A 3-Biomarker 2-Point-Based Risk Stratification Strategy in Acute Heart Failure
Por:
Alvarez-Garcia, J, Garcia-Osuna, A, Vives-Borras, M, Ferrero-Gregori, A, Martinez-Selles, M, Vazquez, R, Gonzalez-Juanatey, JR, Rivera, M, Segovia, J, Pascual-Figal, D, Bover, R, Bascompte, R, Delgado, J, Sepulveda, AG, Bardaji, A, Perez-Villa, F, Zamorano, JL, Crespo-Leiro, M, Sanchez, PL, Ordonez-Llanos, J, Cinca, J
Publicada:
22 oct 2021
Resumen:
Introduction and Objectives: 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.
Methods: 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).
Results: 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% (p < 0.001), and NRI by 57% (p < 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; p < 0.001) were obtained using combination of these biomarkers.
Conclusion: 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.
Filiaciones:
Alvarez-Garcia, J:
Hosp Santa Creu & Sant Pau, Cardiol Dept, Ctr Invest Red Enfermedades Cardiovasc CIBERCV, Barcelona, Spain
Hosp Ramon & Cajal, Ctr Invest Red Enfermedades Cardiovasc CIBERCV, Cardiol Dept, Madrid, Spain
Garcia-Osuna, A:
Hosp Santa Creu & Sant Pau, Biochem Dept, Barcelona, Spain
Vives-Borras, M:
Hosp Santa Creu & Sant Pau, Cardiol Dept, Ctr Invest Red Enfermedades Cardiovasc CIBERCV, Barcelona, Spain
Ferrero-Gregori, A:
Hosp Santa Creu & Sant Pau, Cardiol Dept, Ctr Invest Red Enfermedades Cardiovasc CIBERCV, Barcelona, Spain
Martinez-Selles, M:
Hosp Univ Gregorio Maranon, Ctr Invest Red Enfermedades Cardiovasc CIBERCV, Cardiol Dept, Barcelona, Spain
Vazquez, R:
Hosp Puerta Mar, Cardiol Dept, Ctr Invest Red Enfermedades Cardiovasc CIBERCV, Cadiz, Spain
Gonzalez-Juanatey, JR:
Ctr Invest Red Enfermedades Cardiovasc CIBERCV, Hosp Clin, Cardiol Dept, Santiago De Compostela, Spain
Rivera, M:
Hosp La Fe, Ctr Invest Red Enfermedades Cardiovasc CIBERCV, Cardiol Dept, Valencia, Spain
Segovia, J:
Hosp Puerta Hierro Majadahonda, Ctr Invest Red Enfermedades Cardiovasc CIBERCV, Cardiol Dept, Madrid, Spain
Pascual-Figal, D:
Hosp Virgen Arrixaca, Ctr Invest Red Enfermedades Cardiovasc CIBERCV, Cardiol Dept, Murcia, Spain
Bover, R:
Hosp Clin San Carlos, Ctr Invest Red Enfermedades Cardiovasc CIBERCV, Cardiol Dept, Madrid, Spain
Bascompte, R:
Hosp Arnau Vilanova, Ctr Invest Red Enfermedades Cardiovasc CIBERCV, Cardiol Dept, Lleida, Spain
Delgado, J:
Hosp 12 Octubre, Ctr Invest Red Enfermedades Cardiovasc CIBERCV, Cardiol Dept, Madrid, Spain
Sepulveda, AG:
Hosp Univ Son Espases, Ctr Invest Red Enfermedades Cardiovasc CIBERCV, Cardiol Dept, Palma De Mallorca, Spain
Bardaji, A:
Hosp Joan 23, Ctr Invest Red Enfermedades Cardiovasc CIBERCV, Cardiol Dept, Tarragona, Spain
Perez-Villa, F:
Ctr Invest Red Enfermedades Cardiovasc CIBERCV, Hosp Clin, Cardiol Dept, Barcelona, Spain
Zamorano, JL:
Hosp Ramon & Cajal, Ctr Invest Red Enfermedades Cardiovasc CIBERCV, Cardiol Dept, Madrid, Spain
Crespo-Leiro, M:
Hosp Univ A Coruna, Ctr Invest Red Enfermedades Cardiovasc CIBERCV, Cardiol Dept, La Coruna, Spain
Sanchez, PL:
Hosp Clinico Univ, Ctr Invest Red Enfermedades Cardiovasc CIBERCV, Cardiol Dept, Salamanca, Spain
Ordonez-Llanos, J:
Hosp Santa Creu & Sant Pau, Biochem Dept, Barcelona, Spain
Cinca, J:
Hosp Santa Creu & Sant Pau, Cardiol Dept, Ctr Invest Red Enfermedades Cardiovasc CIBERCV, Barcelona, Spain
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