title: Relationship between osteoprotegerin and mortality in decompensated heart failure with preserved ejection fraction.
abstract: OBJECTIVE
  The aim of this study was to evaluate whether osteoprotegerin - an emerging inflammatory biomarker in cardiovascular diseases - predicts outcomes in patients with acute heart failure and preserved ejection fraction.
  
  
  METHODS
  We measured urea, creatinine, hemoglobin, high-sensitivity C-reactive protein, N-terminal pro-B-type natriuretic peptide and osteoprotegerin on admission in 177 patients admitted with decompensated heart failure and left ventricular ejection fraction at least 45%. The population was divided according to the median values of osteoprotegerin (158.6 ng/l). Primary and secondary endpoints were all-cause mortality and death/readmission at 1-year follow-up, respectively. Multivariable Cox models were generated for osteoprotegerin and common risk factors. We also evaluated the reclassification of patients into risk categories after adding this biomarker to the model.
  
  
  RESULTS
  A total of 43 patients died during the follow-up and 84 had a combined event. Kaplan-Meier curves showed significantly increased primary and secondary endpoints according to the median of osteoprotegerin (log-rank, P < 0.0001 and 0.001, respectively). After adjustment for age, estimated glomerular filtration rate, hemoglobin, N-terminal pro-B-type natriuretic peptide, BMI and New York Heart Association III-IV, osteoprotegerin was a significant predictor of primary endpoint evaluated as continuous and categorized variable (relative risk 2.49, 95% confidence interval 1.18-5.24, P = 0.016 and relative risk 2.35, 95% confidence interval 1.11-4.96, P = 0.025, respectively). The clinical prediction model with osteoprotegerin evaluated with Net Reclassification Index was not significant.
  
  
  CONCLUSIONS
  Osteoprotegerin is independently associated with all-cause mortality in patients hospitalized for heart failure with preserved ejection fraction. However, adding this biomarker into a risk model does not improve its prediction value.
authors.affiliation: aDepartment of Internal Medicine, Hospital Virgen Macarena bDepartment of Internal Medicine, Hospital Virgen de la Merced, Osuna cDepartment of Critical Care and Emergency, Hospital Virgen Macarena, Seville dDepartment of Internal Medicine, Hospital Infanta Margarita, Cabra, Córdoba eDepartment of Clinical Chemistry and Laboratory Medicine, Hospital Virgen Macarena fDepartment of Internal Medicine, Hospital NISA Sevilla Aljarafe, Seville gDepartment of Internal Medicine, Hospital of Bellvitge, L'Hospitalet de Llobregat, Barcelona hDepartment of Internal Medicine, IMIBIC/Hospital Reina Sofía, University of Córdoba, Córdoba iDepartment of Internal Medicine, Hospital Ramón y Cajal, University of Alcalá, Madrid, Spain.
authors.forename: Óscar
authors.initials: Ó
authors.lastname: Aramburu-Bodas
authors.forename: Beatriz
authors.initials: B
authors.lastname: García-Casado
authors.forename: Prado
authors.initials: P
authors.lastname: Salamanca-Bautista
authors.forename: María E
authors.initials: ME
authors.lastname: Guisado-Espartero
authors.forename: José L
authors.initials: JL
authors.lastname: Arias-Jiménez
authors.forename: Antonio
authors.initials: A
authors.lastname: Barco-Sánchez
authors.forename: Juan Carlos
authors.initials: JC
authors.lastname: Santamaría-González
authors.forename: Francesc
authors.initials: F
authors.lastname: Formiga
authors.forename: Manuel
authors.initials: M
authors.lastname: Montero-Pérez-Barquero
authors.forename: Luis
authors.initials: L
authors.lastname: Manzano
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000097:blood / Q000175:diagnosis* / Q000503:physiopathology; D006760:Hospitalization; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D053245:RANK Ligand / Q000097:blood*; D018570:Risk Assessment / Q000379:methods; D013318:Stroke Volume / Q000502:physiology
chemical_list: D015415:Biomarkers; D053245:RANK Ligand; C505688:TNFSF11 protein, human