Zilinski Jodi L, Shah Ravi V, Gaggin Hanna K, Gantzer Mary Lou, Wang Thomas J, Januzzi James L
Crit Care. 2012 Jul 25;16(4):R135. doi: 10.1186/cc11440.
This study was carried out to investigate the prognostic utility of biomarkers in advanced stage heart failure (HF) patients requiring ICU admission for pulmonary artery catheter (PAC) guided therapy.
Thirty patients admitted to an ICU for PAC guided HF therapy were enrolled; concentrations of soluble ST2 (sST2), highly sensitive troponin I, an experimental ultrasensitive troponin I, amino-terminal pro-B type natriuretic peptide, cystatin C, and myeloperoxidase were measured over the first 48 hours. Outcomes included response of filling pressures and hemodynamics to tailored therapy and 90-day event-free survival (death, left ventricular assist device implantation, transplant).
Of the biomarkers evaluated, only sST2 concentrations were higher in those who failed to achieve goals for central venous pressure ((CVP), 225.3 versus 104.6 ng/mL; P = 0.003) and pulmonary capillary wedge pressure ((PCWP), 181.7 versus 88.2 ng/mL; P = 0.05). Only sST2 concentrations were associated with adverse events (186.7 versus 92.2 ng/mL; P = 0.01). In age-adjusted Cox proportional hazards analysis, an elevated sST2 during the first 48 hours following ICU admission independently predicted 90-day outcomes (Hazard Ratio = 5.53; P = 0.03) superior to the Simplified Acute Physiology Score for this application; in Kaplan-Meier analysis the risk associated with elevated sST2 concentrations was present early and sustained through the duration of follow-up (log rank P = 0.01).
In patients undergoing HF therapy guided by invasive monitoring, sST2 concentrations were associated with impending failure to reduce filling pressures and predicted impending events. Elevated sST2 values early in the ICU course theoretically could assist therapeutic decision-making in advanced stage HF patients.
ClinicalTrials.gov Identifier: NCT00595738.
本研究旨在探讨生物标志物在需要入住重症监护病房（ICU）并接受肺动脉导管（PAC）引导治疗的晚期心力衰竭（HF）患者中的预后效用。
纳入30例因PAC引导的HF治疗而入住ICU的患者；在最初的48小时内测量可溶性ST2（sST2）、高敏肌钙蛋白I、一种实验性超敏肌钙蛋白I、氨基末端B型利钠肽原、胱抑素C和髓过氧化物酶的浓度。结局包括充盈压和血流动力学对个体化治疗的反应以及90天无事件生存率（死亡、左心室辅助装置植入、移植）。
在评估的生物标志物中，只有未达到中心静脉压（CVP）目标（225.3对104.6 ng/mL；P = 0.003）和肺毛细血管楔压（PCWP）目标（181.7对88.2 ng/mL；P = 0.05）的患者的sST2浓度较高。只有sST2浓度与不良事件相关（186.7对92.2 ng/mL；P = 0.01）。在年龄校正的Cox比例风险分析中，ICU入院后最初48小时内sST2升高独立预测90天结局（风险比 = 5.53；P = 0.03），优于本应用中的简化急性生理学评分；在Kaplan-Meier分析中，sST2浓度升高相关的风险在早期出现并在随访期间持续存在（对数秩P = 0.01）。
在接受有创监测引导的HF治疗的患者中，sST2浓度与降低充盈压即将失败相关，并预测即将发生事件。ICU病程早期sST2值升高理论上可协助晚期HF患者的治疗决策。
ClinicalTrials.gov标识符：NCT00595738。
