Abstract
Syndecan-1 is found in the endothelial glycocalyx and is released into the bloodstream during stressed conditions, including severe diseases such as acute kidney injury, chronic kidney disease, and cardiovascular disease. This study investigated the prognostic value of serum syndecan-1 concentration in patients with heart failure upon admission. Serum syndecan-1 concentration was analyzed in 152 patients who were hospitalized for worsening heart failure from September 2017 to June 2018. The primary outcome of the study was readmission-free survival, defined as the time from the first admission to readmission for worsened heart failure or death from any cause, which was assessed at 30 months after discharge from the hospital. The secondary outcome of the study was survival time. Blood samples and echocardiogram data were analyzed. Univariate and multivariable time-dependent Cox regression analyses adjusted for age, creatinine levels, and use of antibiotics were conducted. The serum syndecan-1 concentration was significantly associated with readmission-free survival. Subsequently, the syndecan-1 concentration may have gradually decreased with treatment. The administration of human atrial natriuretic peptide and antibiotics may have modified the relationship between readmission-free survival and serum syndecan-1 concentration (p = 0.01 and 0.008, respectively). Serum syndecan-1 concentrations, which may indicate injury to the endothelial glycocalyx, predict readmission-free survival in patients with heart failure.
Highlights
Decompensated heart failure is defined as a clinical syndrome in which a structural or functional change in the heart leads to its inability to eject and/or accommodate blood within the physiological pressure levels [1]
The following data were included in the time-dependent Cox regression model: age, sex, serum albumin, aspartate aminotransferase (AST), alanine aminotransferase (ALT), creatine kinase (CK), triglyceride, total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, blood urea nitrogen (BUN), creatinine (Cre) concentration, sodium, potassium, chlorine, C-reactive protein, estimated glomerular filtration rate, white blood cell number, hemoglobin (Hb) concentration, hematocrit (Ht), hemoglobin A1c, left ventricular diastolic diameter (LVDd), left ventricular systolic diameter (LVDs), interventricular septum thickness (IVST), posterior wall thickness (PWT), left ventricular ejection fraction (LVEF), left atrial dimension (LAD), left atrial volume index (LAVI), and the diameter of the inferior vena cava (IVC)
Differences in syndecan-1 concentrations among patients with different origins of heart failure are shown in S1 Table and those among patients with heart failure due to different medications are shown in S2 Table
Summary
Decompensated heart failure is defined as a clinical syndrome in which a structural or functional change in the heart leads to its inability to eject and/or accommodate blood within the physiological pressure levels [1]. Risk stratification of patients with non-ischemic heart failure is commonly based on clinical parameters, such as the New York Heart Association class; echocardiographic parameters, such as left ventricular ejection fraction (LVEF); and blood markers, such as the level of a 76-amino acid N-terminal fragment in the prohormone called B-type natriuretic peptide and brain natriuretic peptide [3, 4]. The use of plasma brain natriuretic peptide, while very valuable in differentiating heart failure from noncardiac causes of acute dyspnea [5], is debatable as a prognostic marker [6,7,8]. There is no class I indication in the guidelines for the use of specific biomarkers for prognostic purposes [9, 10]
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