Abstract
BackgroundSoluble 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.MethodsThis 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.ResultsIn 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].ConclusionsNT-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.
Highlights
During the past decade, acutely decompensated heart failure (ADHF), a terminal stage of heart disease characterized by high mortality, has become more and more prevalent, which creates a great burden for health care [1]
As one of the remarkable neurohormones from the heart, N-terminal pro-B-type natriuretic peptide (NT-proBNP) is by far an effective indicator that have been verified for its role in predicting the outcomes in both ADHF and chronic heart failure (HF) [2,3,4], while its specificity and sensitivity remain low somehow [5, 6], which warrants a ADHF predictor with higher specificity and sensitivity
Multiple researches have demonstrated the biomarkers of myocardial fibrosis, such as soluble suppression of tumorigenicity 2 and Procollagen Type III N-Terminal Peptid (PIIINP), could serve as predictive factors to identify all-cause death in patients with HF [7,8,9]
Summary
Acutely decompensated heart failure (ADHF), a terminal stage of heart disease characterized by high mortality, has become more and more prevalent, which creates a great burden for health care [1]. Multiple researches have demonstrated the biomarkers of myocardial fibrosis, such as soluble suppression of tumorigenicity 2 (sST2) and Procollagen Type III N-Terminal Peptid (PIIINP), could serve as predictive factors to identify all-cause death in patients with HF [7,8,9]. 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). Whether their combination could improve more specific and sensitive prognostic information than NT-proBNP alone remains unclear
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