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
Division of Emergency Care and Department of Medicine, Helsinki University Central Hospital, Finland; Cardiac diseases and biomarkers, INSERM UMR 942, Lariboisière University Hospital, Paris, France.
Int J Cardiol. 2013 Oct 3;168(3):2186-94. doi: 10.1016/j.ijcard.2013.01.228. Epub 2013 Mar 26.
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).
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 m(2), 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).
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.
本研究旨在评估血浆生物标志物相对于传统临床变量在急性失代偿性心力衰竭（ADHF）患者30天和1年死亡率风险分层中的增量价值。
通过一个国际协作网络，收集了5306例因ADHF住院患者的个体患者数据。30天全因死亡率为11.7%，1年全因死亡率为32.9%。临床预测模型（年龄、性别、入院时血压、估计肾小球滤过率<60 mL/min/1.73 m²、钠和血红蛋白水平以及心率）对30天死亡率的c统计量为0.74，对1年死亡率的c统计量为0.73。几种在入院时检测的生物标志物加入临床模型后改善了风险分层。在30天时，中段肾上腺髓质素（MR-proADM；净重新分类改善率[NRI]为28.7%，p<0.001）和可溶性（s）ST2（NRI为25.5%，p<0.001）。在1年时，sST2（NRI为10.3%）、MR-proADM（NRI为9.1%）、氨基末端前B型利钠肽（NT-proBNP；NRI为9.1%）、中段心房利钠肽（MR-proANP；NRI为7.4%）、B型利钠肽（NRI为5.5%）和C反应蛋白（CRP；NRI为5.3%）对ADHF患者进行了重新分类（所有p<0.05）。CRP作为与MR-proADM的双重生物标志物组合（30天死亡的NRI为36.8% [p<0.001]）或与sST2的组合（1年死亡率的NRI为20.3%；[p<0.001]）时，也显著改善了ADHF患者的风险分层。
在本研究中，生物标志物为ADHF患者的风险分层提供了增量价值。诸如sST2、MR-proADM、利钠肽和CRP等生物标志物反映了不同的病理生理途径，为预测ADHF患者短期和1年死亡率的临床风险因素增加了预后价值。
