Open Access Open Badges Research article

Prognostic utility of plasma S100A12 levels to establish a novel scoring system for predicting mortality in maintenance hemodialysis patients: a two-year prospective observational study in Japan

Yayoi Shiotsu1, Yasukiyo Mori1*, Masato Nishimura2, Tsuguru Hatta3, Naoki Imada4, Noboru Maki5, Kumiko Iida5, Noriyuki Iwamoto2, Eiko Matsuoka1, Keiichi Tamagaki1 and Atsushi Kosaki6

Author Affiliations

1 Division of Nephrology, Department of Medicine, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan

2 Cardiovascular Division, Tojinkai Hospital, Kyoto, Japan

3 Renal Division, Omihachiman Community Medical Center, Omihachiman, Japan

4 Department of Urology, Nishijin Hospital, Kyoto, Japan

5 Advanced Life Science Institute, Saitama, Japan

6 Faculty of Nursing, Setsunan University, Hirakata, Japan

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BMC Nephrology 2013, 14:16  doi:10.1186/1471-2369-14-16

Published: 16 January 2013



S100A12 protein is an endogenous receptor ligand for advanced glycation end products. In this study, the plasma S100A12 level was assessed as an independent predictor of mortality, and its utility in clinical settings was examined.


In a previous cross-sectional study, plasma S100A12 levels were measured in 550 maintenance hemodialysis patients to determine the association between S100A12 and the prevalence of cardiovascular diseases (CVD). In this prospective study, the risk of mortality within a two-year period was determined. An integer scoring system was developed to predict mortality on the basis of the plasma S100A12 levels.


Higher plasma S100A12 levels (≥18.79 ng/mL) were more closely associated with higher all-cause mortality than lower plasma S100A12 levels (<18.79 ng/mL; P = 0.001). Multivariate Cox proportional hazards analysis revealed higher plasma S100A12 levels [hazard ratio (HR), 2.267; 95% confidence interval (CI), 1.195–4.302; P = 0.012], age ≥65 years (HR, 1.961; 95%CI, 1.017–3.781; P = 0.044), serum albumin levels <3.5 g/dL (HR, 2.198; 95%CI, 1.218–3.968; P = 0.012), and history of CVD (HR, 2.068; 95%CI, 1.146–3.732; P = 0.016) to be independent predictors of two-year all-cause mortality. The integer score was derived by assigning points to these factors and determining total scores. The scoring system revealed trends across increasing scores for predicting the all-cause mortality [c-statistic = 0.730 (0.656–0.804)]. The resulting model demonstrated good discriminative power for distinguishing the validation population of 303 hemodialysis patients [c-statistic = 0.721 (0.627–0.815)].


The results indicate that plasma S100A12 level is an independent predictor for two-year all-cause mortality. A simple integer scoring system was therefore established for predicting mortality on the basis of plasma S100A12 levels.

Chronic kidney disease; Receptor for advanced glycation end products; Damage-associated molecular pattern molecules