Incremental value of biomarkers to clinical variables for mortality prediction in acutely decompensated heart failure: The Multinational Observational Cohort on Acute Heart Failure (MOCA) study

• Published in: International journal of cardiology 2013-10, Vol.168 (3), p.2186-2194
• Main Authors: Lassus, Johan, Gayat, Etienne, Mueller, Christian, Peacock, W.Frank, Spinar, Jindrich, Harjola, Veli-Pekka, van Kimmenade, Roland, Pathak, Atul, Mueller, Thomas, diSomma, Salvatore, Metra, Marco, Pascual-Figal, Domingo, Laribi, Said, Logeart, Damien, Nouira, Semir, Sato, Naoki, Potocki, Michael, Parenica, Jiri, Collet, Corinne, Cohen-Solal, Alain, Januzzi, James L, Mebazaa, Alexandre
• Format: Article
• Language: English
• Subjects: Acute Disease; ADHF; Aged; Aged, 80 and over; Biological and medical sciences; Biomarkers; Biomarkers - blood; Cardiology. Vascular system; Cardiovascular; Cause of Death - trends; Female; Follow-Up Studies; Global Health; Heart; Heart Failure - blood; Heart Failure - mortality; Heart failure, cardiogenic pulmonary edema, cardiac enlargement; Humans; Male; Medical sciences; Mortality; Predictive Value of Tests; Reclassification; Risk Assessment; Risk Factors; Risk prediction; Survival Rate - trends
• ISSN: 0167-5273; 1874-1754
• DOI: 10.1016/j.ijcard.2013.01.228

Abstract Aim This study aims to evaluate the incremental value of plasma biomarkers to traditional clinical variables for risk stratification of 30-day and one-year mortality in acutely decompensated heart failure (ADHF). Methods and results Through an international collaborative network, individual patient data on 5306 patients hospitalized for ADHF were collected. The all-cause mortality rate was 11.7% at 30 days and 32.9% at one year. The clinical prediction model (age, gender, blood pressure on admission, estimated glomerular filtration rate < 60 mL/min/1.73 m2 , sodium and hemoglobin levels, and heart rate) had a c-statistic of 0.74 for 30-day mortality and 0.73 for one-year mortality. Several biomarkers measured at presentation improved risk stratification when added to the clinical model. At 30 days, the net reclassification improvement (NRI) was 28.7% for mid-regional adrenomedullin (MR-proADM; p < 0.001) and 25.5% for soluble (s)ST2 (p < 0.001). At one year, sST2 (NRI 10.3%), MR-proADM (NRI 9.1%), amino-terminal pro-B-type natriuretic peptide (NT-proBNP; NRI 9.1%), mid-regional proatrial natriuretic peptide (MR-proANP; NRI 7.4%), B-type natriuretic peptide (NRI 5.5%) and C-reactive protein (CRP; NRI 5.3%) reclassified patients with ADHF (p < 0.05 for all). CRP also markedly improved risk stratification of patients with ADHF as a dual biomarker combination with MR-proADM (NRI 36.8% [p < 0.001] for death at 30 days) or with sST2 (NRI 20.3%; [p < 0.001] for one-year mortality). Conclusion In this study, biomarkers provided incremental value for risk stratification of ADHF patients. Biomarkers such as sST2, MR-proADM, natriuretic peptides and CRP, reflecting different pathophysiologic pathways, add prognostic value to clinical risk factors for predicting both short-term and one-year mortality in ADHF.