Abstract 10998: Prognostic Value of Multimarker Approach Using D-Dimer, N-Terminal Pro-B-Type Natriuretic Peptide, and High-Sensitivity C-Reactive Protein in Patients Hospitalized for Worsening Heart Failure.

Introduction: Patients with heart failure have systemic activation of blood coagulation. In patients with chronic heart failure, N-terminal pro-B-type natriuretic peptide (NT-proBNP) and high-sensitivity C-reactive protein (hsCRP) can predict adverse events. This prospective study aimed to investigate the prognostic value of the multimarker approach using D-dimer, NT-proBNP, and hsCRP in patients with worsening heart failure. Methods: On admission, we measured D-dimer, NT-proBNP, and hsCRP levels in 1380 patients hospitalized to coronary care units for worsening heart failure. We evaluated the Acute Study of Clinical Effectiveness of Nesiritide in Decompensated Heart Failure (ASCEND-HF) risk score, including age, systolic blood pressure, sodium concentration, blood urea nitrogen level, and presence of dyspnea at rest. Results: During 30 days after admission, 105 (7.6%) deaths occurred. Patients who died were older (mean age: 80 vs. 74 years; P < 0.0001); had a higher incidence of NYHA functional class IV (71% vs. 48%; P < 0.0001); had a higher ASCEND-HF risk score (4.6 vs. 3.1; P < 0.0001); and had higher levels of D-dimer (3.50 vs. 1.40 μg/mL; P < 0.0001), NT-proBNP (8025 vs. 4120 pg/mL; P < 0.0001), and hsCRP (14.9 vs. 4.9 mg/L; P < 0.0001) than those of the survivors. In the multivariate logistic analysis including biomarkers, ASCEND-HF risk score, ischemic etiology, and left ventricular ejection fraction, elevation (more than the highest tertile value) in D-dimer (>2.5 μg/mL; P < 0.0001), NT-proBNP (>7399 pg/mL; P = 0.02), and hsCRP (>12.3 mg/L; P = 0.004) levels were independently associated with 1-month mortality. Addition of these biomarkers to the ASCEND-HF risk score further enhanced reclassification (P < 0.0001) and discrimination (P < 0.0001) beyond that achieved by the ASCEND-HF risk score alone. We observed similar results for the 6-month mortalityy. The number of elevated (more than the highest tertile value) biomarkers was strongly associated with an increment in the 1- and 6-month mortality rates (Figure). Conclusions: A simple multimarker strategy using D-dimer, NT-proBNP, and hsCRP facilitates risk stratification for mortality within 6 months after admission in patients with worsening heart failure. [ABSTRACT FROM AUTHOR]