Plasma biomarkers to predict or rule out early post-discharge events in patients discharged after an acute heart failure hospital admission

Demissei, B. G. et al. (2017) Plasma biomarkers to predict or rule out early post-discharge events in patients discharged after an acute heart failure hospital admission. European Journal of Heart Failure, 19(6), pp. 728-738. (doi: 10.1002/ejhf.766) (PMID:28251755)

137920.pdf - Accepted Version



Aim: Improved prediction of early post-discharge death or rehospitalization after admission for acute heart failure is a major unmet need. We evaluated the value of biomarkers to predict either low or high risk for early post-discharge events. Methods and results: A total of 1653 patients enrolled in the PROTECT trial who were discharged alive and with available blood samples were included. Forty-seven biomarkers were serially evaluated in these patients. Measurement closest to discharge was used to evaluate the predictive value of biomarkers for low and high post-discharge risk. Patients were classified as ‘low risk’ if post-discharge 30-day risk of death or heart failure rehospitalization was <5% while risk >20% was used to define ‘high risk’. Cut-off values that yielded a 95% negative predictive value and a 20% positive predictive value were identified for each biomarker. Partial area under the receiver operating characteristic curve (pAUC) in the high-sensitivity and high-specificity regions was calculated to compare low-risk and high-risk predictive values. Of patients analysed, 193 (11.7%) patients reached the 30-day death or heart failure rehospitalization outcome. We found marked differences between low-risk and high-risk predictors. Cardiac-specific troponin I was the strongest biomarker for low-risk prediction (pAUC = 0.552, 95% confidence interval 0.52–0.58) while endothelin-1 showed better performance for high-risk prediction (pAUC = 0.560, 95% confidence interval 0.53–0.59). Several biomarkers (individually and in combination) provided added predictive value, on top of a clinical model, in both low-risk and high-risk regions. Conclusion: Different biomarkers predicted low risk vs. high risk of early post-discharge death or heart failure readmission in patients hospitalized for acute heart failure.

Item Type:Articles
Glasgow Author(s) Enlighten ID:Cleland, Professor John
Authors: Demissei, B. G., Postmus, D., Cleland, J. G.F., O’Connor, C. M., Metra, M., Ponikowski, P., Teerlink, J. R., Cotter, G., Davison, B. A., Givertz, M. M., Bloomfield, D. M., van Veldhuisen, D. J., Dittrich, H., Hillege, H. L., and Voors, A. A.
College/School:College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Robertson Centre
Journal Name:European Journal of Heart Failure
ISSN (Online):1879-0844
Published Online:01 March 2017
Copyright Holders:Copyright © 2017 The Authors and European Society of Cardiology
First Published:First published in European Journal of Heart Failure 19(6): 728-738
Publisher Policy:Reproduced in accordance with the copyright policy of the publisher

University Staff: Request a correction | Enlighten Editors: Update this record