Interleukin family member ST2 and mortality in acute dyspnoea.
OBJECTIVE
The study objective was to investigate the prognostic utility and patient-specific characteristics of ST2 (suppression of tumorigenicity 2), assessed with a novel sensitive assay.


BACKGROUND
Suppression of tumorigenicity 2 signalling has been shown to be associated with death in cardiac and pulmonary diseases.


METHODS
In an international multicentre cohort design, we prospectively enrolled 1091 patients presenting with acute dyspnoea to the emergency department (ED). ST2 was measured in a blinded fashion using a novel assay and compared to B-type natriuretic peptide (BNP) and NT-proBNP. The primary end-point was mortality within 30 days and 1 year. The prognostic value of ST2 was evaluated in comparison and in addition to BNP and NT-proBNP.


RESULTS
Suppression of tumorigenicity 2 concentrations was higher amongst decedents than among survivors (median 85 vs. 43 U mL⁻¹, P < 0.001) and also higher in patients with impaired left ventricular ejection fraction (LVEF) when compared with preserved LVEF (P < 0.001). In receiver operator characteristics analysis, the area under the curve (AUC) for ST2, BNP and NT-proBNP to predict 30-day and 1-year mortality were 0.76, 0.63 and 0.71, and 0.72, 0.71 and 0.73, respectively. The combinations of ST2 with BNP or NT-proBNP improved prediction of mortality provided by BNP or NT-proBNP alone. After multivariable adjustment, ST2 values above the median (50 U mL⁻¹) significantly predicted 1-year mortality (HR 2.3, P < 0.001).


CONCLUSIONS
In patients presenting to the ED with acute dyspnoea, ST2 is a strong and independent predictor of 30-day and 1-year mortality and might improve risk stratification already provided by BNP or NT-proBNP.
Socrates
T
T
Department of Internal Medicine, University Hospital Basel, Basel, Switzerland.
deFilippi
C
C
Reichlin
T
T
Twerenbold
R
R
Breidhardt
T
T
Noveanu
M
M
Potocki
M
M
Reiter
M
M
Arenja
N
N
Heinisch
C
C
Meissner
J
J
Jaeger
C
C
Christenson
R
R
Mueller
C
C
D000208:Acute Disease; D015415:Biomarkers / Q000097:blood; D015331:Cohort Studies; D004417:Dyspnea / Q000097:blood* / Q000401:mortality*; D006801:Humans; D000072179:Interleukin-1 Receptor-Like 1 Protein; D011379:Prognosis; D011446:Prospective Studies; 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