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Kern A, Stompór T, Bojko K, Sienkiewicz E, Pawlak S, Pawlak K, Pawlak D, Poskrobko G, Andrasz E, Gromadziński L, Jalali R, Onichimowski D, Piwko G, Zalewski A, Bil J. Kynurenine as a Predictor of Long-Term Mortality: A 10-Year Follow-Up from the KORONEF Registry. Biomedicines 2025; 13:1123. [PMID: 40426950 PMCID: PMC12109461 DOI: 10.3390/biomedicines13051123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2025] [Revised: 04/25/2025] [Accepted: 05/02/2025] [Indexed: 05/29/2025] Open
Abstract
Background: The kynurenine (KYN) pathway of tryptophan metabolism has been linked to inflammation and cardiovascular risk, but its long-term prognostic value remains unclear. Methods: 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. Results: 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) (p < 0.001). In a multivariable Cox analysis, KYN independently predicted mortality (HR: 1.79; 95% CI: 1.15-2.44; p < 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. Conclusions: 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.
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Affiliation(s)
- Adam Kern
- Department of Cardiology and Internal Medicine, School of Medicine, Collegium Medicum, University of Warmia and Mazury in Olsztyn, 10-727 Olsztyn, Poland; (K.B.); (S.P.); (L.G.)
- Department of Cardiology, Regional Specialist Hospital in Olsztyn, 10-045 Olsztyn, Poland; (E.S.); (G.P.); (E.A.)
| | - Tomasz Stompór
- Department of Nephrology, Hypertension and Internal Medicine, School of Medicine, Collegium Medicum, University of Warmia and Mazury in Olsztyn, 10-727 Olsztyn, Poland;
| | - Krystian Bojko
- Department of Cardiology and Internal Medicine, School of Medicine, Collegium Medicum, University of Warmia and Mazury in Olsztyn, 10-727 Olsztyn, Poland; (K.B.); (S.P.); (L.G.)
- Department of Cardiology, Regional Specialist Hospital in Olsztyn, 10-045 Olsztyn, Poland; (E.S.); (G.P.); (E.A.)
| | - Ewa Sienkiewicz
- Department of Cardiology, Regional Specialist Hospital in Olsztyn, 10-045 Olsztyn, Poland; (E.S.); (G.P.); (E.A.)
| | - Sebastian Pawlak
- Department of Cardiology and Internal Medicine, School of Medicine, Collegium Medicum, University of Warmia and Mazury in Olsztyn, 10-727 Olsztyn, Poland; (K.B.); (S.P.); (L.G.)
- Department of Cardiology, Regional Specialist Hospital in Olsztyn, 10-045 Olsztyn, Poland; (E.S.); (G.P.); (E.A.)
| | - Krystyna Pawlak
- Department of Monitored Pharmacotherapy, Medical University of Bialystok, 15-089 Bialystok, Poland;
| | - Dariusz Pawlak
- Department of Pharmacodynamics, Medical University of Bialystok, 15-089 Bialystok, Poland;
| | - Grzegorz Poskrobko
- Department of Cardiology, Regional Specialist Hospital in Olsztyn, 10-045 Olsztyn, Poland; (E.S.); (G.P.); (E.A.)
| | - Ewa Andrasz
- Department of Cardiology, Regional Specialist Hospital in Olsztyn, 10-045 Olsztyn, Poland; (E.S.); (G.P.); (E.A.)
| | - Leszek Gromadziński
- Department of Cardiology and Internal Medicine, School of Medicine, Collegium Medicum, University of Warmia and Mazury in Olsztyn, 10-727 Olsztyn, Poland; (K.B.); (S.P.); (L.G.)
| | - Rakesh Jalali
- Department of Emergency Medicine, School of Medicine, Collegium Medicum, University of Warmia and Mazury in Olsztyn, 10-727 Olsztyn, Poland; (R.J.); (D.O.)
- Clinical Emergency Department, Regional Specialist Hospital in Olsztyn, 10-045 Olsztyn, Poland
| | - Dariusz Onichimowski
- Department of Emergency Medicine, School of Medicine, Collegium Medicum, University of Warmia and Mazury in Olsztyn, 10-727 Olsztyn, Poland; (R.J.); (D.O.)
- Clinical Department of Anaesthesiology and Intensive Care, Regional Specialist Hospital in Olsztyn, 10-727 Olsztyn, Poland
| | - Grażyna Piwko
- Department of Cardiology, University of Warmia and Mazury in Olsztyn, Branch in Ełk, 19-300 Ełk, Poland;
- Scanmed Cardiology Center in Ełk, 19-300 Ełk, Poland;
| | | | - Jacek Bil
- National Medical Institute of the Ministry of Interior and Administration, 02-507 Warsaw, Poland
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