Department of Clinical Sciences, Lund University, Malmö, Malmö, Sweden.
Department of Cardiology, Skåne University Hospital, Malmö, Carl-Bertil Laurells gata 9, 214 28, Malmö, Sweden.
ESC Heart Fail. 2019 Oct;6(5):992-999. doi: 10.1002/ehf2.12486. Epub 2019 Jul 24.
The aim of this study was to assess the predictive role of biomarkers, associated with cardiovascular stress and its neuroendocrine response as well as renal function, in relation to mortality and risk of re-hospitalization among consecutive patients admitted because of heart failure (HF).
A total of 286 patients (mean age, 75 years; 29% women) hospitalized for newly diagnosed or exacerbated HF were analysed. Associations between circulating levels of mid-regional pro-adrenomedullin (MR-proADM), copeptin, C-terminal pro-endothelin-1, N-terminal pro-brain natriuretic peptide (NT-proBNP), cystatin C, and all-cause mortality as well as risk of re-hospitalization due to cardiac causes were assessed using multivariable Cox regression models. A two-sided Bonferroni-corrected P-value of 0.05/5 = 0.010 was considered statistically significant. All biomarkers were related to echocardiographic measurements of cardiac dimensions and function. A total of 57 patients died (median follow-up time, 17 months). In the multivariable-adjusted Cox regression analyses, all biomarkers, except C-terminal pro-endothelin-1, were significantly associated with increased mortality: NT-proBNP [hazard ratio (HR) 1.85, 95% confidence interval (CI) 1.17-2.17; P = 4.0 × 10 ], MR-proADM (HR 1.94, 95% CI 1.36-2.75; P = 2.2 × 10 ), copeptin (HR 1.70, 95% CI 1.22-2.36; P = 0.002), and cystatin C (HR 2.11, 95% CI 1.56-2.86; P = 1.0 × 10 ). A total of 90 patients were re-hospitalized (median time to re-hospitalization, 5 months). In multivariable Cox regression analyses, NT-proBNP was the only biomarker that showed significant association with risk of re-hospitalization due to cardiac causes (HR 1.43, 95% CI 1.10-1.87; P = 0.009).
Among patients hospitalized for HF, elevated plasma levels of NT-proBNP, MR-proADM, copeptin, and cystatin C are associated with higher mortality after discharge, whereas NT-proBNP is the only biomarker that predicts the risk of re-hospitalization due to cardiac causes.
本研究旨在评估与心血管应激及其神经内分泌反应以及肾功能相关的生物标志物的预测作用，以评估连续因心力衰竭（HF）住院的患者的死亡率和再住院风险。
分析了 286 名新诊断或恶化的 HF 住院患者的循环中 mid-regional pro-adrenomedullin（MR-proADM）、copeptin、C 末端 pro-endothelin-1、N 末端 pro-brain natriuretic peptide（NT-proBNP）、胱抑素 C 的水平与全因死亡率以及因心脏原因再住院的风险之间的关系，并使用多变量 Cox 回归模型进行评估。双侧 Bonferroni 校正的 P 值为 0.05/5=0.010，认为具有统计学意义。所有生物标志物均与心脏尺寸和功能的超声心动图测量值相关。共有 57 名患者死亡（中位随访时间为 17 个月）。在多变量调整的 Cox 回归分析中，除 C 末端 pro-endothelin-1 外，所有生物标志物均与死亡率增加显著相关：NT-proBNP[风险比（HR）1.85，95%置信区间（CI）1.17-2.17；P=4.0×10]、MR-proADM（HR 1.94，95%CI 1.36-2.75；P=2.2×10）、copeptin（HR 1.70，95%CI 1.22-2.36；P=0.002）和胱抑素 C（HR 2.11，95%CI 1.56-2.86；P=1.0×10）。共有 90 名患者因心脏原因再次住院（中位再住院时间为 5 个月）。在多变量 Cox 回归分析中，NT-proBNP 是唯一与因心脏原因再住院风险显著相关的生物标志物（HR 1.43，95%CI 1.10-1.87；P=0.009）。
在因 HF 住院的患者中，血浆 NT-proBNP、MR-proADM、copeptin 和胱抑素 C 水平升高与出院后死亡率增加相关，而 NT-proBNP 是唯一预测因心脏原因再住院风险的生物标志物。
