- 作者：Bernhard Richter ; Lorenz Koller ; Philipp J. Hohensinner ; Gerlinde Zorn ; Mira Brekalo ; Rudolf Berger ; Deddo M?rtl ; Gerald Maurer ; Richard Pacher ; Kurt Huber ; Johann Wojta ; Martin H¨¹lsmann ; Alex ; er Niessner
- 关键词：Heart failure ; Multimarker ; Biomarker ; Cytokine ; Survival ; Prognosis
- 刊名：International Journal of Cardiology
- 出版年：2013
- 出版时间：30 September, 2013
- 年：2013
- 卷：168
- 期：2
- 页码：1251-1257
- 全文大小：437 K
Background
Accurate risk prediction is important for an adequate management of heart failure (HF) patients. We assessed the incremental prognostic ability of a multi-biomarker approach in advanced HF.Methods
In 349 patients with advanced HF (median 75 years, 66 % male) we investigated the incremental prognostic value of 12 novel biomarkers involved in different pathophysiological pathways including inflammation, immunological activation, oxidative stress, cell growth, remodeling, angiogenesis and apoptosis.
Results
During a median follow-up of 4.9 years 55.9 % of patients died. Using multivariable Cox regression and bootstrap variable-selection age, chronic obstructive pulmonary disease, N-terminal pro-B-type natriuretic peptide (NT-proBNP) and the following 5 novel biomarkers were retained in the best mortality prediction model: the chemokine fractalkine, the angiogenic and mitogenic hepatocyte growth factor (HGF), the growth differentiation factor 15 (GDF-15) influencing cardiac remodeling and apoptosis, and the 2 pro-apoptotic molecules soluble apoptosis-stimulating fragment (sFAS) and soluble tumor necrosis factor-related apoptosis-inducing ligand (sTRAIL). This multi-biomarker score had strong discriminatory power for 5-year mortality (area under the Receiver Operating Characteristic curve [AUC] = 0.81) and improved risk prediction beyond the prognostic power of a comprehensive conventional risk score including known clinical predictors and NT-proBNP (AUC = 0.77). Net reclassification confirmed a significant improvement of individual risk prediction (p = 0.003).
Conclusions
Risk prediction by a multi-biomarker score is superior to a conventional risk score including clinical parameters and NT-proBNP. Additional predictive information from different biological pathways reflects the multisystemic character of HF.