Traxler Denise, Zimmermann Matthias, Simader Elisabeth, Veraar Cecilia M, Moser Bernhard, Mueller Thomas, Mildner Michael, Dannenberg Varius, Lainscak Mitja, Jug Borut, Ankersmit Hendrik J
Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria; Laboratory for Cardiac and Thoracic Diagnosis, Regeneration and Applied Immunology, Waehringergürtel 18-20, 1090 Vienna, Austria; Division of Thoracic Surgery, Department of Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria.
Department of Oral and Maxillofacial Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria.
Clin Chim Acta. 2020 Nov;510:507-514. doi: 10.1016/j.cca.2020.07.050. Epub 2020 Jul 29.
The inflammatory markers sST2, HSP27 and hsCRP have already been identified as prognostic markers in chronic heart failure (HF). Though individual biomarkers have proven their value in mortality risk prediction, the role of a multimarker strategy needs further evaluation.
This is an exploratory reanalysis in chronic HF patients. Plasma HSP27, sST2 and hsCRP in outpatients with chronic HF were analysed. Patients were followed for a minimum of twelve months for the endpoint cardiovascular mortality and unplanned HF associated hospitalisation (=event). 15 year overall mortality was assessed retrospectively. The prognostic impact was assessed using a Cox proportional hazard model.
113 chronic HF patients were included. Median follow up time was 614 days and 37 patients (32.7%) experienced an event. A Kaplan-Meier analysis revealed that patients with increased sST2, HSP27 and hsCRP levels have significantly worse prognosis (p < 0.001). The use of a three-biomarker combination was superior in an independent risk prediction of an event (one high vs. two high: HR = 4.5, 95% CI: 1.3-15.5, p = 0.018; and one high vs. all high: HR = 9.8, 95% CI: 2.8-34.3, p < 0.001) as shown in a multivariable cox proportional hazard model. However, the biomarker panel did not predict 15 year overall mortality, in contrast to elevated HSP27 levels (p = 0.012).
The combination of all three markers is an independent predictor of cardiovascular death and unplanned HF associated hospitalisation but not overall mortality. Our findings suggest that adding those markers in combination to well established risk assessment parameters may improve risk stratification.
炎症标志物可溶性生长刺激表达基因2蛋白（sST2）、热休克蛋白27（HSP27）和高敏C反应蛋白（hsCRP）已被确定为慢性心力衰竭（HF）的预后标志物。尽管单个生物标志物已在死亡风险预测中证明了其价值，但多标志物策略的作用仍需进一步评估。
这是一项针对慢性HF患者的探索性再分析。对慢性HF门诊患者的血浆HSP27、sST2和hsCRP进行了分析。对患者进行了至少12个月的随访，以观察心血管死亡和非计划性HF相关住院（=事件）这一终点。回顾性评估15年总死亡率。使用Cox比例风险模型评估预后影响。
纳入了113例慢性HF患者。中位随访时间为614天，37例患者（32.7%）发生了事件。Kaplan-Meier分析显示，sST2、HSP27和hsCRP水平升高的患者预后明显更差（p<0.001）。如多变量Cox比例风险模型所示，使用三种生物标志物组合在事件的独立风险预测方面更具优势（一个指标升高vs两个指标升高：风险比[HR]=4.5，95%置信区间[CI]：1.3-15.5，p=0.018；一个指标升高vs所有指标升高：HR=9.8，95%CI：2.8-34.3，p<0.001）。然而，与HSP27水平升高相反，该生物标志物组合并未预测15年总死亡率（p=0.012）。
这三种标志物的组合是心血管死亡和非计划性HF相关住院的独立预测指标，但不是总死亡率的预测指标。我们的研究结果表明，将这些标志物与成熟的风险评估参数相结合可能会改善风险分层。
