title: Serum YKL-40 predicts long-term mortality in patients with stable coronary disease: a prognostic study within the CLARICOR trial.
abstract: OBJECTIVE
  We investigated whether the inflammatory biomarker YKL-40 could improve the long-term prediction of death made by common risk factors plus high-sensitivity C-reactive protein (hs-CRP) and N-terminal-pro-B natriuretic peptide (NT-proBNP) in patients with stable coronary artery disease (CAD).
  
  
  BACKGROUND
  Non-hospitalized CAD patients are usually followed in general practice. There is a need for identify biomarkers which could help to foresee the prognoses of these patients. Elevated serum YKL-40 is a short-term predictor for myocardial infarction, cardiovascular mortality and all-cause mortality in patients with stable CAD.
  
  
  METHODS
  Serum YKL-40, hs-CRP, and NT-proBNP were measured in 4265 (97.6%) of the 4372 patients with stable CAD included in the CLARICOR trial, and death was registered in a 6-years follow-up period.
  
  
  RESULTS
  The median serum YKL-40 was 110 μg/L [IQR=93], hs-CRP 2.8 mg/L [IQR=4.74], and NT-proBNP 203 ng/L [IQR=407]. During 6 years follow-up period 923 (21.1%) patients died. After adjustment for type of intervention, risk factors (age, sex, hypertension, diabetes, smoking status, and previous myocardial infarction) and medical treatment (diuretics, digoxin, and statin) serum YKL-40 (transformed as ln(max(82, YKL-40/μg/L)) was significantly associated with all-cause mortality [hazard ratio (HR)=1.55, 95% CI=1.39-1.73, p<0.001]. After additional adjustment for ln(hs-CRP) and ln(NT-proBNP) this was still true [HR=1.38, 95% CI=1.21-1.53, p<0.001].
  
  
  CONCLUSIONS
  Serum YKL-40 is a predictor of long-term mortality in patients with stable CAD independent of common risk factors and ln(hs-CRP) and ln(NT-proBNP). Serum YKL-40 can be used for prognostication in these patients.
authors.affiliation: Department of Medicine B, The Heart Centre, Rigshospitalet, Copenhagen University Hospital and Faculty of Health Sciences, Copenhagen, Denmark. marinah@dadlnet.dk
authors.forename: Marina
authors.initials: M
authors.lastname: Harutyunyan
authors.forename: Jens P
authors.initials: JP
authors.lastname: Gøtze
authors.forename: Per
authors.initials: P
authors.lastname: Winkel
authors.forename: Julia S
authors.initials: JS
authors.lastname: Johansen
authors.forename: Jørgen Fischer
authors.initials: JF
authors.lastname: Hansen
authors.forename: Gorm Boje
authors.initials: GB
authors.lastname: Jensen
authors.forename: Jørgen
authors.initials: J
authors.lastname: Hilden
authors.forename: Erik
authors.initials: E
authors.lastname: Kjøller
authors.forename: Hans J
authors.initials: HJ
authors.lastname: Kolmos
authors.forename: Christian
authors.initials: C
authors.lastname: Gluud
authors.forename: Jens
authors.initials: J
authors.lastname: Kastrup
mesh_terms: D054392:Adipokines / Q000097:blood*; D000368:Aged; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism; D002316:Cardiotonic Agents / Q000627:therapeutic use; D016022:Case-Control Studies; D000071451:Chitinase-3-Like Protein 1; D003324:Coronary Artery Disease / Q000097:blood* / Q000175:diagnosis* / Q000188:drug therapy / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D037102:Lectins / Q000097:blood*; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood; D010446:Peptide Fragments / Q000097:blood; D011237:Predictive Value of Tests; D011379:Prognosis; D012307:Risk Factors; D016019:Survival Analysis
chemical_list: D054392:Adipokines; D015415:Biomarkers; C084533:CHI3L1 protein, human; D002316:Cardiotonic Agents; D000071451:Chitinase-3-Like Protein 1; D037102:Lectins; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain; D002097:C-Reactive Protein