Xiao Junjie, Gao Rongrong, Bei Yihua, Zhou Qiulian, Zhou Yanli, Zhang Haifeng, Jin Mengchao, Wei Siqi, Wang Kai, Xu Xuejuan, Yao Wenming, Xu Dongjie, Zhou Fang, Jiang Jingfa, Li Xinli, Das Saumya
Cell Physiol Biochem. 2017;41(3):865-874. doi: 10.1159/000459899. Epub 2017 Feb 16.
BACKGROUND/AIMS: Identification of novel biomarkers to identify acute heart failure (AHF) patients at high risk of mortality is an area of unmet clinical need. Recently, we reported that the baseline level of circulating miR-30d was associated with left ventricular remodeling in response to cardiac resynchronization therapy in advanced chronic heart failure patients. However, the role of circulating miR-30d as a prognostic marker of survival in patients with AHF has not been explored.
Patients clinically diagnosed with AHF were enrolled and followed up for 1 year. Quantitative reverse transcription polymerase chain reactions were used to determine serum miR-30d levels. The univariate logistic regression analysis and multivariate logistic regression analysis were used to determine the predictors for all-cause mortality in AHF patients. Kaplan-Meier survival analysis was used to analyze the role of miR-30d in prediction of survival.
A total of 96 AHF patients were enrolled and followed up for 1 year. Serum miR-30d was significantly lower in AHF patients who expired in the one year follow-up period compared to those who survived. Univariate logistic regression analysis yielded 18 variables that were associated with all-cause mortality in AHF patients, while the multivariate logistic regression analysis identified 4 variables including heart rate, hemoglobin, serum sodium, and serum miR-30d level associated with mortality. ROC curve analysis showed that hemoglobin, heart rate and serum sodium displayed poor prognostic value for AHF (AUCs not higher than 0.700) compared to miR-30d level (AUC = 0.806). Kaplan-Meier survival analysis confirmed that patients with higher serum miR-30d levels had significantly lower mortality (P=0.001).
In conclusion, this study shows evidence for the predictive value of circulating miR-30d as 1-year all-cause mortality in AHF patients. Large multicentre studies are further needed to validate our findings and accelerate the transition to clinical utilization.
背景/目的：识别可用于确定急性心力衰竭（AHF）患者死亡高风险的新型生物标志物是临床需求未得到满足的领域。最近，我们报道了晚期慢性心力衰竭患者循环miR - 30d的基线水平与心脏再同步治疗后的左心室重塑相关。然而，循环miR - 30d作为AHF患者生存预后标志物的作用尚未得到探索。
纳入临床诊断为AHF的患者并随访1年。采用定量逆转录聚合酶链反应测定血清miR - 30d水平。单因素逻辑回归分析和多因素逻辑回归分析用于确定AHF患者全因死亡的预测因素。采用Kaplan - Meier生存分析来分析miR - 30d在生存预测中的作用。
共纳入96例AHF患者并随访1年。与存活患者相比，在1年随访期内死亡的AHF患者血清miR - 30d显著降低。单因素逻辑回归分析产生了18个与AHF患者全因死亡相关的变量，而多因素逻辑回归分析确定了4个与死亡相关的变量，包括心率、血红蛋白、血清钠和血清miR - 30d水平。ROC曲线分析表明，与miR - 30d水平（AUC = 0.806）相比，血红蛋白、心率和血清钠对AHF的预后价值较差（AUC不高于0.700）。Kaplan - Meier生存分析证实，血清miR - 水平较高的患者死亡率显著较低（P = 0.001）。
总之，本研究表明循环miR - 30d对AHF患者1年全因死亡具有预测价值。还需要进一步的大型多中心研究来验证我们的发现，并加速向临床应用的转化。
