Abstract: Objective  To explore the predictive value of soluble growth stimulation expressed gene2 (sST2) combined with coronary artery calcium score (CACS) for cardiovascular events (CVE) in patients undergoing maintenance hemodialysis (MHD).  Method  A total of 200 patients who received MHD treatment for more than 3 months at the Hemodialysis Center of Gaochun People’s Hospital in Nanjing from January to December 2022 were included. Clinical data were collected, serum sST2 levels were detected using ELISA, and CACS was assessed using multi-slice spiral CT. The patients were divided into groups according to the median value of serum sST2 and CACS. All patients were followed up for 2 years, andt major cardiovascular events were recorded. The incidence of CVE among different groups and related risk factors were analyzed to explore the value of sST2 combined with CACS in predicting CVE in MHD patients.  Results  After a 2-year-follow-up, the incidence of CVE among the 200 MHD patients was 34.5% (69/200). The high sST2 group (≥27.06ng/ml) and high CACS group (≥183.5 points) exhibited significantly higher incidence rates and cumulative risks of CVE compared to their low-level counterparts (sST2 group: χ2=13.829, P＜0.001; χ2=15.797, P＜0.001; CACS group: χ2=18.608, P＜0.001; χ2=22.977, P＜0.001). The following factors were significantly higher in the CVE group than in the non-CVE group: age (t=2.858, P=0.005), dialysis duration (Z=3.473, P =0.001), proportion of diabetes (χ2=4.029, P=0.045), low-density lipoprotein (t=1.987, P =0.047)，sST2 (Z=4.743, P＜0.001) and CACS (Z=5.565, P＜0.001). Multivariate Logistic regression analysis showed that advanced age (OR=1.033, 95% CI: 1.000～1.066, P=0.047), long dialysis duration (OR=1.009, 95% CI: 1.001～1.018, P =0.038), high sST2 (OR=1.073, 95% CI: 1.045～1.101, P＜0.001) and high CACS (OR=1.001, 95% CI: 1.000～1.002, P =0.002) were independent risk factors for CVE in MHD patients. ROC curve analysis revealed that the combination of serum sST2 and CACS in predicting CVE in MHD patients achieved an AUC of 0.846, surpassing the individual predictors with AUC values of 0.724(Z=2.410，P =0.016) and 0.749 (Z=2.093，P=0.035) , respectively.  Conclusion  The incidence of CVE in MHD patients is high. Both serum sST2 and CACS have good predictive value for CVE in MHD patients, but their combination has higher predictive value.

Key words: Soluble growth stimulation expressed gene2, Coronary artery calcium score, Hemodialysis, Cardiovascular event