Department of Cardiology, Charité Medical School, Campus Virchow-Klinikum, Berlin, Germany.
Int J Cardiol. 2012 Apr 5;156(1):62-8. doi: 10.1016/j.ijcard.2010.10.028. Epub 2010 Nov 19.
A vast array of parameters has been proposed to predict mortality in chronic heart failure (CHF). Their applicability into clinical practice remains challenging due to economical and availability considerations.
We studied serum uric acid, total cholesterol, and soluble tumour necrosis factor receptor 1 (sTNF-R1) in 114 CHF patients (63.0 ± 1.0 years, NYHA functional class I/II/III/IV: 11/34/54/15) recruited prospectively into a metabolic study program. All patients underwent assessment of left ventricular ejection fraction and measurement of peak oxygen consumption (pVO(2)). Patients were followed for 24 months or until death. A total of 31 patients died; cumulative survival was 78% (95% confidence interval [CI] 70-86%) and 73% (65-81%) at 12 and 24 months, respectively. In single predictor Cox proportional hazard analysis, uric acid, pVO2, sTNFR-1, LVEF (all p<0.0001) and cholesterol (p<0.02) all predicted survival. All parameters remained significant predictors of death after multivariable adjustment (all p<0.02). Receiver-operator characteristic (ROC) curve analyses showed that uric acid and sTNF-R1 are equally strong with regards to their prognostic performance in CHF like pVO(2,) but even better than LVEF. The combination of pVO(2), LVEF, uric acid, and sTNF-R1 in ROC statistics turned out as the best model with the highest prognostic value in CHF (AUC: 0.91, sensitivity: 90.4, specificity: 74.2, p=0.0001).
Including metabolic-immunological parameters into risk assessment might result in a better risk stratification than modeling based on clinical parameters alone, probably due to a better reflection of CHF as multisystem disease. We suggest metabolic-immunological parameters to be tested in larger populations.
已经提出了大量的参数来预测慢性心力衰竭（CHF）的死亡率。由于经济和可用性方面的考虑，它们在临床实践中的适用性仍然具有挑战性。
我们研究了血清尿酸、总胆固醇和可溶性肿瘤坏死因子受体 1（sTNF-R1）在 114 例 CHF 患者（63.0±1.0 岁，NYHA 心功能 I/II/III/IV 级：11/34/54/15）中，这些患者前瞻性地纳入了一项代谢研究计划。所有患者均接受左心室射血分数评估和峰值摄氧量（pVO2）测量。患者随访 24 个月或直至死亡。共有 31 例患者死亡；累积生存率为 78%（95%置信区间 [CI] 70-86%）和 73%（65-81%）分别在 12 个月和 24 个月。在单因素 Cox 比例风险分析中，尿酸、pVO2、sTNFR-1、LVEF（均 p<0.0001）和胆固醇（p<0.02）均预测生存。在多变量调整后，所有参数均为死亡的重要预测因素（均 p<0.02）。接收者操作特征（ROC）曲线分析表明，尿酸和 sTNF-R1 在 CHF 中的预后性能与 pVO2 一样强，但优于 LVEF。在 ROC 统计中，将 pVO2、LVEF、尿酸和 sTNF-R1 相结合，结果证明是 CHF 中具有最高预后价值的最佳模型（AUC：0.91，敏感性：90.4，特异性：74.2，p=0.0001）。
将代谢-免疫参数纳入风险评估可能比仅基于临床参数建模的风险分层更好，这可能是由于 CHF 作为一种多系统疾病的更好反映。我们建议在更大的人群中测试代谢-免疫参数。
