Bhandari Sanjay S, Narayan Hafid, Jones Donald J L, Suzuki Toru, Struck Joachim, Bergmann Andreas, Squire Iain B, Ng Leong L
Department of Cardiovascular Sciences, University of Leicester, Leicester, UK.
NIHR Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, University of Leicester, Leicester, UK.
Eur J Heart Fail. 2016 Mar;18(3):281-9. doi: 10.1002/ejhf.459. Epub 2015 Dec 15.
We sought to compare the prognostic utility of growth hormone (GH) with NT-proBNP) and the ADHERE score in a large cohort of acute heart failure (HF) patients, subcategorized into HF with reduced EF <50% (HFrEF) and preserved EF ≥50% (HFpEF).
GH and NTproBNP levels were measured in 537 patients (HFrEF n = 415; HFpEF n = 122) with acute HF recruited into this prospective cohort study. The main outcome measure was death or HF readmission at 1 year. GH levels were higher in both HFrEF [1.26 (0.54-2.62) vs. 0.8 (0.26-1.94) ng/mL, P < 0.001] and HFpEF [1.04 (0.48-2.92) vs. 0.53 (0.18-1.94) ng/mL, P = 0.020] patients with the outcome compared with event-free survivors. GH levels were independently predictive for the outcome at 1 year in the entire cohort [HR 1.47, 95% confidence interval (CI) 1.16-1.86, P = 0.001] and those with HFrEF (HR 1.54, 95% CI 1.19-1.99, P = 0.001) in multivariate Cox hazard analysis. GH improved risk classification as measured by continuous net reclassification improvement (NRI) when added to the ADHERE multivariate logistic model of age, sex, urea, heart rate, and systolic blood pressure, for all patients [NRI 29.6 (12.1-47.1), P = 0.001] and HFrEF NRI 21.7 (1.9-41.6), P = 0.034] patients, as well as in addition to the ADHERE model combined with NT-proBNP for all patients [NRI 25.4 (7.8-43.1), P = 0.005].
GH offers incremental prognostic information over the ADHERE score clinical predictors and NT-proBNP for risk stratification of acute HF patients.
我们试图在一大群急性心力衰竭（HF）患者中比较生长激素（GH）与N末端脑钠肽前体（NT-proBNP）以及ADHERE评分的预后效用，这些患者被分为射血分数降低<50%的心力衰竭（HFrEF）和射血分数保留≥50%的心力衰竭（HFpEF）。
在纳入这项前瞻性队列研究的537例急性HF患者（HFrEF组n = 415；HFpEF组n = 122）中测量了GH和NTproBNP水平。主要结局指标是1年时的死亡或HF再入院。与无事件幸存者相比，发生结局的HFrEF患者[1.26（0.54 - 2.62）对0.8（0.26 - 1.94）ng/mL，P < 0.001]和HFpEF患者[1.04（0.48 - 2.92）对0.53（0.18 - 1.94）ng/mL，P = 0.020]的GH水平更高。在多变量Cox风险分析中，GH水平在整个队列[风险比（HR）1.47，95%置信区间（CI）1.16 - 1.86，P = 0.001]以及HFrEF患者（HR 1.54，95% CI 1.19 - 1.99，P = 0.001）中对1年时的结局具有独立预测性。当将GH添加到年龄、性别、尿素、心率和收缩压的ADHERE多变量逻辑模型中时，对于所有患者[连续净重新分类改善（NRI）29.6（12.1 - 47.1），P = 0.001]和HFrEF患者（NRI 21.7（1.9 - 41.6），P = 0.034），以及添加到与NT-proBNP联合的ADHERE模型中时，GH改善了风险分类。
对于急性HF患者的风险分层，GH比ADHERE评分临床预测指标和NT-proBNP提供了更多的预后信息。
