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)
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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.
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