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Predictive biomarkers for death and rehospitalization in comorbid frail elderly heart failure patients.
- Source :
-
BMC geriatrics [BMC Geriatr] 2018 May 09; Vol. 18 (1), pp. 109. Date of Electronic Publication: 2018 May 09. - Publication Year :
- 2018
-
Abstract
- Background: Heart failure (HF) is associated with a high rate of readmissions within 30 days post-discharge and in the following year, especially in frail elderly patients. Biomarker data are scarce in this high-risk population. This study assessed the value of early post-discharge circulating levels of ST2, NT-proBNP, CA125, and hs-TnI for predicting 30-day and 1-year outcomes in comorbid frail elderly patients with HF with mainly preserved ejection fraction (HFpEF).<br />Methods: Blood samples were obtained at the first visit shortly after discharge (4.9 ± 2 days). The primary endpoint was the composite of all-cause mortality or HF-related rehospitalization at 30 days and at 1 year. All-cause mortality alone at one year was also a major endpoint. HF-related rehospitalizations alone were secondary end-points.<br />Results: From February 2014 to November 2016, 522 consecutive patients attending the STOP-HF Clinic were included (57.1% women, age 82 ± 8.7 years, mean Barthel index 70 ± 25, mean Charlson comorbidity index 5.6 ± 2.2). The composite endpoint occurred in 8.6% patients at 30 days and in 38.5% at 1 year. In multivariable analysis, ST2 [hazard ratio (HR) 1.53; 95% CI 1.19-1.97; p = 0.001] was the only predictive biomarker at 30 days; at 1 year, both ST2 (HR 1.34; 95% CI 1.15-1.56; p < 0.001) and NT-proBNP (HR 1.19; 95% CI 1.02-1.40; p = 0.03) remained significant. The addition of ST2 and NT-proBNP into a clinical predictive model increased the AUC from 0.70 to 0.75 at 30 days (p = 0.02) and from 0.71 to 0.74 at 1 year (p < 0.05). For all-cause death at 1 year, ST2 (HR 1.50; 95% CI 1.26-1.80; p < 0.001), and CA125 (HR 1.41; 95% CI 1.21-1.63; p < 0.001) remained independent predictors in multivariable analysis. The addition of ST2 and CA125 into a clinical predictive model increased the AUC from 0.74 to 0.78 (p = 0.03). For HF-related hospitalizations, ST2 was the only predictive biomarker in multivariable analyses, both at 30 days and at 1 year.<br />Conclusions: In a comorbid frail elderly population with HFpEF, ST2 outperformed NT-proBNP for predicting the risk of all-cause mortality or HF-related rehospitalization. ST2, a surrogate marker of inflammation and fibrosis, may be a better predictive marker in high-risk HFpEF.
- Subjects :
- Aged
Aged, 80 and over
Biomarkers blood
CA-125 Antigen blood
Comorbidity
Female
Follow-Up Studies
Heart Failure diagnosis
Humans
Male
Membrane Proteins blood
Natriuretic Peptide, Brain blood
Peptide Fragments blood
Prognosis
Prospective Studies
Risk Factors
Cause of Death trends
Frail Elderly
Heart Failure blood
Heart Failure epidemiology
Patient Readmission trends
Subjects
Details
- Language :
- English
- ISSN :
- 1471-2318
- Volume :
- 18
- Issue :
- 1
- Database :
- MEDLINE
- Journal :
- BMC geriatrics
- Publication Type :
- Academic Journal
- Accession number :
- 29743019
- Full Text :
- https://doi.org/10.1186/s12877-018-0807-2