• Johan Lassus, Etienne Gayat, Christian Mueller, W Frank Peacock, Jindrich Spinar, Veli-Pekka Harjola, Roland van Kimmenade, Atul Pathak, Thomas Mueller, Salvatore Disomma, Marco Metra, Domingo Pascual-Figal, Said Laribi, Damien Logeart, Semir Nouira, Naoki Sato, Michael Potocki, Jiri Parenica, Corinne Collet, Alain Cohen-Solal, James L Januzzi, Alexandre Mebazaa, and GREAT-Network.
• Division of Emergency Care and Department of Medicine, Helsinki University Central Hospital, Finland; Cardiac diseases and biomarkers, INSERM UMR 942, Lariboisière University Hospital, Paris, France.
• Int. J. Cardiol. 2013 Oct 3;168(3):2186-94.

AimThis 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 ResultsThrough 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 m(2), 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).ConclusionIn 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.Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

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