title: Measurement of the interleukin family member ST2 in patients with acute dyspnea: results from the PRIDE (Pro-Brain Natriuretic Peptide Investigation of Dyspnea in the Emergency Department) study.
abstract: OBJECTIVE
  The aim of this study was to examine the value of measurement of the interleukin-1 receptor family member ST2 in patients with dyspnea.
  
  
  BACKGROUND
  Concentrations of ST2 have been reported to be elevated in patients with heart failure (HF).
  
  
  METHODS
  Five hundred ninety-three dyspneic patients with and without acute destabilized HF presenting to an urban emergency department were evaluated with measurements of ST2 concentrations. Independent predictors of death at 1 year were identified.
  
  
  RESULTS
  Concentrations of ST2 were higher among those with acute HF compared with those without (0.50 vs. 0.15 ng/ml; p < 0.001), although amino-terminal pro-brain natriuretic peptide (NT-proBNP) was superior to ST2 for diagnosis of acute HF. Median concentrations of ST2 at presentation to the emergency department were higher among decedents than survivors at 1 year (1.08 vs. 0.18 ng/ml; p < 0.001), and in multivariable analyses, an ST2 concentration > or =0.20 ng/ml strongly predicted death at 1 year in dyspneic patients as a whole (HR = 5.6, 95% confidence interval [CI] 2.2 to 14.2; p < 0.001) as well as those with acute HF (hazard ratio [HR] = 9.3, 95% CI 1.3 to 17.8; p = 0.03). This risk associated with an elevated ST2 in dyspneic patients with and without HF appeared early and was sustained at 1 year after presentation (log-rank p value <0.001). A multi-marker approach with both ST2 and NT-proBNP levels identified subjects with the highest risk for death.
  
  
  CONCLUSIONS
  Among dyspneic patients with and without acute HF, ST2 concentrations are strongly predictive of mortality at 1 year and might be useful for prognostication when used alone or together with NT-proBNP.
authors: Department of Medicine and Laboratory Medicine, Massachusetts General Hospital, Boston, Massachusetts 02114, USA. JJanuzzi@Partners.org
authors: James L
authors: JL
authors: Januzzi
authors: W Frank
authors: WF
authors: Peacock
authors: Alan S
authors: AS
authors: Maisel
authors: Claudia U
authors: CU
authors: Chae
authors: Robert L
authors: RL
authors: Jesse
authors: Aaron L
authors: AL
authors: Baggish
authors: Michelle
authors: M
authors: O'Donoghue
authors: Rahul
authors: R
authors: Sakhuja
authors: Annabel A
authors: AA
authors: Chen
authors: Roland R J
authors: RR
authors: van Kimmenade
authors: Kent B
authors: KB
authors: Lewandrowski
authors: Donald M
authors: DM
authors: Lloyd-Jones
authors: Alan H B
authors: AH
authors: Wu
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D016022:Case-Control Studies; D015331:Cohort Studies; D004417:Dyspnea / Q000097:blood* / Q000209:etiology; D005260:Female; D006333:Heart Failure / Q000097:blood* / Q000150:complications / Q000401:mortality*; D006801:Humans; D000072179:Interleukin-1 Receptor-Like 1 Protein; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011956:Receptors, Cell Surface / Q000097:blood*; D015996:Survival Rate
chemical_list: D015415:Biomarkers; C079241:IL1RL1 protein, human; D000072179:Interleukin-1 Receptor-Like 1 Protein; D011956:Receptors, Cell Surface