Herrero-Puente Pablo, Prieto-García Belén, García-García María, Jacob Javier, Martín-Sánchez F Javier, Pascual-Figal Domingo, Bueno Héctor, Gil Victor, Llorens Pere, Vázquez-Alvarez Joaquin, Romero-Pareja Rodolfo, Sanchez-Gonzalez Marta, Miró Òscar
Unidad de Gestión Clínica de Urgencias, Hospital Universitario Central de Asturias, Universidad de Oviedo, Oviedo, Asturias, Spain.
Área de Gestión del Laboratorio de Medicina, Hospital Universitario Central de Asturias, Hospital Universitario Central de Asturias, Universidad de Oviedo, Oviedo, Asturias, Spain.
Clin Chim Acta. 2017 Mar;466:22-30. doi: 10.1016/j.cca.2017.01.003. Epub 2017 Jan 6.
A multimarker strategy may help determine the prognosis of patients with acute heart failure (AHF). The aim of this study was to evaluate the capacity of mid-regional pro-adrenomedullin (MRproADM), copeptin and interleukin-6 (IL-6) combined with conventional clinical and biochemical markers to predict the 30-day mortality of patients with AHF.
We performed an observational, multicenter, prospective study of patients attended in the emergency department (ED) for AHF. We collected clinical and biochemical data as well as comorbidities and biomarker values. The endpoint variable was mortality at 7, 14, 30, 90 and 180days. The clinical model included: gender, age, blood pressure values, hemoglobin, sodium <135mmol/L and estimated glomerular filtration <60mL/min/1.73m2. We made receiver operating curves (ROC) curves, and areas under the curve (AUC) and survival analysis for each model and calculated the hazard ratio (HR) and its 95% confidence interval.
A total of 547 individuals were included: 55.6% were women with a mean age of 79.9 (9.5) years. Copeptin alone showed greater discriminatory power for 30-mortality [AUC 0.70 (0.62-0.78)]. The AUC for 30-day mortality of the clinical model plus copeptin and NTproBNP was 0.75 (0.67-0.83), being better than the clinical model alone with 0.67 (0.58-0.76; p=0.19). The discriminatory power of the different biomarkers alone, in combination or together with the clinical model decreased over time.
The combination of a clinical model with copeptin and NTproBNP, which are available in the ED, is able to prognose early mortality in patients with an episode of AHF.
多标志物策略可能有助于确定急性心力衰竭（AHF）患者的预后。本研究旨在评估中段肾上腺髓质素原（MRproADM）、 copeptin和白细胞介素-6（IL-6）与传统临床和生化标志物联合预测AHF患者30天死亡率的能力。
我们对因AHF在急诊科（ED）就诊的患者进行了一项观察性、多中心、前瞻性研究。我们收集了临床和生化数据以及合并症和生物标志物值。终点变量为7、14、30、90和180天的死亡率。临床模型包括：性别、年龄、血压值、血红蛋白、钠<135mmol/L和估计肾小球滤过率<60mL/min/1.73m²。我们绘制了每个模型的受试者工作特征曲线（ROC）、曲线下面积（AUC）并进行生存分析，计算了风险比（HR）及其95%置信区间。
共纳入547例个体：55.6%为女性，平均年龄79.9（9.5）岁。单独的copeptin对30天死亡率显示出更大的鉴别力【AUC为0.70（0.62 - 0.78）】。临床模型加copeptin和NTproBNP对30天死亡率的AUC为0.75（0.67 - 0.83），优于单独的临床模型，其AUC为0.67（0.58 - 0.76；p = 0.19）。不同生物标志物单独、联合或与临床模型一起的鉴别力随时间下降。
临床模型与ED中可用的copeptin和NTproBNP联合，能够预测AHF发作患者的早期死亡率。
