Cardiovascular biomarkers predict post‐discharge re‐hospitalization risk and mortality among Swedish heart failure patients

Abstract

AimThe aim of this study was to assess the predictive role of biomarkers, associated with cardiovascular stress and its neuroendocrine response as well as renal function, in relation to mortality and risk of re‐hospitalization among consecutive patients admitted because of heart failure (HF).Methods and resultsA total of 286 patients (mean age, 75 years; 29% women) hospitalized for newly diagnosed or exacerbated HF were analysed. Associations between circulating levels of mid‐regional pro‐adrenomedullin (MR‐proADM), copeptin, C‐terminal pro‐endothelin‐1, N‐terminal pro‐brain natriuretic peptide (NT‐proBNP), cystatin C, and all‐cause mortality as well as risk of re‐hospitalization due to cardiac causes were assessed using multivariable Cox regression models. A two‐sided Bonferroni‐corrected P‐value of 0.05/5 = 0.010 was considered statistically significant. All biomarkers were related to echocardiographic measurements of cardiac dimensions and function. A total of 57 patients died (median follow‐up time, 17 months). In the multivariable‐adjusted Cox regression analyses, all biomarkers, except C‐terminal pro‐endothelin‐1, were significantly associated with increased mortality: NT‐proBNP [hazard ratio (HR) 1.85, 95% confidence interval (CI) 1.17–2.17; P = 4.0 × 10−4], MR‐proADM (HR 1.94, 95% CI 1.36–2.75; P = 2.2 × 10−4), copeptin (HR 1.70, 95% CI 1.22–2.36; P = 0.002), and cystatin C (HR 2.11, 95% CI 1.56–2.86; P = 1.0 × 10−6). A total of 90 patients were re‐hospitalized (median time to re‐hospitalization, 5 months). In multivariable Cox regression analyses, NT‐proBNP was the only biomarker that showed significant association with risk of re‐hospitalization due to cardiac causes (HR 1.43, 95% CI 1.10–1.87; P = 0.009).ConclusionsAmong patients hospitalized for HF, elevated plasma levels of NT‐proBNP, MR‐proADM, copeptin, and cystatin C are associated with higher mortality after discharge, whereas NT‐proBNP is the only biomarker that predicts the risk of re‐hospitalization due to cardiac causes.

Prevalence and Prognostic Significance of Frailty in Gerontal Inpatients With Pre-clinical Heart Failure: A Subgroup Analysis of a Prospective Observational Cohort Study in China

“…This finding is coincident with that of other studies that report the predictive value of frailty in the general population ( 6 ) and clinical HF patients ( 21 ). The NT-proBNP level increases with the HF stage ( 22 ) and predicts mortality and readmission among patients aged ≥65 years who are hospitalized for HF ( 23 ). Our study also showed its predictive value for 1-year death or readmission in gerontal SBHF inpatients.…”

Copeptin combined with National Early Warning Score for predicting survival in elderly patients with acute and critical illness

“…In recent years, many studies have found that copeptin exhibits early diagnosis, severity assessment and survival prognostic abilities in various patient cohorts, including acute coronary syndrome, decompensated heart failure, acute exacerbation of chronic obstructive disease, sepsis and trauma [5][6][7][8][9][10][11].…”

Heart Failure and Cardiac Events: Is a Consecutive Measurement of Biomarkers a Simple and Practical Approach?

“…[5][6][7][8][9][10][11] In the clinical setting, specifically in HF, the natriuretic peptides (NPs) (B-type natriuretic peptide [BNP], N-terminal fraction of BNP [NT-proBNP], and midregional proANP) are markers of myocardial stress that have been widely investigated, being predictive of mortality and rehospitalization. [12][13][14] Similarly, cardiac troponins are markers of myocardial injury that have been observed to be elevated in many HF patients even in the absence of an acute coronary syndrome due to the stress and damage of myofibrillar proteins. Hence, NP and troponins concentrations may help in the diagnosis and prognosis of HF.…”