title: Incremental value of biomarkers to clinical variables for mortality prediction in acutely decompensated heart failure: the Multinational Observational Cohort on Acute Heart Failure (MOCA) study.
abstract: OBJECTIVE
  This study aims to evaluate the incremental value of plasma biomarkers to traditional clinical variables for risk stratification of 30-day and one-year mortality in acutely decompensated heart failure (ADHF).
  
  
  RESULTS
  Through an international collaborative network, individual patient data on 5306 patients hospitalized for ADHF were collected. The all-cause mortality rate was 11.7% at 30 days and 32.9% at one year. The clinical prediction model (age, gender, blood pressure on admission, estimated glomerular filtration rate <60 mL/min/1.73 m(2), sodium and hemoglobin levels, and heart rate) had a c-statistic of 0.74 for 30-day mortality and 0.73 for one-year mortality. Several biomarkers measured at presentation improved risk stratification when added to the clinical model. At 30 days, the net reclassification improvement (NRI) was 28.7% for mid-regional adrenomedullin (MR-proADM; p<0.001) and 25.5% for soluble (s)ST2 (p<0.001). At one year, sST2 (NRI 10.3%), MR-proADM (NRI 9.1%), amino-terminal pro-B-type natriuretic peptide (NT-proBNP; NRI 9.1%), mid-regional proatrial natriuretic peptide (MR-proANP; NRI 7.4%), B-type natriuretic peptide (NRI 5.5%) and C-reactive protein (CRP; NRI 5.3%) reclassified patients with ADHF (p<0.05 for all). CRP also markedly improved risk stratification of patients with ADHF as a dual biomarker combination with MR-proADM (NRI 36.8% [p<0.001] for death at 30 days) or with sST2 (NRI 20.3%; [p<0.001] for one-year mortality).
  
  
  CONCLUSIONS
  In this study, biomarkers provided incremental value for risk stratification of ADHF patients. Biomarkers such as sST2, MR-proADM, natriuretic peptides and CRP, reflecting different pathophysiologic pathways, add prognostic value to clinical risk factors for predicting both short-term and one-year mortality in ADHF.
authors.affiliation: Division of Emergency Care and Department of Medicine, Helsinki University Central Hospital, Finland; Cardiac diseases and biomarkers, INSERM UMR 942, Lariboisière University Hospital, Paris, France.
authors.forename: Johan
authors.initials: J
authors.lastname: Lassus
authors.forename: Etienne
authors.initials: E
authors.lastname: Gayat
authors.forename: Christian
authors.initials: C
authors.lastname: Mueller
authors.forename: W Frank
authors.initials: WF
authors.lastname: Peacock
authors.forename: Jindrich
authors.initials: J
authors.lastname: Spinar
authors.forename: Veli-Pekka
authors.initials: VP
authors.lastname: Harjola
authors.forename: Roland
authors.initials: R
authors.lastname: van Kimmenade
authors.forename: Atul
authors.initials: A
authors.lastname: Pathak
authors.forename: Thomas
authors.initials: T
authors.lastname: Mueller
authors.forename: Salvatore
authors.initials: S
authors.lastname: Disomma
authors.forename: Marco
authors.initials: M
authors.lastname: Metra
authors.forename: Domingo
authors.initials: D
authors.lastname: Pascual-Figal
authors.forename: Said
authors.initials: S
authors.lastname: Laribi
authors.forename: Damien
authors.initials: D
authors.lastname: Logeart
authors.forename: Semir
authors.initials: S
authors.lastname: Nouira
authors.forename: Naoki
authors.initials: N
authors.lastname: Sato
authors.forename: Michael
authors.initials: M
authors.lastname: Potocki
authors.forename: Jiri
authors.initials: J
authors.lastname: Parenica
authors.forename: Corinne
authors.initials: C
authors.lastname: Collet
authors.forename: Alain
authors.initials: A
authors.lastname: Cohen-Solal
authors.forename: James L
authors.initials: JL
authors.lastname: Januzzi
authors.forename: Alexandre
authors.initials: A
authors.lastname: Mebazaa
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood*; D002423:Cause of Death / Q000639:trends; D005260:Female; D005500:Follow-Up Studies; D014943:Global Health; D006333:Heart Failure / Q000097:blood / Q000401:mortality*; D006801:Humans; D008297:Male; D011237:Predictive Value of Tests; D018570:Risk Assessment; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends
chemical_list: D015415:Biomarkers
keywords: ADHF; Biomarkers; Mortality; Reclassification; Risk prediction