Incremental value of biomarkers to clinical variables for mortality prediction in acutely decompensated heart failure: The Multinational Observational Cohort on Acute Heart Failure (MOCA) study

被引：247

作者：

Lassus, Johan ^{[1
,2
,3
]}

Gayat, Etienne ^{[4
,5
]}

Mueller, Christian ^{[6
]}

Peacock, W. Frank ^{[7
]}

Spinar, Jindrich ^{[8
,9
]}

Harjola, Veli-Pekka ^{[1
,2
]}

van Kimmenade, Roland ^{[10
]}

Pathak, Atul ^{[11
]}

Mueller, Thomas ^{[12
]}

diSomma, Salvatore ^{[13
]}

Metra, Marco ^{[14
]}

Pascual-Figal, Domingo ^{[15
,16
,17
]}

Laribi, Said ^{[3
,18
]}

Logeart, Damien ^{[3
,19
]}

Nouira, Semir ^{[20
,21
]}

Sato, Naoki ^{[22
]}

Potocki, Michael ^{[6
]}

Parenica, Jiri ^{[8
,9
]}

Collet, Corinne ^{[3
]}

Cohen-Solal, Alain ^{[3
,19
]}

Januzzi, James L., Jr. ^{[23
]}

Mebazaa, Alexandre ^{[3
,4
]}

机构：

[1] Univ Helsinki, Cent Hosp, Div Emergency Care, FIN-00014 Helsinki, Finland

[2] Univ Helsinki, Cent Hosp, Dept Med, FIN-00014 Helsinki, Finland

[3] Lariboisiere Univ Hosp, INSERM UMR 942, Paris, France

[4] Lariboisiere Univ Hosp, AP HP, Dept Anesthesiol & Crit Care Med, Mobile Care Unit, Paris, France

[5] St Louis Univ Hosp, INSERM UMR 717, Paris, France

[6] Univ Basel Hosp, Dept Internal Med, CH-4031 Basel, Switzerland

[7] Baylor Coll Med, Houston, TX 77030 USA

[8] Univ Hosp Brno, Dept Internal Med & Cardiol, Brno, Czech Republic

[9] Masaryk Univ, Fac Med, Brno, Czech Republic

[10] Univ Med Ctr Utrecht, Dept Cardiol, Utrecht, Netherlands

[11] Toulouse Univ Hosp, Dept Cardiol, Toulouse, France

[12] Konventhosp Barmherzige Brueder, Dept Lab Med, Linz, Austria

[13] Univ Roma La Sapienza, St Andrea Hosp, Emergency Dept, I-00185 Rome, Italy

[14] Univ Brescia, Dept Expt & Appl Med, Brescia, Italy

[15] Virgen Arrixaca Hosp, Serv Cardiol, Murcia, Spain

[16] Univ Murcia, Dept Med, Murcia, Spain

[17] Univ Murcia, Fac Med, Murcia, Spain

[18] Lariboisiere Univ Hosp, AP HP, Dept Emergency Med, Paris, France

[19] Lariboisiere Univ Hosp, AP HP, Dept Cardiol, Paris, France

[20] Fattouma Bourguiba Univ Hosp, Emergency Dept, Monastir, Tunisia

[21] Fattouma Bourguiba Univ Hosp, Res Unit UR06SP21, Monastir, Tunisia

[22] Nippon Med Sch, Musashi Kosugi Hosp, Tokyo 113, Japan

[23] Massachusetts Gen Hosp, Div Cardiol, Boston, MA 02114 USA

来源：

INTERNATIONAL JOURNAL OF CARDIOLOGY | 2013年 / 168卷 / 03期

关键词：

ADHF; Mortality; Risk prediction; Biomarkers; Reclassification; IN-HOSPITAL MORTALITY; NATRIURETIC PEPTIDE; RISK STRATIFICATION; RENAL-FUNCTION; ROC CURVE; NT-PROBNP; DIAGNOSIS; RECLASSIFICATION; GUIDELINES; PROGNOSIS;

D O I：

10.1016/j.ijcard.2013.01.228

中图分类号：

R5 [内科学];

学科分类号：

100201 [内科学];

摘要：

Aim: This study aims to evaluate the incremental value of plasma biomarkers to traditional clinical variables for risk stratification of 30-day and one-year mortality in acutely decompensated heart failure (ADHF). Methods and results: Through an international collaborative network, individual patient data on 5306 patients hospitalized for ADHF were collected. The all-cause mortality rate was 11.7% at 30 days and 32.9% at one year. The clinical prediction model (age, gender, blood pressure on admission, estimated glomerular filtration rate <60mL/min/1.73 m(2), sodium and hemoglobin levels, and heart rate) had a c-statistic of 0.74 for 30-day mortality and 0.73 for one-year mortality. Several biomarkers measured at presentation improved risk stratification when added to the clinical model. At 30 days, the net reclassification improvement (NRI) was 28.7% for mid-regional adrenomedullin (MR-proADM; p<0.001) and 25.5% for soluble (s) ST2 (p<.001). At one year, sST2 (NRI 10.3%), MR-proADM (NRI 9.1%), amino-terminal pro-B-type natriuretic peptide (NT-proBNP; NRI 9.1%), mid-regional proatrial natriuretic peptide (MR-proANP; NRI 7.4%), B-type natriuretic peptide (NRI 5.5%) and C-reactive protein (CRP; NRI 5.3%) reclassified patients with ADHF (p<0.05 for all). CRP also markedly improved risk stratification of patients with ADHF as a dual biomarker combination with MR-proADM (NRI 36.8% [p<0.001] for death at 30 days) or with sST2 (NRI 20.3%; [p<0.001] for one-year mortality). Conclusion: In this study, biomarkers provided incremental value for risk stratification of ADHF patients. Biomarkers such as sST2, MR-proADM, natriuretic peptides and CRP, reflecting different pathophysiologic pathways, add prognostic value to clinical risk factors for predicting both short-term and one-year mortality in ADHF. (C) 2013 Elsevier Ireland Ltd. All rights reserved.

引用

页码：2186 / 2194

页数：9

共 31 条

[1]

Predictors of in-hospital mortality in patients hospitalized for heart failure - Insights from the Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure (OPTIMIZE-HF) [J].