Multimarker strategy for the prediction of 31 days cardiac death in patients with acutely decompensated chronic heart failure.
BACKGROUND
To investigate the combined prognostic value of admission serum levels of B-type natriuretic peptide (BNP), cardiac troponin I (cTnI) and high sensitivity C-reactive protein (hs-CRP), in patients hospitalized because of acutely decompensated severe (New York Heart Association class III/IV) low-output chronic heart failure (CHF).


METHODS
A total of 577 consecutive patients recruited in the 5 participating centers, were studied. Cardiac mortality by 31 days was the prespecified primary study end point.


RESULTS
A total of 102 (17.7%) patients died by 31 days. When the study patients were divided according to the number of elevated study biomarkers, there was a significant gradual increased risk of 31-day cardiac death with increasing in the number of elevated biomarkers (p<0.001). The value of the discriminant C statistic for the Cox regression analysis, increased significantly when each of the study biomarkers was incorporated with the other risk predictors into a Cox regression model, with the highest C statistic value for the Cox regression model that included all the study biomarkers (p<0.001). By multivariate Cox regression analysis, elevated serum levels of BNP (p=0.002), cTnI (p<0.001) and hs-CRP (p=0.02) were independent predictors of the study end point.


CONCLUSIONS
In conclusion, in patients hospitalized for acute decompensation of severe (NYHA III/IV) low-output CHF, BNP, cTnI and hs-CRP upon admission offers enhanced early risk stratification. With increasing number of elevated biomarkers, the risk of 31-day cardiac death increases gradually that implies treatment intensification, and closer follow-up.
Zairis
Michael N
MN
Department of Cardiology, Tzanio Hospital, Piraeus, Greece. zairis66@otenet.gr
Tsiaousis
George Z
GZ
Georgilas
Anastassios Theodossis
AT
Makrygiannis
Stamatis S
SS
Adamopoulou
Evdokia N
EN
Handanis
Stelios M
SM
Batika
Pelagia C
PC
Prekates
Athanasios A
AA
Velissaris
Dimitris
D
Kouris
Nikolaos T
NT
Mytas
Demetrios Z
DZ
Babalis
Demetrios K
DK
Karidis
Kostas S
KS
Foussas
Stefanos G
SG
D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood*; D002097:C-Reactive Protein / Q000378:metabolism; D002302:Cardiac Output; D002908:Chronic Disease; D016757:Death, Sudden, Cardiac / Q000453:epidemiology*; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000097:blood / Q000175:diagnosis / Q000401:mortality; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D020097:Natriuretic Peptide, Brain / Q000097:blood; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D012372:ROC Curve; D012307:Risk Factors; D012720:Severity of Illness Index; D019210:Troponin I / Q000097:blood
D015415:Biomarkers; D019210:Troponin I; D020097:Natriuretic Peptide, Brain; D002097:C-Reactive Protein