title: Soluble ST2 serum concentration and renal function in heart failure.
abstract: BACKGROUND
  Soluble ST2 (sST2) provides important prognostic information in patients with heart failure (HF). How sST2 serum concentration is related to renal function is uncertain. We evaluated the association between sST2 and renal function and compared its prognostic value in HF patients with renal insufficiency.
  
  
  RESULTS
  Patients (n = 879; median age 70.4 years; 71.8% men) were divided into 3 subgroups according to estimated glomerular filtration rate (eGFR): ≥60 mL/min/1.73 m(2) (n = 337); 30-59 mL/min/1.73 m(2) (n = 352); and <30 mL/min/1.73 m(2) (n = 190). sST2 (rho = -0.16; P < .001), N-terminal pro-B-type natriuretic peptide (rho = -0.40; P < .001), and high-sensitivity cardiac troponin T (rho = -0.47; P < .001) inversely correlated with eGFR. All-cause mortality was the primary end point. During a median follow-up of 3.46 years, 312 patients (35%) died, 246 of them from the subgroup of 542 patients with eGFR <60 mL/min/1.73 m(2) (45%). Biomarker combination including sST2 showed best discrimination, calibration, and reclassification metrics in renal insufficiency patients (net reclassification improvement 16.6 [95% confidence interval (CI) 8.1-25; P < .001]; integrated discrimination improvement 4.2 [95% CI 2.2-6.2; P < .001]). Improvement in reclassification was higher in these patients than in the total cohort.
  
  
  CONCLUSIONS
  The prognostic value of sST2 was not influenced by renal function. On top of other biomarkers, sST2 improved long-term prediction in patients with renal insufficiency even more than in the total cohort.
authors.affiliation: Heart Failure Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Spain; Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain. Electronic address: abayesgenis@gmail.com.
authors.forename: Antoni
authors.initials: A
authors.lastname: Bayes-Genis
authors.forename: Elisabet
authors.initials: E
authors.lastname: Zamora
authors.forename: Marta
authors.initials: M
authors.lastname: de Antonio
authors.forename: Amparo
authors.initials: A
authors.lastname: Galán
authors.forename: Joan
authors.initials: J
authors.lastname: Vila
authors.forename: Agustín
authors.initials: A
authors.lastname: Urrutia
authors.forename: Crisanto
authors.initials: C
authors.lastname: Díez
authors.forename: Ramon
authors.initials: R
authors.lastname: Coll
authors.forename: Salvador
authors.initials: S
authors.lastname: Altimir
authors.forename: Josep
authors.initials: J
authors.lastname: Lupón
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate / Q000502:physiology; D006333:Heart Failure / Q000097:blood* / Q000175:diagnosis*; D006801:Humans; D000072179:Interleukin-1 Receptor-Like 1 Protein; D007668:Kidney / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D011956:Receptors, Cell Surface / Q000097:blood*; D051437:Renal Insufficiency / Q000097:blood* / Q000175:diagnosis*
chemical_list: D015415:Biomarkers; C079241:IL1RL1 protein, human; D000072179:Interleukin-1 Receptor-Like 1 Protein; D011956:Receptors, Cell Surface
keywords: Heart failure; cardiac markers; prognosis; renal dysfunction; risk prediction