The incremental prognostic and clinical value of multiple novel biomarkers in heart failure

Jackson, C. E. et al. (2016) The incremental prognostic and clinical value of multiple novel biomarkers in heart failure. European Journal of Heart Failure, 18(12), pp. 1491-1498. (doi: 10.1002/ejhf.543) (PMID:27114189)

Abstract

Aims: In recent years there has been an increase in the number of biomarkers in heart failure(HF). The clinical role for these novel biomarkers in combination is not clear. Methods: The following novel biomarkers were measured from 628 patients recently hospitalised with decompensated HF; mid regional pro-adrenomedullin(MR-proADM), mid regional pro-atrial natriuretic peptide(MR-proANP), copeptin, high sensitivity cardiac troponin T(hs-cTnT), ST2, galectin-3, cystatin C, combined free light chains(cFLC) and high sensitivity C-reactive protein(hsCRP). The incremental prognostic value of these novel biomarkers was evaluated within an extensive model containing established predictors of mortality. Results: During a mean(SD) follow-up of 3.2(1.5) years, 290(46%) patients died. Elevated concentrations of all of the novel biomarkers were associated with an increased unadjusted risk of mortality but only two-thirds were independent predictors following multivariable analysis. Using dichotomized cut-points from ROC analysis, MR-proADM, hs-cTnT, cFLC, hsCRP and ST2 remained independent predictors of mortality. Further dichotomization into low(0-2 elevated biomarkers) or high(at least 3 of the 5 biomarkers elevated) risk groups provided greatest incremental prognostic value(HR 2.20; 95%CI, 1.37 to 3.54; p=0.001) and improved the predictive power of the model(C-statistic 0.730 from 0.721, NRI 32.5%). Conclusion: The novel biomarkers included in this study added little, if any, incremental prognostic value on their own to an extensive model containing established predictors of mortality. However, following dichotomization, 5 of the novel biomarkers provided incremental prognostic value. There was a clear gradient in the risk of death with increasing numbers of elevated novel biomarkers; the presence of at least 3 identifying patients at greatest mortality risk.

• Item Type: Articles
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Jackson, Dr Colette and Dalzell, Dr Jonathan and McConnachie, Professor Alex and Welsh, Professor Paul and Petrie, Professor Mark and McMurray, Professor John and Preiss, Dr David and Gardner, Professor Roy and Haig, Dr Caroline and Sattar, Professor Naveed
• Authors: Jackson, C. E., Haig, C., Welsh, P., Dalzell, J. R., Tsorlalis, I. K., McConnachie, A., Preiss, D., Anker, S. D., Sattar, N., Petrie, M. C., Gardner, R. S., and McMurray, J. J. V.
• College/School: College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health; College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Robertson Centre; College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
• Journal Name: European Journal of Heart Failure
• Publisher: Oxford University Press
• ISSN: 1388-9842
• ISSN (Online): 1879-0844
• Published Online: 26 April 2016
• Copyright Holders: Copyright © 2016 Oxford University Press
• First Published: First published in European Journal of Heart Failure 18(12):1491-1498
• Publisher Policy: Reproduced in accordance with the copyright policy of the publisher

Project Code	Award No	Project Name	Principal Investigator	Funder's Name	Funder Ref	Lead Dept
46036	2	Microvolt T-wave alternans in chronic heart failure: a study of prevalence and incremental prognostic value.	Stuart Cobbe	Scottish Executive Health Department (SEHHD-CSO)	CZH/4/439	SCHOOL OF MEDICINE