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)
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Abstract
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 |
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Status: | Published |
Refereed: | Yes |
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 |
Publisher: | Wiley |
ISSN: | 1388-9842 |
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 |
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