Álvarez-García Jesús, García-Osuna Álvaro, Vives-Borrás Miquel, Ferrero-Gregori Andreu, Martínez-Sellés Manuel, Vázquez Rafael, González-Juanatey José R, Rivera Miguel, Segovia Javier, Pascual-Figal Domingo, Bover Ramón, Bascompte Ramón, Delgado Juan, Grau Sepúlveda Andrés, Bardají Alfredo, Pérez-Villa Félix, Zamorano José Luis, Crespo-Leiro Marisa, Sánchez Pedro Luis, Ordoñez-Llanos Jordi, Cinca Juan
Cardiology Department, Hospital de la Santa Creu i Sant Pau, IIb-SantPau, Centro de Investigación en Red en Enfermedades Cardiovasculares (CIBERCV), Barcelona, Spain.
Cardiology Department, Hospital Ramón y Cajal, Centro de Investigación en Red en Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.
Front Physiol. 2021 Oct 22;12:708890. doi: 10.3389/fphys.2021.708890. eCollection 2021.
Most multi-biomarker strategies in acute heart failure (HF) have only measured biomarkers in a single-point time. This study aimed to evaluate the prognostic yielding of NT-proBNP, hsTnT, Cys-C, hs-CRP, GDF15, and GAL-3 in HF patients both at admission and discharge. We included 830 patients enrolled consecutively in a prospective multicenter registry. Primary outcome was 12-month mortality. The gain in the C-index, calibration, net reclassification improvement (NRI), and integrated discrimination improvement (IDI) was calculated after adding each individual biomarker value or their combination on top of the best clinical model developed in this study (C-index 0.752, 0.715-0.789) and also on top of 4 currently used scores (MAGGIC, GWTG-HF, Redin-SCORE, BCN-bioHF). After 12-month, death occurred in 154 (18.5%) cases. On top of the best clinical model, the addition of NT-proBNP, hs-CRP, and GDF-15 above the respective cutoff point at admission and discharge and their delta during compensation improved the C-index to 0.782 (0.747-0.817), IDI by 5% ( < 0.001), and NRI by 57% ( < 0.001) for 12-month mortality. A 4-risk grading categories for 12-month mortality (11.7, 19.2, 26.7, and 39.4%, respectively; < 0.001) were obtained using combination of these biomarkers. A model including NT-proBNP, hs-CRP, and GDF-15 measured at admission and discharge afforded a mortality risk prediction greater than our clinical model and also better than the most currently used scores. In addition, this 3-biomarker panel defined 4-risk categories for 12-month mortality.
大多数急性心力衰竭（HF）的多生物标志物策略仅在单一时间点测量生物标志物。本研究旨在评估NT-proBNP、hsTnT、Cys-C、hs-CRP、GDF15和GAL-3在HF患者入院时和出院时的预后价值。我们纳入了830例连续入选前瞻性多中心登记研究的患者。主要结局为12个月死亡率。在本研究开发的最佳临床模型（C指数0.752，0.715 - 0.789）之上，以及在4种目前使用的评分系统（MAGGIC、GWTG-HF、Redin-SCORE、BCN-bioHF）之上，分别加入每个个体生物标志物值或其组合后，计算C指数、校准、净重新分类改善（NRI）和综合鉴别改善（IDI）的增加情况。12个月后，154例（18.5%）患者死亡。在最佳临床模型之上，入院时和出院时分别加入高于各自临界值的NT-proBNP、hs-CRP和GDF-15及其在代偿期间的变化值，可将12个月死亡率的C指数提高至0.782（0.747 - 0.817），IDI提高5%（<0.001），NRI提高57%（<0.001）。使用这些生物标志物的组合可得出12个月死亡率的4个风险分级类别（分别为11.7%、19.2%、26.7%和39.4%；<0.001）。一个包括入院时和出院时测量的NT-proBNP、hs-CRP和GDF-15的模型提供的死亡风险预测优于我们的临床模型，也优于目前使用最多的评分系统。此外，这个三生物标志物组合定义了12个月死亡率的4个风险类别。
