title: Elevated plasma galectin-3 is associated with near-term rehospitalization in heart failure: a pooled analysis of 3 clinical trials.
abstract: BACKGROUND
  Rehospitalization is a major cause for heart failure (HF)-related morbidity and is associated with considerable loss of quality of life and costs. The rate of unplanned rehospitalization in patients with HF is unacceptably high; current risk stratification to identify patients at risk for rehospitalization is inadequate. We evaluated whether measurement of galectin-3 would be helpful in identifying patients at such risk.
  
  
  METHODS
  We analyzed pooled data from patients (n = 902) enrolled in 3 cohorts (COACH, n = 592; PRIDE, n = 181; and UMD H-23258, n = 129) originally admitted because of HF. Mean patient age was between 61.6 and 72.9 years across the cohorts, with a wide range of left ventricular ejection fraction. Galectin-3 levels were measured during index admission. We used fixed and random-effects models, as well as continuous and categorical reclassification statistics to assess the association of baseline galectin-3 levels with risk of postdischarge rehospitalization at different time points and the composite end point all-cause mortality and rehospitalization.
  
  
  RESULTS
  Compared with patients with galectin-3 concentrations less than 17.8 ng/mL, those with results exceeding this value were significantly more likely to be rehospitalized for HF at 30, 60, 90, and 120 days after discharge, with odds ratios (ORs) of 2.80 (95% CI 1.41-5.57), 2.61 (95% CI 1.46-4.65), 3.01 (95% CI 1.79-5.05), and 2.79 (95% CI 1.75-4.45), respectively. After adjustment for age, gender, New York Heart Association class, renal function (estimated glomerular filtration rate), left ventricular ejection fraction, and B-type natriuretic peptide, galectin-3 remained an independent predictor of HF rehospitalization. The addition of galectin-3 to risk models significantly reclassified patient risk of postdischarge rehospitalization and fatal event at each time point (continuous net reclassification improvement at 30 days of +42.6% [95% CI +19.9%-65.4%], P < .001).
  
  
  CONCLUSIONS
  Among patients hospitalized for HF, plasma galectin-3 concentration is useful for the prediction of near-term rehospitalization.
authors.affiliation: University of Groningen, Medical Center Groningen, Department of Cardiology, Groningen, The Netherlands.
authors.forename: Wouter C
authors.initials: WC
authors.lastname: Meijers
authors.affiliation: Massachusetts General Hospital, Division of Cardiology, Boston, MA.
authors.forename: James L
authors.initials: JL
authors.lastname: Januzzi
authors.affiliation: University of Maryland School of Medicine, Department of Medicine, Baltimore, MD.
authors.forename: Christopher
authors.initials: C
authors.lastname: deFilippi
authors.affiliation: BG Medicine, Waltham, MA.
authors.forename: Aram S
authors.initials: AS
authors.lastname: Adourian
authors.affiliation: Northwestern University Feinberg School of Medicine, Division of Cardiology, Chicago, IL.
authors.forename: Sanjiv J
authors.initials: SJ
authors.lastname: Shah
authors.affiliation: University of Groningen, Medical Center Groningen, Department of Cardiology, Groningen, The Netherlands.
authors.forename: Dirk J
authors.initials: DJ
authors.lastname: van Veldhuisen
authors.affiliation: University of Groningen, Medical Center Groningen, Department of Cardiology, Groningen, The Netherlands. Electronic address: r.a.de.boer@umcg.nl.
authors.forename: Rudolf A
authors.initials: RA
authors.lastname: de Boer
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001798:Blood Proteins; D015331:Cohort Studies; D005260:Female; D037502:Galectin 3 / Q000097:blood*; D037161:Galectins; D005919:Glomerular Filtration Rate; D006333:Heart Failure / Q000097:blood* / Q000175:diagnosis; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D020097:Natriuretic Peptide, Brain / Q000097:blood; D016017:Odds Ratio; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011379:Prognosis; D016016:Proportional Hazards Models; D012306:Risk; D018570:Risk Assessment; D013318:Stroke Volume; D016277:Ventricular Function, Left
chemical_list: D001798:Blood Proteins; D037502:Galectin 3; D037161:Galectins; C428445:LGALS3 protein, human; D020097:Natriuretic Peptide, Brain