血浆半乳糖凝集素-3 水平升高与心力衰竭近期再住院相关：3 项临床试验的汇总分析。
Elevated plasma galectin-3 is associated with near-term rehospitalization in heart failure: a pooled analysis of 3 clinical trials.
机构信息
University of Groningen, Medical Center Groningen, Department of Cardiology, Groningen, The Netherlands.
Massachusetts General Hospital, Division of Cardiology, Boston, MA.
出版信息
Am Heart J. 2014 Jun;167(6):853-60.e4. doi: 10.1016/j.ahj.2014.02.011. Epub 2014 Mar 5.
BACKGROUND
Rehospitalization is a major cause for heart failure (HF)-related morbidity and is associated with considerable loss of quality of life and costs. The rate of unplanned rehospitalization in patients with HF is unacceptably high; current risk stratification to identify patients at risk for rehospitalization is inadequate. We evaluated whether measurement of galectin-3 would be helpful in identifying patients at such risk.
METHODS
We analyzed pooled data from patients (n = 902) enrolled in 3 cohorts (COACH, n = 592; PRIDE, n = 181; and UMD H-23258, n = 129) originally admitted because of HF. Mean patient age was between 61.6 and 72.9 years across the cohorts, with a wide range of left ventricular ejection fraction. Galectin-3 levels were measured during index admission. We used fixed and random-effects models, as well as continuous and categorical reclassification statistics to assess the association of baseline galectin-3 levels with risk of postdischarge rehospitalization at different time points and the composite end point all-cause mortality and rehospitalization.
RESULTS
Compared with patients with galectin-3 concentrations less than 17.8 ng/mL, those with results exceeding this value were significantly more likely to be rehospitalized for HF at 30, 60, 90, and 120 days after discharge, with odds ratios (ORs) of 2.80 (95% CI 1.41-5.57), 2.61 (95% CI 1.46-4.65), 3.01 (95% CI 1.79-5.05), and 2.79 (95% CI 1.75-4.45), respectively. After adjustment for age, gender, New York Heart Association class, renal function (estimated glomerular filtration rate), left ventricular ejection fraction, and B-type natriuretic peptide, galectin-3 remained an independent predictor of HF rehospitalization. The addition of galectin-3 to risk models significantly reclassified patient risk of postdischarge rehospitalization and fatal event at each time point (continuous net reclassification improvement at 30 days of +42.6% [95% CI +19.9%-65.4%], P < .001).
CONCLUSIONS
Among patients hospitalized for HF, plasma galectin-3 concentration is useful for the prediction of near-term rehospitalization.
背景
再入院是心力衰竭（HF）相关发病率的主要原因，并且与相当大的生活质量损失和成本有关。HF 患者的非计划性再入院率高得令人无法接受；目前的风险分层不足以识别再入院风险患者。我们评估了测量半乳糖凝集素-3是否有助于识别此类风险患者。
方法
我们分析了来自 3 个队列（COACH，n=592；PRIDE，n=181；和 UMD H-23258，n=129）的患者（n=902）的汇总数据，这些患者最初因 HF 入院。各队列患者的平均年龄在 61.6 至 72.9 岁之间，左心室射血分数范围较宽。在入院期间测量半乳糖凝集素-3 水平。我们使用固定和随机效应模型以及连续和分类再分类统计数据来评估基线半乳糖凝集素-3 水平与不同时间点出院后再住院风险以及全因死亡率和再住院复合终点的相关性。
结果
与半乳糖凝集素-3 浓度低于 17.8ng/mL 的患者相比，浓度超过该值的患者出院后 30、60、90 和 120 天因 HF 再住院的可能性明显更高，优势比（OR）分别为 2.80（95%CI 1.41-5.57）、2.61（95%CI 1.46-4.65）、3.01（95%CI 1.79-5.05）和 2.79（95%CI 1.75-4.45）。在调整年龄、性别、纽约心脏协会（NYHA）分级、肾功能（估算肾小球滤过率）、左心室射血分数和 B 型利钠肽后，半乳糖凝集素-3 仍然是 HF 再住院的独立预测因子。在每个时间点，将半乳糖凝集素-3 添加到风险模型中可显著重新分类患者出院后再住院和致命事件的风险（30 天连续净重新分类改善率为+42.6%[95%CI+19.9%-65.4%]，P<.001）。
结论
在因 HF 住院的患者中，血浆半乳糖凝集素-3 浓度可用于预测近期再入院。
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