Department of Cardiology, Zhongshan People Hospital, Sun Yat-Sen University, No. 2 Sunwen East Road, Zhongshan, 528400, Guangdong, People's Republic of China.
Department of Cardiology, State Key Laboratory of Organ Failure Research, Nanfang Hospital, Southern Medical University, Guangzhou, People's Republic of China.
BMC Cardiovasc Disord. 2021 May 28;21(1):264. doi: 10.1186/s12872-021-02083-6.
Soluble suppression of tumorigenesis-2 (sST2), Procollagen Type III N-Terminal Peptid (PIIINP) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) have been verified their role in predicting survival in acutely decompensated heart failure (ADHF). However, whether their combination could improve more specific and sensitive prognostic information than NT-proBNP alone remains unclear.
This was a prospective study, in which 217 ADHF patients at admission were enrolled from November 2018 and August 2019 (mean age 66.18 years ± 13.60, 63.98% male). The blood samples were collected to measure the concentrations of NT-proBNP, sST2 and PIIINP in the first 24 h of hospitalizations. All-cause mortality was registered for all patients after they were discharge over a median period of 339 days.
In univariate Cox analysis, the three biomarkers were predictive of short-term mortality of ADHF patients. After adjusted for some clinical variables including age, admission systolic blood pressure, peripheral edema on admission, history of chronic obstructive pulmonary disease, admission sodium < 135 mmol/L, admission hemoglobin, NT-proBNP, sST2 and PIIINP was significantly associated with the poor outcome (hazard ratio [HR] 1.32, 95% confidence interval [CI] 1.14-1.53, P < 0.01; HR 1.21, 95% CI 1.03-1.43, P = 0.020; HR 1.40, 95% CI 1.08-1.81, P = 0.011). After added with Log2 PIIINP, but not Log2 sST2, the area under the curves (AUC) in the model of clinical variables and Log2 NT-proBNP could increase from 0.79 to 0.85 (95% CI 0.0071-0.10, P = 0.024). Furthermore, compared with the model of clinical variables, Log2 NT-proBNP, the improvement in the prognostic model of clinical variables, Log2 NT-proBNP and Log2 PIIINP had statistical significance [net reclassification improvement (NRI) 0.31, P = 0.018; integrated discrimination improvement (IDI) 0.068, P < 0.01].
NT-proBNP, sST2 and PIIINP are independent prognostic factors for all-cause mortality in ADHF patients. Furthermore, the combination of NT-proBNP and PIIINP may provide incremental prognostic value over NT-proBNP in the survival of ADHF patients.
可溶性肿瘤抑制物 2（sST2）、III 型前胶原氨基末端肽（PIIINP）和 N-末端脑钠肽前体（NT-proBNP）已被证实可预测急性失代偿性心力衰竭（ADHF）患者的生存率。然而，它们的联合应用是否比单独使用 NT-proBNP 能提供更特异和敏感的预后信息尚不清楚。
这是一项前瞻性研究，共纳入 2018 年 11 月至 2019 年 8 月期间入院的 217 例 ADHF 患者（平均年龄 66.18 ± 13.60 岁，63.98%为男性）。在入院后 24 小时内采集血液样本，以测量 NT-proBNP、sST2 和 PIIINP 的浓度。所有患者在中位随访 339 天后出院，登记全因死亡率。
单因素 Cox 分析显示，这三种生物标志物均与 ADHF 患者的短期死亡率相关。在校正了一些临床变量后，包括年龄、入院收缩压、入院时外周水肿、慢性阻塞性肺疾病病史、入院时血清钠 <135mmol/L、入院时血红蛋白、NT-proBNP、sST2 和 PIIINP 与不良预后显著相关（风险比 [HR] 1.32，95%置信区间 [CI] 1.14-1.53，P<0.01；HR 1.21，95% CI 1.03-1.43，P=0.020；HR 1.40，95% CI 1.08-1.81，P=0.011）。在加入 Log2 PIIINP 后，而不是 Log2 sST2 后，临床变量和 Log2 NT-proBNP 模型的曲线下面积（AUC）从 0.79 增加到 0.85（95% CI 0.0071-0.10，P=0.024）。此外，与临床变量模型相比，临床变量、Log2 NT-proBNP 和 Log2 PIIINP 预后模型的改善具有统计学意义[净重新分类改善（NRI）0.31，P=0.018；综合判别改善（IDI）0.068，P<0.01]。
NT-proBNP、sST2 和 PIIINP 是 ADHF 患者全因死亡率的独立预后因素。此外，NT-proBNP 和 PIIINP 的联合应用可能比单独使用 NT-proBNP 提供 ADHF 患者生存的增量预后价值。
