title: Diagnostic and prognostic value of osteopontin in patients with acute congestive heart failure.
abstract: OBJECTIVE
  To evaluate the diagnostic and prognostic value of osteopontin in patients with acute dyspnoea and/or peripheral oedema suspected of having acute congestive heart failure (aCHF).
  
  
  RESULTS
  A total of 401 patients presenting with acute dyspnoea and/or peripheral oedema to the emergency department were prospectively enrolled and followed up for up to 5 years. Blood samples for biomarker measurements were collected on admission to the emergency department. Osteopontin combined with NT-proBNP vs. NT-proBNP alone for diagnosis of aCHF was tested. Additionally, osteopontin vs. NT-proBNP for prognostic outcomes (i.e. all-cause mortality, aCHF-related rehospitalization, and both in combination) was tested. The diagnostic and prognostic capacity of osteopontin was tested by C-statistics, reclassification indices, and multivariable Cox prediction models. Osteopontin plus NT-proBNP improved the diagnostic capacity for aCHF diagnosis [accuracy 76%, 95% confidence interval (CI) 72-80%; specificity 74%, 95% CI 69-79%, net reclassification improvement (NRI) +0.10] compared with NT-proBNP alone in the emergency department (P = 0.0001). Osteopontin independently predicted all-cause mortality and aCHF-related rehospitalization after 1 and 5 years. Compared with NT-proBNP, osteopontin was of superior prognostic value, specifically in aCHF patients and for the prognostic outcome of aCHF-related rehospitalization.
  
  
  CONCLUSIONS
  Osteopontin improves aCHF diagnosis when combined with NT-proBNP. Osteopontin identifies aCHF patients with high 1- and 5-year mortality and rehospitalization risk, and adds prognostic value to NT-proBNP. Trial registration NCT00143793.
authors.affiliation: First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, Mannheim, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Behnes
authors.forename: Martina
authors.initials: M
authors.lastname: Brueckmann
authors.forename: Siegfried
authors.initials: S
authors.lastname: Lang
authors.forename: Florian
authors.initials: F
authors.lastname: Espeter
authors.forename: Christel
authors.initials: C
authors.lastname: Weiss
authors.forename: Michael
authors.initials: M
authors.lastname: Neumaier
authors.forename: Parviz
authors.initials: P
authors.lastname: Ahmad-Nejad
authors.forename: Martin
authors.initials: M
authors.lastname: Borggrefe
authors.forename: Ursula
authors.initials: U
authors.lastname: Hoffmann
mesh_terms: D000208:Acute Disease; D000368:Aged; D015415:Biomarkers / Q000097:blood; D016001:Confidence Intervals; D004417:Dyspnea / Q000097:blood / Q000209:etiology* / Q000503:physiopathology; D004489:Edema, Cardiac / Q000097:blood / Q000209:etiology* / Q000503:physiopathology; D005260:Female; D006333:Heart Failure / Q000097:blood / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000097:blood; D053495:Osteopontin / Q000097:blood*; D017063:Outcome Assessment, Health Care; D010446:Peptide Fragments / Q000097:blood; D011237:Predictive Value of Tests; D011379:Prognosis; D012720:Severity of Illness Index; D016019:Survival Analysis
chemical_list: D015415:Biomarkers; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D053495:Osteopontin; D020097:Natriuretic Peptide, Brain
keywords: Acute congestive heart failure; Mortality; NT-proBNP; Osteopontin; Prognosis; Rehospitalization