocardial infarction, chronic kidney disease, and left ventricular ejection fraction. Other kynurenine pathway metabolites were not independently associated with outcomes. <b>Conclusions</b>: Elevated kynurenine levels independently predict 10-year all-cause mortality in patients undergoing coronary angiography. KYN may represent a useful prognostic biomarker beyond traditional clinical and angiographic variables.
ISSN:2227-9059