Prealbumin improves death risk prediction of BNP-added Seattle Heart Failure Model: Results from a pilot study in elderly chronic heart failure patients |
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Authors: | Aderville Cabassi Jacques de Champlain Umberto Maggiore Elisabetta Parenti Pietro Coghi Vanni Vicini Stefano Tedeschi Elena Cremaschi Simone Binno Rossana Rocco Salvatore Bonali Michele Bianconcini Clelia Guerra Giuseppina Folesani Alberto Montanari Giuseppe Regolisti Enrico Fiaccadori |
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Institution: | 1. Cardiorenal Research Unit, Department of Clinical and Experimental Medicine, University of Parma Medical School, Via Gramsci 14, 43126 Parma, Italy;2. Institut de Recherches Cliniques de Montreal, 110 Avenue des Pins Ouest, Montreal, QC, Canada;3. Unità Terapia Intensiva Cardiologica, Azienda Ospedaliera-Universitaria Parma, Italy;4. Italian Workers Compensation Authority (INAIL), Research Center at the University of Parma, Italy |
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Abstract: | BackgroundAn accurate prognosis prediction represents a key element in chronic heart failure (CHF) management. Seattle Heart Failure Model (SHFM) prognostic power, a validated risk score for predicting mortality in CHF, is improved by adding B-type natriuretic peptide (BNP). We evaluated in a prospective study the incremental value of several biomarkers, linked to different biological domains, on death risk prediction of BNP-added SHFM.MethodsTroponin I (cTnI), norepinephrine, plasma renin activity, aldosterone, high sensitivity-C reactive protein (hs-CRP), tumor necrosis factor-α ?(TNF-α), interleukin 6 (IL-6), interleukin 2 soluble receptor, leptin, prealbumin, free malondialdehyde, and 15-F2t-isoprostane were measured in plasma from 142 consecutive ambulatory, non-diabetic stable CHF (mean NYHA-class 2.6) patients (mean age 75 ± 8 years). Calibration, discrimination, and risk reclassification of BNP-added SHFM were evaluated after individual biomarker addition.ResultsIndividual addition of biomarkers to BNP-added SHFM did not improve death prediction, except for prealbumin (HR 0.49 CI: (0.31–0.76) p = 0.002) and cTnI (HR 2.03 CI: (1.20–3.45) p = 0.009). In fact, with respect to BNP-added SHFM (Harrell's C-statistic 0.702), prealbumin emerged as a stronger predictor of death showing the highest improvement in model discrimination (+ 0.021, p = 0.033) and only a trend was observed for cTn I (+ 0.023, p = 0.063). These biomarkers showed also the best reclassification statistic (Integrated Discrimination Improvement—IDI) at 1-year (IDI: cTnI, p = 0.002; prealbumin, p = 0.020), 2-years (IDI: cTnI, p = 0.018; prealbumin: p = 0.006) and 3-years of follow-up (IDI: cTnI p = 0.024; prealbumin: p = 0.012).ConclusionsIndividual addition of prealbumin allows a more accurate prediction of mortality of BNP enriched SHFM in ambulatory elderly CHF suggesting its potential use in identifying those at high-risk that need nutritional surveillance. |
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Keywords: | Heart failure Mortality Elderly Biomarker |
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