title: Single sST2 protein measurement predicts adverse outcomes at 1-year follow-up in patients with chronic heart failure.
abstract: BACKGROUND
  sST2 protein is a new biomarker. Its prognostic value in chronic heart failure (CHF) is still unclear.
  
  
  OBJECTIVE
  The aim of the study was to evaluate the value of sST2 protein in patients with CHF during 1-year follow-up after hospitalization for prediction of adverse events: cardiovascular death, rehospitalization, an increase in diuretic doses, and/or worsening of the New York Heart Association functional class, defined as the composite endpoint.
  
  
  METHODS
  The study involved 145 consecutive patients (mean age, 62.16 ±11.25 y; men, 82.76%) with left ventricular (LV) ejection fraction of 30% or less and symptomatic CHF. We analyzed clinical and biochemical data along with the serum concentrations of N-terminal pro-B-type natriuretic peptide (NT-proBNP) and sST2. The optimal cut-off points for significant predictors of the composite endpoint were determined using receiver operating characteristi c curves.
  
  
  RESULTS
  Patients with elevated levels of sST2 and NT-proBNP had more than a 4-fold higher risk of composite endpoint (odds ratio [OR], 4.033; 95%CI, 1.540-10.559) compared with patients in whom both biomarkers were below the cut-off points. The C-statistic for predicting the composite endpoint was improved when both biomarkers were incorporated into the model (C-statistic, 0.692; P = 0.0001) compared with an individual analysis for NT-proBNP (C-statistic, 0.606; P = 0.009) and sST2 (C-statistic, 0.613; P = 0.003). Moreover, after the addition of sST2 to NT-proBNP, the continuous net reclassification improvement index (OR, 0.256; 95% CI, 0.090-0.401; P = 0.007) and the integrated discrimination improvement index (OR, 0.104; 95% CI 0.011-0.221; P = 0.007) significantly improved.
  
  
  CONCLUSIONS
  A single measurement of sST2 levels on admission in patients with poor LV systolic function and stable CHF is useful in short-term risk stratification and, in combination with NT-proBNP, it could be more useful in identifying patients with unfavorable c ourse of CHF.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Sobczak
authors.forename: Karolina
authors.initials: K
authors.lastname: Wojtczak-Soska
authors.forename: Tomasz
authors.initials: T
authors.lastname: Ciurus
authors.forename: Agata
authors.initials: A
authors.lastname: Sakowicz
authors.forename: Tadeusz
authors.initials: T
authors.lastname: Pietrucha
authors.forename: Małgorzata
authors.initials: M
authors.lastname: Lelonek
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D002908:Chronic Disease; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000097:blood* / Q000175:diagnosis*; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D010456:Peptides, Cyclic / Q000097:blood*; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D017481:Receptors, Somatostatin / Q000097:blood*
chemical_list: D015415:Biomarkers; D010446:Peptide Fragments; D010456:Peptides, Cyclic; D017481:Receptors, Somatostatin; C582336:cyclo(acetylcysteinyl-prolyl-glycyl-cysteinamide); C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain