Multi-Marker Strategy in Heart Failure: Combination of ST2 and CRP Predicts Poor Outcome.
Natriuretic peptides (BNP and NT-proBNP) are recognized as gold-standard predictive markers in Heart Failure (HF). However, currently ST2 (member of the interleukin 1 receptor family) has emerged as marker of inflammation, fibrosis and cardiac stress. We evaluated ST2 and CRP as prognostic markers in 178 patients with chronic heart failure in comparison with other classical markers such as clinical established parameters but also biological markers: NT-proBNP, hs-cTnT alone or in combination. In multivariate analysis, subsequent addition of ST2 led to age, CRP and ST2 as the only remaining predictors of all-cause mortality (HR 1.03, HR 1.61 and HR 2.75, respectively) as well as of cardiovascular mortality (HR 1.00, HR 2.27 and HR 3.78, respectively). The combined increase of ST2 and CRP was significant for predicting worsened outcomes leading to identify a high risk subgroup that individual assessment of either marker. The same analysis was performed with ST2 in combination with Barcelona score. Overall, our findings extend previous data demonstrating that ST2 in combination with CRP as a valuable tool for identifying patients at risk of death.
Department of Biochemistry, Centre Ressources Biologiques de Montpellier, University Hospital of Montpellier, Montpellier, France.
Anne Marie
AM
Dupuy
Cardiology Department, University Hospital of Montpellier, Montpellier, France.
Corentin
C
Curinier
Department of Biochemistry, Centre Ressources Biologiques de Montpellier, University Hospital of Montpellier, Montpellier, France.
Nils
N
Kuster
Cardiology Department, University Hospital of Montpellier, Montpellier, France.
Fabien
F
Huet
Cardiology Department, University Hospital of Montpellier, Montpellier, France.
Florence
F
Leclercq
Cardiology Department, University Hospital of Montpellier, Montpellier, France.
Jean Marc
JM
Davy
Department of Biochemistry, Centre Ressources Biologiques de Montpellier, University Hospital of Montpellier, Montpellier, France.|PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR 9214, Montpellier, France.
Jean Paul
JP
Cristol
Cardiology Department, University Hospital of Montpellier, Montpellier, France.|PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR 9214, Montpellier, France.
François
F
Roubille
D000368:Aged; D015415:Biomarkers / Q000097:blood*; D002097:C-Reactive Protein / Q000378:metabolism*; D005260:Female; D006333:Heart Failure / Q000097:blood* / Q000401:mortality; D006801:Humans; D000072179:Interleukin-1 Receptor-Like 1 Protein / Q000097:blood*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D020097:Natriuretic Peptide, Brain / Q000097:blood; D010446:Peptide Fragments / Q000097:blood; D011379:Prognosis; D018570:Risk Assessment
D015415:Biomarkers; C079241:IL1RL1 protein, human; D000072179:Interleukin-1 Receptor-Like 1 Protein; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain; D002097:C-Reactive Protein