Hammadah Muhammad, Fan Yiying, Wu Yuping, Hazen Stanley L, Tang W H Wilson
Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
Department of Mathematics, Cleveland State University, Cleveland, Ohio.
J Card Fail. 2014 Dec;20(12):946-52. doi: 10.1016/j.cardfail.2014.08.001. Epub 2014 Aug 13.
Ceruloplasmin (Cp) is a copper-binding acute-phase protein that is increased in inflammatory states and deficient in Wilson's disease. Recent studies demonstrate that increased levels of Cp are associated with increased risk of developing heart failure. Our objective was to test the hypothesis that serum Cp provides incremental and independent prediction of survival in stable patients with heart failure.
We measured serum Cp levels in 890 patients with stable heart failure undergoing elective cardiac evaluation that included coronary angiography. We examined the role of Cp levels in predicting survival over 5 years of follow-up. Mean Cp level was 26.6 ± 6.9 mg/dL and demonstrated relatively weak correlation with B-type natriuretic peptide (BNP; r = 0.187; P < .001). Increased Cp levels were associated with increased 5-year all-cause mortality (quartile [Q] 4 vs Q1 hazard ratio [HR] 1.9, 95% confidence interval [CI] 1.4-2.8; P < .001). When controlled for coronary disease traditional risk factors, creatinine clearance, dialysis, body mass index, medications, history of myocardial infarction, BNP, left ventricular ejection fraction (LVEF), heart rate, QRS duration, left bundle branch blockage, and implantable cardioverter-defibrillator placement, higher Cp remained an independent predictor of increased mortality (Q4 vs Q1 HR 1.7, 95% CI 1.1-2.6; P < .05). Model quality was improved with addition of Cp to the aforementioned covariables (net reclassification improvement of 9.3%; P < .001).
Ceruloplasmin is an independent predictor of all-cause mortality in patients with heart failure. Measurement of Cp may help to identify patients at heightened mortality risk.
铜蓝蛋白（Cp）是一种结合铜的急性期蛋白，在炎症状态下升高，在威尔逊病中缺乏。最近的研究表明，Cp水平升高与发生心力衰竭的风险增加有关。我们的目的是检验血清Cp能对稳定期心力衰竭患者的生存提供额外且独立预测的假设。
我们测量了890例接受包括冠状动脉造影在内的择期心脏评估的稳定期心力衰竭患者的血清Cp水平。我们研究了Cp水平在预测5年随访期生存中的作用。平均Cp水平为26.6±6.9mg/dL，与B型利钠肽（BNP）的相关性相对较弱（r = 0.187；P <.001）。Cp水平升高与5年全因死亡率增加相关（四分位数[Q]4与Q1的风险比[HR]为1.9，95%置信区间[CI]为1.4 - 2.8；P <.001）。当对冠心病传统危险因素、肌酐清除率、透析、体重指数、药物治疗、心肌梗死病史、BNP、左心室射血分数（LVEF）、心率、QRS时限、左束支传导阻滞和植入式心脏复律除颤器植入情况进行控制后，较高的Cp仍然是死亡率增加的独立预测因素（Q4与Q1的HR为1.7，95%CI为1.1 - 2.6；P <.05）。将Cp添加到上述协变量中可改善模型质量（净重新分类改善率为9.3%；P <.001）。
铜蓝蛋白是心力衰竭患者全因死亡率的独立预测因素。测量Cp可能有助于识别死亡风险较高的患者。
