Shah Keyur B, Kop Willem J, Christenson Robert H, Diercks Deborah B, Kuo Dick, Henderson Sue, Hanson Karen, Mehra Mandeep R, deFilippi Christopher R
The University of Maryland School of Medicine, Department of Medicine, Baltimore, MD, USA.
Clin Chem. 2009 Jan;55(1):59-67. doi: 10.1373/clinchem.2008.108159. Epub 2008 Nov 6.
Plasma myeloperoxidase (MPO), an inflammatory biomarker, is associated with increased mortality in patients with acute coronary syndrome or chronic left ventricular systolic dysfunction. We sought to assess the diagnostic accuracy of MPO for acute decompensated heart failure (ADHF) and its prognostic value for patients with acute dyspnea.
In a prospective, observational study conducted in 5 US centers, 412 patients [mean (SD) age, 58 (14) years; 39% women] presenting with dyspnea to the emergency department were enrolled and followed for 1 year. Clinical, serum/plasma biomarker [MPO, B-type natriuretic peptide (BNP), N-terminal proBNP (NT-proBNP)], and transthoracic echocardiographic data were obtained.
We observed no differences in MPO concentration (P = 0.07) between patients with ADHF [n = 147; median, 553 pmol/L; interquartile range (IQR), 415-738 pmol/L] and those without ADHF (n = 265; median, 576 pmol/L; IQR, 413-884 pmol/L). The diagnostic accuracy for ADHF was excellent for BNP [area under the ROC curve (AUC), 0.90; P < 0.001] and NT-proBNP (AUC, 0.90; P < 0.001) but poor for MPO (AUC, 0.46; P = 0.18). MPO appeared uncorrelated with echocardiographic measures of cardiac structure or function. The observed 1-year mortality rate was 12%. MPO concentration also appeared unrelated to mortality [hazard ratio, 1.25 (above vs below the median); 95% CI, 0.71-2.18], whereas BNP (P = 0.001) and NT-proBNP (P < 0.001) were significant predictors of mortality. MPO concentration provided no prognostic information in addition to that of BNP or NT-proBNP concentration.
Unlike natriuretic peptides, MPO concentration was not predictive of ADHF diagnosis or 1-year mortality in a heterogeneous sample of emergency department patients with acute dyspnea.
血浆髓过氧化物酶（MPO）是一种炎症生物标志物，与急性冠脉综合征或慢性左心室收缩功能障碍患者的死亡率增加相关。我们旨在评估MPO对急性失代偿性心力衰竭（ADHF）的诊断准确性及其对急性呼吸困难患者的预后价值。
在5个美国中心进行的一项前瞻性观察性研究中，纳入了412例因呼吸困难到急诊科就诊的患者[平均（标准差）年龄，58（14）岁；39%为女性]，并对其进行了1年的随访。获取了临床、血清/血浆生物标志物[MPO、B型利钠肽（BNP）、N末端前脑钠肽（NT-proBNP）]以及经胸超声心动图数据。
我们观察到ADHF患者[n = 147；中位数，553 pmol/L；四分位间距（IQR），415 - 738 pmol/L]与无ADHF患者（n = 265；中位数，576 pmol/L；IQR，413 - 884 pmol/L）之间的MPO浓度无差异（P = 0.07）。BNP[ROC曲线下面积（AUC），0.90；P < 0.001]和NT-proBNP（AUC，0.90；P < 0.001）对ADHF的诊断准确性极佳，但MPO的诊断准确性较差（AUC，0.46；P = 0.18）。MPO似乎与心脏结构或功能的超声心动图测量值无关。观察到的1年死亡率为12%。MPO浓度似乎也与死亡率无关[风险比，1.25（高于中位数与低于中位数相比）；95%可信区间，0.71 - 2.18]，而BNP（P = 0.001）和NT-proBNP（P < 0.001）是死亡率的显著预测因子。除了BNP或NT-proBNP浓度外，MPO浓度未提供任何预后信息。
与利钠肽不同，在急诊科急性呼吸困难的异质性患者样本中，MPO浓度不能预测ADHF诊断或1年死亡率。
