title: Prealbumin improves death risk prediction of BNP-added Seattle Heart Failure Model: results from a pilot study in elderly chronic heart failure patients.
abstract: BACKGROUND
  An accurate prognosis prediction represents a key element in chronic heart failure (CHF) management. Seattle Heart Failure Model (SHFM) prognostic power, a validated risk score for predicting mortality in CHF, is improved by adding B-type natriuretic peptide (BNP). We evaluated in a prospective study the incremental value of several biomarkers, linked to different biological domains, on death risk prediction of BNP-added SHFM.
  
  
  METHODS
  Troponin I (cTnI), norepinephrine, plasma renin activity, aldosterone, high sensitivity-C reactive protein (hs-CRP), tumor necrosis factor-α (TNF-α), interleukin 6 (IL-6), interleukin 2 soluble receptor, leptin, prealbumin, free malondialdehyde, and 15-F2t-isoprostane were measured in plasma from 142 consecutive ambulatory, non-diabetic stable CHF (mean NYHA-class 2.6) patients (mean age 75±8years). Calibration, discrimination, and risk reclassification of BNP-added SHFM were evaluated after individual biomarker addition.
  
  
  RESULTS
  Individual addition of biomarkers to BNP-added SHFM did not improve death prediction, except for prealbumin (HR 0.49 CI: (0.31-0.76) p=0.002) and cTnI (HR 2.03 CI: (1.20-3.45) p=0.009). In fact, with respect to BNP-added SHFM (Harrell's C-statistic 0.702), prealbumin emerged as a stronger predictor of death showing the highest improvement in model discrimination (+0.021, p=0.033) and only a trend was observed for cTn I (+0.023, p=0.063). These biomarkers showed also the best reclassification statistic (Integrated Discrimination Improvement-IDI) at 1-year (IDI: cTnI, p=0.002; prealbumin, p=0.020), 2-years (IDI: cTnI, p=0.018; prealbumin: p=0.006) and 3-years of follow-up (IDI: cTnI p=0.024; prealbumin: p=0.012).
  
  
  CONCLUSIONS
  Individual addition of prealbumin allows a more accurate prediction of mortality of BNP enriched SHFM in ambulatory elderly CHF suggesting its potential use in identifying those at high-risk that need nutritional surveillance.
authors.affiliation: Cardiorenal Research Unit, Department of Clinical and Experimental Medicine, University of Parma Medical School, Via Gramsci 14, 43126 Parma, Italy. Electronic address: aderville.cabassi@unipr.it.
authors.forename: Aderville
authors.initials: A
authors.lastname: Cabassi
authors.forename: Jacques
authors.initials: J
authors.lastname: de Champlain
authors.forename: Umberto
authors.initials: U
authors.lastname: Maggiore
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Parenti
authors.forename: Pietro
authors.initials: P
authors.lastname: Coghi
authors.forename: Vanni
authors.initials: V
authors.lastname: Vicini
authors.forename: Stefano
authors.initials: S
authors.lastname: Tedeschi
authors.forename: Elena
authors.initials: E
authors.lastname: Cremaschi
authors.forename: Simone
authors.initials: S
authors.lastname: Binno
authors.forename: Rossana
authors.initials: R
authors.lastname: Rocco
authors.forename: Salvatore
authors.initials: S
authors.lastname: Bonali
authors.forename: Michele
authors.initials: M
authors.lastname: Bianconcini
authors.forename: Clelia
authors.initials: C
authors.lastname: Guerra
authors.forename: Giuseppina
authors.initials: G
authors.lastname: Folesani
authors.forename: Alberto
authors.initials: A
authors.lastname: Montanari
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Regolisti
authors.forename: Enrico
authors.initials: E
authors.lastname: Fiaccadori
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D002908:Chronic Disease; D015331:Cohort Studies; D005260:Female; D006333:Heart Failure / Q000097:blood* / Q000175:diagnosis* / Q000401:mortality; D006801:Humans; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010865:Pilot Projects; D011228:Prealbumin / Q000378:metabolism*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012307:Risk Factors; D014861:Washington / Q000453:epidemiology
chemical_list: D015415:Biomarkers; D011228:Prealbumin; D020097:Natriuretic Peptide, Brain
keywords: Biomarker; Elderly; Heart failure; Mortality