Details

Autor(en) / Beteiligte

• Lassus, Johan
• Gayat, Etienne
• Mueller, Christian
• Peacock, W.Frank
• Spinar, Jindrich
• Harjola, Veli-Pekka
• van Kimmenade, Roland
• Pathak, Atul
• Mueller, Thomas
• diSomma, Salvatore
• Metra, Marco
• Pascual-Figal, Domingo
• Laribi, Said
• Logeart, Damien
• Nouira, Semir
• Sato, Naoki
• Potocki, Michael
• Parenica, Jiri
• Collet, Corinne
• Cohen-Solal, Alain
• Januzzi, James L
• Mebazaa, Alexandre

Titel

Incremental value of biomarkers to clinical variables for mortality prediction in acutely decompensated heart failure: The Multinational Observational Cohort on Acute Heart Failure (MOCA) study

Ist Teil von

• International journal of cardiology, 2013-10, Vol.168 (3), p.2186-2194

Ort / Verlag

Shannon: Elsevier Ireland Ltd

Erscheinungsjahr

2013

Quelle

MEDLINE

Beschreibungen/Notizen

• Abstract Aim This study aims to evaluate the incremental value of plasma biomarkers to traditional clinical variables for risk stratification of 30-day and one-year mortality in acutely decompensated heart failure (ADHF). Methods and results Through an international collaborative network, individual patient data on 5306 patients hospitalized for ADHF were collected. The all-cause mortality rate was 11.7% at 30 days and 32.9% at one year. The clinical prediction model (age, gender, blood pressure on admission, estimated glomerular filtration rate < 60 mL/min/1.73 m2 , sodium and hemoglobin levels, and heart rate) had a c-statistic of 0.74 for 30-day mortality and 0.73 for one-year mortality. Several biomarkers measured at presentation improved risk stratification when added to the clinical model. At 30 days, the net reclassification improvement (NRI) was 28.7% for mid-regional adrenomedullin (MR-proADM; p < 0.001) and 25.5% for soluble (s)ST2 (p < 0.001). At one year, sST2 (NRI 10.3%), MR-proADM (NRI 9.1%), amino-terminal pro-B-type natriuretic peptide (NT-proBNP; NRI 9.1%), mid-regional proatrial natriuretic peptide (MR-proANP; NRI 7.4%), B-type natriuretic peptide (NRI 5.5%) and C-reactive protein (CRP; NRI 5.3%) reclassified patients with ADHF (p < 0.05 for all). CRP also markedly improved risk stratification of patients with ADHF as a dual biomarker combination with MR-proADM (NRI 36.8% [p < 0.001] for death at 30 days) or with sST2 (NRI 20.3%; [p < 0.001] for one-year mortality). Conclusion In this study, biomarkers provided incremental value for risk stratification of ADHF patients. Biomarkers such as sST2, MR-proADM, natriuretic peptides and CRP, reflecting different pathophysiologic pathways, add prognostic value to clinical risk factors for predicting both short-term and one-year mortality in ADHF.