title: Predictive capacity of a multimarker strategy to determine short-term mortality in patients attending a hospital emergency Department for acute heart failure. BIO-EAHFE study.
abstract: OBJECTIVE
  A multimarker strategy may help determine the prognosis of patients with acute heart failure (AHF). The aim of this study was to evaluate the capacity of mid-regional pro-adrenomedullin (MRproADM), copeptin and interleukin-6 (IL-6) combined with conventional clinical and biochemical markers to predict the 30-day mortality of patients with AHF.
  
  
  METHODS
  We performed an observational, multicenter, prospective study of patients attended in the emergency department (ED) for AHF. We collected clinical and biochemical data as well as comorbidities and biomarker values. The endpoint variable was mortality at 7, 14, 30, 90 and 180days. The clinical model included: gender, age, blood pressure values, hemoglobin, sodium <135mmol/L and estimated glomerular filtration <60mL/min/1.73m2. We made receiver operating curves (ROC) curves, and areas under the curve (AUC) and survival analysis for each model and calculated the hazard ratio (HR) and its 95% confidence interval.
  
  
  RESULTS
  A total of 547 individuals were included: 55.6% were women with a mean age of 79.9 (9.5) years. Copeptin alone showed greater discriminatory power for 30-mortality [AUC 0.70 (0.62-0.78)]. The AUC for 30-day mortality of the clinical model plus copeptin and NTproBNP was 0.75 (0.67-0.83), being better than the clinical model alone with 0.67 (0.58-0.76; p=0.19). The discriminatory power of the different biomarkers alone, in combination or together with the clinical model decreased over time.
  
  
  CONCLUSIONS
  The combination of a clinical model with copeptin and NTproBNP, which are available in the ED, is able to prognose early mortality in patients with an episode of AHF.
authors.affiliation: Unidad de Gestión Clínica de Urgencias, Hospital Universitario Central de Asturias, Universidad de Oviedo, Oviedo, Asturias, Spain. Electronic address: pabloherrero71@hotmail.com.
authors.forename: Pablo
authors.initials: P
authors.lastname: Herrero-Puente
authors.affiliation: Área de Gestión del Laboratorio de Medicina, Hospital Universitario Central de Asturias, Hospital Universitario Central de Asturias, Universidad de Oviedo, Oviedo, Asturias, Spain.
authors.forename: Belén
authors.initials: B
authors.lastname: Prieto-García
authors.affiliation: Area de Gestión del Laboratorio de Medicina, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain.
authors.forename: María
authors.initials: M
authors.lastname: García-García
authors.affiliation: Servicio de Urgencias, Hospital Universitario de Bellvitge, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Jacob
authors.affiliation: Servicio de Urgencias, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Universidad Complutense de Madrid, Madrid, Spain.
authors.forename: F Javier
authors.initials: FJ
authors.lastname: Martín-Sánchez
authors.affiliation: Servicio de Cardiología, Hospital Universitario Arrixaca, Murcia, Spain.
authors.forename: Domingo
authors.initials: D
authors.lastname: Pascual-Figal
authors.affiliation: Multidisciplinary Translational Cardiovascular Research (MTCR) Group, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Spain.
authors.forename: Héctor
authors.initials: H
authors.lastname: Bueno
authors.affiliation: Área de Urgencias, Hospital Clinic, Barcelona, Grupo de Investigación "Urgencias: procesos y patologías", IDIBAPS, Barcelona, Spain.
authors.forename: Victor
authors.initials: V
authors.lastname: Gil
authors.affiliation: Servicio de Urgencias-Unidad de Corta Estancia, Hospital Universitario General de Alicante, Spain.
authors.forename: Pere
authors.initials: P
authors.lastname: Llorens
authors.affiliation: Unidad de Gestión Clínica de Urgencias, Hospital Universitario Central de Asturias, Universidad de Oviedo, Oviedo, Asturias, Spain.
authors.forename: Joaquin
authors.initials: J
authors.lastname: Vázquez-Alvarez
authors.affiliation: Servicio de Urgencias, Hospital de Getafe, Spain.
authors.forename: Rodolfo
authors.initials: R
authors.lastname: Romero-Pareja
authors.affiliation: Unidad de Gestión Clínica de Urgencias, Hospital Universitario Central de Asturias, Universidad de Oviedo, Oviedo, Asturias, Spain.
authors.forename: Marta
authors.initials: M
authors.lastname: Sanchez-Gonzalez
authors.affiliation: Área de Urgencias, Hospital Clinic, Barcelona, Grupo de Investigación "Urgencias: procesos y patologías", IDIBAPS, Barcelona, Spain.
authors.forename: Òscar
authors.initials: Ò
authors.lastname: Miró
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D015415:Biomarkers / Q000097:blood; D004636:Emergency Service, Hospital; D005260:Female; D006020:Glycopeptides / Q000097:blood*; D006333:Heart Failure / Q000401:mortality*; D006801:Humans; D008297:Male; D009026:Mortality; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D016019:Survival Analysis
chemical_list: D015415:Biomarkers; D006020:Glycopeptides; D010446:Peptide Fragments; C048197:copeptins; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain
keywords: Acute heart failure; Biomarkers; Copeptin; Emergency department; Interleukin 6; MRproadrenomedullin; Prognosis