Publication Date

2016

Abstract

Aims: In recent years there has been an increase in the number of biomarkers in heart failure ( HF ). The clinical role for these novel biomarkers in combination is not clear. Methods and results: The following novel biomarkers were measured from 628 patients recently hospitalized with decompensated HF; mid-regional pro-adrenomedullin ( MR-proADM ), mid-regional pro-atrial natriuretic peptide ( MR-proANP ), copeptin, high-sensitivity cardiac troponin T ( hs-cTnT ), ST2, galectin-3, cystatin C, combined free light chains ( cFLC ) and high sensitivity C-reactive protein ( hsCRP ). The incremental prognostic value of these novel biomarkers was evaluated within an extensive model containing established predictors of mortality. During a mean ( SD ) follow-up of 3.2 ( 1.5 ) years, 290 ( 46% ) patients died. Elevated concentrations of all novel biomarkers were associated with an increased unadjusted risk of mortality but only two-thirds were independent predictors following multivariable analysis. Using dichotomized cut-points from receiver operating characteristic analysis, MR-proADM, hs-cTnT, cFLC, hsCRP, and ST2 remained independent predictors of mortality. Further dichotomization into low ( 0–2 elevated biomarkers ) or high ( at least three of the five biomarkers elevated ) risk groups provided greatest incremental prognostic value ( hazard ratio 2.20, 95% confidence interval 1.37–3.54; P = 0.001 ) and improved the performance of the model ( C-statistic 0.730 from 0.721, net reclassification index 32.5% ). Conclusion: The novel biomarkers included in this study added little, if any, incremental prognostic value on their own to a model containing established predictors of mortality. However, following dichotomization, five of the novel biomarkers provided incremental prognostic value. There was a clear gradient in the risk of death with increasing numbers of elevated novel biomarkers, with the presence of at least three identifying patients at greatest risk of mortality.

School/Institute

Mary MacKillop Institute for Health Research

Document Type

Journal Article

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