Kim Hong Nyun, Yang Dong Heon, Park Bo Eun, Park Yoon Jung, Kim Hyeon Jeong, Jang Se Yong, Bae Myung Hwan, Lee Jang Hoon, Park Hun Sik, Cho Yongkeun, Chae Shung Chull
Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea.
Cardiology Center, Kyungpook National University Chilgok Hospital, Daegu, Korea.
Yeungnam Univ J Med. 2021 Oct;38(4):337-343. doi: 10.12701/yujm.2020.00843. Epub 2021 Jul 8.
Chromogranin A (CgA) levels have been reported to predict mortality in patients with heart failure. However, information on the prognostic value and clinical availability of CgA is limited. We compared the prognostic value of CgA to that of previously proven natriuretic peptide biomarkers in patients with acute heart failure.
We retrospectively evaluated 272 patients (mean age, 68.5±15.6 years; 62.9% male) who underwent CgA test in the acute stage of heart failure hospitalization between June 2017 and June 2018. The median follow-up period was 348 days. Prognosis was assessed using the composite events of 1-year death and heart failure hospitalization.
In-hospital mortality rate during index admission was 7.0% (n=19). During the 1-year follow-up, a composite event rate was observed in 12.1% (n=33) of the patients. The areas under the receiver-operating characteristic curves for predicting 1-year adverse events were 0.737 and 0.697 for N-terminal pro-B-type natriuretic peptide (NT-proBNP) and CgA, respectively. During follow-up, patients with high CgA levels (>158 pmol/L) had worse outcomes than those with low CgA levels (≤158 pmol/L) (85.2% vs. 58.6%, p<0.001). When stratifying the patients into four subgroups based on CgA and NT-proBNP levels, patients with high NT-proBNP and high CgA had the worst outcome. CgA had an incremental prognostic value when added to the combination of NT-proBNP and clinically relevant risk factors.
The prognostic power of CgA was comparable to that of NT-proBNP in patients with acute heart failure. The combination of CgA and NT-proBNP can improve prognosis prediction in these patients.
据报道，嗜铬粒蛋白A（CgA）水平可预测心力衰竭患者的死亡率。然而，关于CgA的预后价值和临床实用性的信息有限。我们比较了CgA与先前已证实的利钠肽生物标志物在急性心力衰竭患者中的预后价值。
我们回顾性评估了2017年6月至2018年6月期间在心力衰竭住院急性期接受CgA检测的272例患者（平均年龄68.5±15.6岁；男性占62.9%）。中位随访期为348天。使用1年死亡和心力衰竭住院的复合事件评估预后。
首次住院期间的院内死亡率为7.0%（n = 19）。在1年随访期间，12.1%（n = 33）的患者观察到复合事件发生率。用于预测1年不良事件的受试者工作特征曲线下面积，N末端B型利钠肽原（NT-proBNP）和CgA分别为0.737和0.697。随访期间，CgA水平高（>158 pmol/L）的患者比CgA水平低（≤158 pmol/L）的患者预后更差（85.2%对58.6%，p<0.001）。根据CgA和NT-proBNP水平将患者分为四个亚组时，NT-proBNP高且CgA高的患者预后最差。当将CgA添加到NT-proBNP与临床相关危险因素的组合中时，CgA具有增量预后价值。
在急性心力衰竭患者中，CgA的预后能力与NT-proBNP相当。CgA和NT-proBNP的联合使用可改善这些患者的预后预测。
