新建立的生物标志物补充急性失代偿性心力衰竭患者的风险评分-一项初步研究

IF 1.3 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

American heart journal plus : cardiology research and practice Pub Date : 2025-04-10 DOI:10.1016/j.ahjo.2025.100544

Valentin Hähnel , Victoria Meretz , Christian Butter , Vera Paar , Christoph Edlinger , Michael Lichtenauer , Ronald Biemann , Berend Isermann , Meike Hoffmeister , Michael Haase , Anja Haase-Fielitz , Marwin Bannehr

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引用次数: 0

摘要

研究目的急性失代偿性心力衰竭（ADHF）患者的死亡率有几种风险评分，如欧洲急性失代偿性心力衰竭评分（ELAN-HF评分）、ADHF/ nt - probnp评分或a2b评分（年龄、贫血、BNP）。本研究的目的是评估这些风险评分在加入和不加入新的心肾生物标志物的情况下的预测价值。设计,在勃兰登堡大学医院心脏中心进行的单中心、探索性前瞻性队列研究。参与者：44例ADHF住院的成年患者。入院时已建立的和新的生物标志物的测量，包括n-端原脑钠肽（NT-pro-BNP）、肌钙蛋白T、肌酐、胱抑素C、可溶性抑制致瘤性2 （sST2）、Neprilysin、Dickkopf-3 （DKK3）、白细胞介素6 （IL-6）、生长分化因子15 （GDF-15）、半乳糖凝集素-3、Progranulin和尿中性粒细胞明胶酶相关脂钙蛋白（uNGAL）。添加和不添加生物标志物时，ELAN-HF、ADHF/NT-proBNP和a2b评分对90天死亡率的预测指标分析。AUC <；0.8为一般，≥0.8为良好，>；0.9作为优秀的预测值。结果患者年龄中位数为78.0（25 ~ 75百分位69.3 ~ 83.8）岁，女性占50%（22/44）。出院后90天内死亡12例（27.3%）。所有三个风险评分在非幸存者中都较高，并且90天死亡率的AUC相当(ELAN-HF: 0.792 [0.639-0.901], p = 0.003；ADHF-NT-proBNP评分：0.749 [0.559-0.938],p = 0.012；A2B评分：0.734 [0.541-0.927],p = 0.017)。在所有模型中，将肌钙蛋白T、胱抑素c估计的肾小球滤过率（eGFR）或uNGAL加入风险评分与曲线下面积（AUC） >；0.80相关。联合肌钙蛋白T、胱抑素c为基础的eGFR和uNGAL使风险评分增加到AUC >；0.91。结论：这些发现表明，在ADHF风险评分中加入一组心肾生物标志物是有必要进一步评估的。

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Novel and established biomarkers to complement risk scores in patients with acute decompensated heart failure – a pilot study

Study Objective

There are several risk scores for mortality in patients with acute decompensated heart failure (ADHF) such as the European Collaboration on Acute Decompensated Heart Failure Score (ELAN-HF Score), the ADHF/NT-proBNP-Score or A2B-Score (age, anemia, BNP). The aim of this study was to evaluate the predictive value of such risk scores with and without addition of novel cardiorenal biomarkers.

Design & Setting

Single-center, exploratory prospective cohort study at the University Hospital Heart Centre Brandenburg.

Participants

Forty-four adult patients hospitalized for ADHF.

Interventions

Measurement of established and novel biomarkers at hospital admission including N-terminal-pro brain natriuretic peptide (NT-pro-BNP), troponin T, creatinine, cystatin C, soluble suppression of tumorigenicity 2 (sST2), Neprilysin, Dickkopf-3 (DKK3), interleukin-6 (IL-6), growth differentiation factor-15 (GDF-15), Galectin-3, Progranulin and urine neutrophil gelatinase-associated lipocalin (uNGAL).

Main Outcome Measures

Analysis of predictive indices of ELAN-HF, ADHF/NT-proBNP and A2B-Scores for 90-day mortality with and without adding biomarkers. AUC <0.8 was considered as fair, ≥0.8 as good and > 0.9 as excellent predictive value.

Results

Median age was 78.0 (25th–75th percentiles 69.3–83.8) years, 50 % (22/44) were female. Twelve patients (27.3 %) died within 90 days after discharge. All three risk scores were higher in non-survivors and showed fair AUC for 90-day mortality (ELAN-HF: 0.792 [0.639–0.901], p = 0.003; ADHF-NT-proBNP score: 0.749 [0.559–0.938], p = 0.012; A2B score: 0.734 [0.541–0.927], p = 0.017). Adding troponin T, cystatin C-based estimated glomerular filtration rate (eGFR) or uNGAL to risk scores was associated with an area under the curve (AUC) >0.80 for all models. Combination of troponin T, cystatin C-based eGFR and uNGAL increased risk scores to AUC >0.91.