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| Pàgina inicial > Articles > Articles publicats > Predictive biomarkers for death and rehospitalization in comorbid frail elderly heart failure patients |
(Institut Germans Trias i Pujol. Hospital Universitari Germans Trias i Pujol) (Institut Germans Trias i Pujol. Hospital Universitari Germans Trias i Pujol) (Universitat de València. Departament de Medicina) (Institut Germans Trias i Pujol. Hospital Universitari Germans Trias i Pujol) (Institut Germans Trias i Pujol. Hospital Universitari Germans Trias i Pujol) (Institut Germans Trias i Pujol. Hospital Universitari Germans Trias i Pujol) (Universitat Autònoma de Barcelona. Departament de Medicina) (Institut Germans Trias i Pujol. Hospital Universitari Germans Trias i Pujol) (Institut Germans Trias i Pujol. Hospital Universitari Germans Trias i Pujol) (Universitat Autònoma de Barcelona. Departament de Medicina)
| Data: | 2018 |
| Resum: | Heart failure (HF) is associated with a high rate of readmissions within 30 days post-discharge and in the following year, especially in frail elderly patients. Biomarker data are scarce in this high-risk population. This study assessed the value of early post-discharge circulating levels of ST2, NT-proBNP, CA125, and hs-TnI for predicting 30-day and 1-year outcomes in comorbid frail elderly patients with HF with mainly preserved ejection fraction (HFpEF). Blood samples were obtained at the first visit shortly after discharge (4. 9 ± 2 days). The primary endpoint was the composite of all-cause mortality or HF-related rehospitalization at 30 days and at 1 year. All-cause mortality alone at one year was also a major endpoint. HF-related rehospitalizations alone were secondary end-points. From February 2014 to November 2016, 522 consecutive patients attending the STOP-HF Clinic were included (57. 1% women, age 82 ± 8. 7 years, mean Barthel index 70 ± 25, mean Charlson comorbidity index 5. 6 ± 2. 2). The composite endpoint occurred in 8. 6% patients at 30 days and in 38. 5% at 1 year. In multivariable analysis, ST2 [hazard ratio (HR) 1. 53; 95% CI 1. 19-1. 97; p = 0. 001] was the only predictive biomarker at 30 days; at 1 year, both ST2 (HR 1. 34; 95% CI 1. 15-1. 56; p < 0. 001) and NT-proBNP (HR 1. 19; 95% CI 1. 02-1. 40; p = 0. 03) remained significant. The addition of ST2 and NT-proBNP into a clinical predictive model increased the AUC from 0. 70 to 0. 75 at 30 days (p = 0. 02) and from 0. 71 to 0. 74 at 1 year (p < 0. 05). For all-cause death at 1 year, ST2 (HR 1. 50; 95% CI 1. 26-1. 80; p < 0. 001), and CA125 (HR 1. 41; 95% CI 1. 21-1. 63; p < 0. 001) remained independent predictors in multivariable analysis. The addition of ST2 and CA125 into a clinical predictive model increased the AUC from 0. 74 to 0. 78 (p = 0. 03). For HF-related hospitalizations, ST2 was the only predictive biomarker in multivariable analyses, both at 30 days and at 1 year. In a comorbid frail elderly population with HFpEF, ST2 outperformed NT-proBNP for predicting the risk of all-cause mortality or HF-related rehospitalization. ST2, a surrogate marker of inflammation and fibrosis, may be a better predictive marker in high-risk HFpEF. |
| Ajuts: | Ministerio de Economía y Competitividad SAF2014-59892 Ministerio de Economía y Competitividad CB16/11/00403 Ministerio de Economía y Competitividad PI14/01682 Ministerio de Economía y Competitividad CB16/11/00420 Ministerio de Economía y Competitividad PIE15/00013 |
| Nota: | Altres ajuts: Fundació La Marató de TV3 (201502, 201516) |
| Drets: | Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.  |
| Llengua: | Anglès |
| Document: | Article ; recerca ; Versió publicada |
| Publicat a: | BMC geriatrics, Vol. 18 (may 2018) , ISSN 1471-2318 |
