Aramburu-Bodas Óscar, García-Casado Beatriz, Salamanca-Bautista Prado, Guisado-Espartero María E, Arias-Jiménez José L, Barco-Sánchez Antonio, Santamaría-González Juan Carlos, Formiga Francesc, Montero-Pérez-Barquero Manuel, Manzano Luis
aDepartment of Internal Medicine, Hospital Virgen Macarena bDepartment of Internal Medicine, Hospital Virgen de la Merced, Osuna cDepartment of Critical Care and Emergency, Hospital Virgen Macarena, Seville dDepartment of Internal Medicine, Hospital Infanta Margarita, Cabra, Córdoba eDepartment of Clinical Chemistry and Laboratory Medicine, Hospital Virgen Macarena fDepartment of Internal Medicine, Hospital NISA Sevilla Aljarafe, Seville gDepartment of Internal Medicine, Hospital of Bellvitge, L'Hospitalet de Llobregat, Barcelona hDepartment of Internal Medicine, IMIBIC/Hospital Reina Sofía, University of Córdoba, Córdoba iDepartment of Internal Medicine, Hospital Ramón y Cajal, University of Alcalá, Madrid, Spain.
J Cardiovasc Med (Hagerstown). 2015 Jun;16(6):438-43. doi: 10.2459/JCM.0000000000000229.
The aim of this study was to evaluate whether osteoprotegerin - an emerging inflammatory biomarker in cardiovascular diseases - predicts outcomes in patients with acute heart failure and preserved ejection fraction.
We measured urea, creatinine, hemoglobin, high-sensitivity C-reactive protein, N-terminal pro-B-type natriuretic peptide and osteoprotegerin on admission in 177 patients admitted with decompensated heart failure and left ventricular ejection fraction at least 45%. The population was divided according to the median values of osteoprotegerin (158.6 ng/l). Primary and secondary endpoints were all-cause mortality and death/readmission at 1-year follow-up, respectively. Multivariable Cox models were generated for osteoprotegerin and common risk factors. We also evaluated the reclassification of patients into risk categories after adding this biomarker to the model.
A total of 43 patients died during the follow-up and 84 had a combined event. Kaplan-Meier curves showed significantly increased primary and secondary endpoints according to the median of osteoprotegerin (log-rank, P < 0.0001 and 0.001, respectively). After adjustment for age, estimated glomerular filtration rate, hemoglobin, N-terminal pro-B-type natriuretic peptide, BMI and New York Heart Association III-IV, osteoprotegerin was a significant predictor of primary endpoint evaluated as continuous and categorized variable (relative risk 2.49, 95% confidence interval 1.18-5.24, P = 0.016 and relative risk 2.35, 95% confidence interval 1.11-4.96, P = 0.025, respectively). The clinical prediction model with osteoprotegerin evaluated with Net Reclassification Index was not significant.
Osteoprotegerin is independently associated with all-cause mortality in patients hospitalized for heart failure with preserved ejection fraction. However, adding this biomarker into a risk model does not improve its prediction value.
本研究旨在评估骨保护素（一种心血管疾病中新兴的炎症生物标志物）是否能预测急性心力衰竭且射血分数保留患者的预后。
我们对177例因失代偿性心力衰竭入院且左心室射血分数至少为45%的患者入院时测定了尿素、肌酐、血红蛋白、高敏C反应蛋白、N末端B型利钠肽原和骨保护素。根据骨保护素的中位数（158.6 ng/l）对人群进行划分。主要终点和次要终点分别是全因死亡率和1年随访时的死亡/再入院率。针对骨保护素和常见危险因素生成多变量Cox模型。我们还评估了将该生物标志物添加到模型后患者重新分类到风险类别的情况。
共有43例患者在随访期间死亡，84例发生联合事件。Kaplan-Meier曲线显示，根据骨保护素中位数，主要终点和次要终点均显著增加（对数秩检验，P分别<0.0001和0.叭）。在调整年龄、估算肾小球滤过率、血红蛋白、N末端B型利钠肽原、体重指数和纽约心脏协会心功能Ⅲ-Ⅳ级后，骨保护素是评估为连续变量和分类变量的主要终点的显著预测因子（相对风险分别为2.49，95%置信区间1.18-5.24，P=0.016；相对风险为2.35，95%置信区间1.11-4.96，P=0.025）。用净重新分类指数评估的含骨保护素的临床预测模型无显著性。
骨保护素与射血分数保留的心力衰竭住院患者的全因死亡率独立相关。然而，将该生物标志物添加到风险模型中并不能提高其预测价值。
