title: Prognostic Value of Osteoprotegerin in Acute Heart Failure.
abstract: BACKGROUND
  Osteoprotegerin (OPG) is promising as a predictor of adverse prognosis in patients with acute coronary syndromes and chronic heart failure. Its prognostic value in acute heart failure (AHF) is unknown. The aim of this study was to assess the prognostic value provided by serum OPG levels at discharge after an admission for AHF.
  
  
  METHODS
  In a prospective study, we enrolled 338 patients consecutively admitted with AHF to the internal medicine department of a tertiary care university hospital in Porto, Portugal between March 2009 and December 2010. OPG was measured using a commercial enzyme-linked immunosorbent assay and was both analyzed as a continuous variable and categorized by quartiles. Patients were followed for up to 6 months after discharge to ascertain the occurrence of all-cause death or hospital readmission resulting from AHF.
  
  
  RESULTS
  During follow-up, 119 patients died or were readmitted for AHF. A graded increase in the risk of the combined end point was observed across quartiles of OPG. At 6 months, the cumulative risk of the end point was 25% for the first quartile and 50% for the fourth quartile. The multivariable adjusted risk of death or hospitalization for AHF increased progressively across categories of OPG up to a statistically significant 2.44-fold increase in risk in the highest category (P for linear trend = 0.002, ie, by 5% per 10 pg/mL increase in OPG).
  
  
  CONCLUSIONS
  Serum OPG was directly associated with a higher probability of death or readmission for AHF within 6 months, irrespective of other known prognostic markers. This was true both when the ejection fraction was preserved and when it was reduced.
authors.affiliation: Department of Internal Medicine, São João Hospital Centre, Porto, Portugal; Department of Medicine, University of Porto Medical School, Porto, Portugal. Electronic address: fbfrioes@gmail.com.
authors.forename: Fernando
authors.initials: F
authors.lastname: Friões
authors.affiliation: EPIUnit, Institute of Public Health, University of Porto, Porto, Portugal.
authors.forename: Olga
authors.initials: O
authors.lastname: Laszczynska
authors.affiliation: Department of Cardiology, São João Hospital Centre, Porto, Portugal.
authors.forename: Pedro-Bernardo
authors.initials: PB
authors.lastname: Almeida
authors.affiliation: Department of Clinical Pathology, São João Hospital Centre, Porto, Portugal.
authors.forename: Nuno
authors.initials: N
authors.lastname: Silva
authors.affiliation: EPIUnit, Institute of Public Health, University of Porto, Porto, Portugal; Department of Clinical Pathology, São João Hospital Centre, Porto, Portugal; Department of Biochemistry, University of Porto Medical School, Porto, Portugal.
authors.forename: João-Tiago
authors.initials: JT
authors.lastname: Guimarães
authors.affiliation: Department of Cardiology, Division of Medicine, Akershus University Hospital, Lørenskog, Norway; Center for Heart Failure Research and K.G. Jebsen Cardiac Research Centre, University of Oslo, Oslo, Norway.
authors.forename: Torbjørn
authors.initials: T
authors.lastname: Omland
authors.affiliation: EPIUnit, Institute of Public Health, University of Porto, Porto, Portugal; Department of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, Porto, Portugal.
authors.forename: Ana
authors.initials: A
authors.lastname: Azevedo
authors.affiliation: Department of Internal Medicine, São João Hospital Centre, Porto, Portugal; Department of Medicine, University of Porto Medical School, Porto, Portugal.
authors.forename: Paulo
authors.initials: P
authors.lastname: Bettencourt
mesh_terms: D000208:Acute Disease; D000368:Aged; D015415:Biomarkers / Q000097:blood; D015331:Cohort Studies; D005260:Female; D006333:Heart Failure / Q000097:blood / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D053244:Osteoprotegerin / Q000097:blood*; D017063:Outcome Assessment, Health Care; D010359:Patient Readmission / Q000706:statistics & numerical data; D011174:Portugal / Q000453:epidemiology; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D016019:Survival Analysis
chemical_list: D015415:Biomarkers; D053244:Osteoprotegerin