The incremental prognostic and clinical value of multiple novel biomarkers in heart failure
Aims In recent years there has been an increase in the number of biomarkers in heart failure (HF). The clinical role for these novel biomarkers in combination is not clear. Methods and results The following novel biomarkers were measured from 628 patients recently hospitalized with decompensated H...
| Main Author: | |
|---|---|
| Format: | Journal article |
| Published: |
Wiley
2016
|
| _version_ | 1797060110708637696 |
|---|---|
| author | Preiss, D |
| author_facet | Preiss, D |
| author_sort | Preiss, D |
| collection | OXFORD |
| description | Aims In recent years there has been an increase in the number of biomarkers in heart failure (HF). The clinical role for these novel biomarkers in combination is not clear. Methods and results The following novel biomarkers were measured from 628 patients recently hospitalized with decompensated HF; mid-regional pro-adrenomedullin (MR-proADM), mid-regional pro-atrial natriuretic peptide (MR-proANP), copeptin, high-sensitivity cardiac troponin T (hs-cTnT), ST2, galectin-3, cystatin C, combined free light chains (cFLC) and high sensitivity C-reactive protein (hsCRP). The incremental prognostic value of these novel biomarkers was evaluated within an extensive model containing established predictors of mortality. During a mean (SD) follow-up of 3.2 (1.5) years, 290 (46%) patients died. Elevated concentrations of all novel biomarkers were associated with an increased unadjusted risk of mortality but only two-thirds were independent predictors following multivariable analysis. Using dichotomized cut-points from receiver operating characteristic analysis, MR-proADM, hs-cTnT, cFLC, hsCRP, and ST2 remained independent predictors of mortality. Further dichotomization into low (0–2 elevated biomarkers) or high (at least three of the five biomarkers elevated) risk groups provided greatest incremental prognostic value (hazard ratio 2.20, 95% confidence interval 1.37–3.54; P = 0.001) and improved the performance of the model (C-statistic 0.730 from 0.721, net reclassification index 32.5%). Conclusion The novel biomarkers included in this study added little, if any, incremental prognostic value on their own to a model containing established predictors of mortality. However, following dichotomization, five of the novel biomarkers provided incremental prognostic value. There was a clear gradient in the risk of death with increasing numbers of elevated novel biomarkers, with the presence of at least three identifying patients at greatest risk of mortality. |
| first_indexed | 2024-03-06T20:13:00Z |
| format | Journal article |
| id | oxford-uuid:2b36166c-d4ea-4bff-9e4c-657941ea3c27 |
| institution | University of Oxford |
| last_indexed | 2024-03-06T20:13:00Z |
| publishDate | 2016 |
| publisher | Wiley |
| record_format | dspace |
| spelling | oxford-uuid:2b36166c-d4ea-4bff-9e4c-657941ea3c272022-03-26T12:29:37ZThe incremental prognostic and clinical value of multiple novel biomarkers in heart failureJournal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:2b36166c-d4ea-4bff-9e4c-657941ea3c27Symplectic Elements at OxfordWiley2016Preiss, DAims In recent years there has been an increase in the number of biomarkers in heart failure (HF). The clinical role for these novel biomarkers in combination is not clear. Methods and results The following novel biomarkers were measured from 628 patients recently hospitalized with decompensated HF; mid-regional pro-adrenomedullin (MR-proADM), mid-regional pro-atrial natriuretic peptide (MR-proANP), copeptin, high-sensitivity cardiac troponin T (hs-cTnT), ST2, galectin-3, cystatin C, combined free light chains (cFLC) and high sensitivity C-reactive protein (hsCRP). The incremental prognostic value of these novel biomarkers was evaluated within an extensive model containing established predictors of mortality. During a mean (SD) follow-up of 3.2 (1.5) years, 290 (46%) patients died. Elevated concentrations of all novel biomarkers were associated with an increased unadjusted risk of mortality but only two-thirds were independent predictors following multivariable analysis. Using dichotomized cut-points from receiver operating characteristic analysis, MR-proADM, hs-cTnT, cFLC, hsCRP, and ST2 remained independent predictors of mortality. Further dichotomization into low (0–2 elevated biomarkers) or high (at least three of the five biomarkers elevated) risk groups provided greatest incremental prognostic value (hazard ratio 2.20, 95% confidence interval 1.37–3.54; P = 0.001) and improved the performance of the model (C-statistic 0.730 from 0.721, net reclassification index 32.5%). Conclusion The novel biomarkers included in this study added little, if any, incremental prognostic value on their own to a model containing established predictors of mortality. However, following dichotomization, five of the novel biomarkers provided incremental prognostic value. There was a clear gradient in the risk of death with increasing numbers of elevated novel biomarkers, with the presence of at least three identifying patients at greatest risk of mortality. |
| spellingShingle | Preiss, D The incremental prognostic and clinical value of multiple novel biomarkers in heart failure |
| title | The incremental prognostic and clinical value of multiple novel biomarkers in heart failure |
| title_full | The incremental prognostic and clinical value of multiple novel biomarkers in heart failure |
| title_fullStr | The incremental prognostic and clinical value of multiple novel biomarkers in heart failure |
| title_full_unstemmed | The incremental prognostic and clinical value of multiple novel biomarkers in heart failure |
| title_short | The incremental prognostic and clinical value of multiple novel biomarkers in heart failure |
| title_sort | incremental prognostic and clinical value of multiple novel biomarkers in heart failure |
| work_keys_str_mv | AT preissd theincrementalprognosticandclinicalvalueofmultiplenovelbiomarkersinheartfailure AT preissd incrementalprognosticandclinicalvalueofmultiplenovelbiomarkersinheartfailure |