title: Serum beta2-microglobulin concentration as a novel marker to distinguish levels of risk in acute heart failure patients.
abstract: BACKGROUND
  Recently, serum beta2-microglobulin, an endogenous marker for renal function, has been shown to be an independent predictor of mortality in older adults. However, the prognostic role of beta2-microglobulin in heart failure has not been elucidated.
  
  
  METHODS
  We prospectively evaluated serum beta2-microglobulin and creatinine concentrations, creatinine-based renal parameters (estimated glomerular filtration rate and creatinine clearance), and echocardiographic data in 131 patients with acute heart failure and creatinine concentrations < or =3.0mg/dL admitted to our hospitals.
  
  
  RESULTS
  During 2.3+/-1.3 years, 42 patients died of cardiovascular causes and 12 died of noncardiac causes. Cardiovascular events were observed in 63 patients: 53 were readmitted due to worsening heart failure, 5 readmitted for cerebral embolism, and 5 died from sudden cardiac death. According to multivariate stepwise Cox proportional hazard analysis, higher baseline serum beta2-microglobulin concentrations (X(2)=16, p<0.0001), previous congestive heart failure (X(2)=11, p<0.001), presence of chronic obstructive pulmonary disease (X(2)=8, p<0.01), and lower diastolic blood pressure (X(2)=6, p<0.05) were independent predictors of increased cardiovascular events. Also, higher baseline serum beta2-microglobulin (X(2)=20, p<0.0001), lower systolic blood pressure (X(2)=11, p<0.001), higher relative left ventricular wall thickness (X(2)=6, p<0.05), and lower body mass index (X(2)=5, p<0.05) were independent predictors of increased cardiac mortality. The adjusted hazard ratio for cardiovascular events increased with baseline serum beta2-microglobulin above 2.1 mg/L: 2.9 with beta2-microglobulin of 2.2-2.6 mg/L (95%CI 1.2-6.9, p<0.05), 2.9 with beta2-microglobulin of 2.7-3.9 mg/L (95%CI 1.2-7.2, p<0.05), and 4.7 with beta2-microglobulin of > or =4.0 mg/L (95%CI 2.0-11, p<0.001).
  
  
  CONCLUSIONS
  Higher baseline serum beta2-microglobulin concentration could be a promising risk marker in acute heart failure patients with creatinine < or =3.0 mg/dL.
authors.affiliation: Department of Internal Medicine, Kasai City Hospital, 1-13, Yoko-o, Hojo-cho, Kasai, Hyogo 675-2311, Japan. kkawai@river.sannet.ne.jp
authors.forename: Keisuke
authors.initials: K
authors.lastname: Kawai
authors.forename: Seinosuke
authors.initials: S
authors.lastname: Kawashima
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Miyazaki
authors.forename: Eiichi
authors.initials: E
authors.lastname: Tajiri
authors.forename: Masuki
authors.initials: M
authors.lastname: Mori
authors.forename: Kazuhisa
authors.initials: K
authors.lastname: Kitazaki
authors.forename: Tomohiko
authors.initials: T
authors.lastname: Shirotani
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Inatome
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Yamabe
authors.forename: Ken-Ichi
authors.initials: K
authors.lastname: Hirata
authors.forename: Mitsuhiro
authors.initials: M
authors.lastname: Yokoyama
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood*; D001794:Blood Pressure; D015992:Body Mass Index; D003404:Creatinine / Q000097:blood / Q000378:metabolism; D004452:Echocardiography; D005260:Female; D005919:Glomerular Filtration Rate; D006333:Heart Failure / Q000097:blood / Q000401:mortality*; D006801:Humans; D008297:Male; D017835:Nedocromil; D011379:Prognosis; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications; D012008:Recurrence; D001613:beta 2-Microglobulin / Q000097:blood*
chemical_list: D015415:Biomarkers; D001613:beta 2-Microglobulin; D017835:Nedocromil; D003404:Creatinine