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.
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.
Januzzi
James L
JL
Department of Medicine and Laboratory Medicine, Massachusetts General Hospital, Boston, Massachusetts 02114, USA. JJanuzzi@Partners.org
Peacock
W Frank
WF
Maisel
Alan S
AS
Chae
Claudia U
CU
Jesse
Robert L
RL
Baggish
Aaron L
AL
O'Donoghue
Michelle
M
Sakhuja
Rahul
R
Chen
Annabel A
AA
van Kimmenade
Roland R J
RR
Lewandrowski
Kent B
KB
Lloyd-Jones
Donald M
DM
Wu
Alan H B
AH
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
D015415:Biomarkers; C079241:IL1RL1 protein, human; D000072179:Interleukin-1 Receptor-Like 1 Protein; D011956:Receptors, Cell Surface