目的:本研究旨在研究在调整包括N末端B型利钠肽原(NT-proBNP)和高敏心肌肌钙蛋白T(hs-cTnT)在内的其他预测因子后,通过即时检测试验测定的可溶性肿瘤形成抑制-2(sST2)与心力衰竭住院患者的临床结局之间的关系。
方法:纳入2015年7月至2021年12月的1726例心力衰竭连续住院患者。通过免疫荧光法测量基线血清sST2浓度。主要终点事件是全因死亡的复合,心脏移植,或左心室辅助装置。
结果:在682天的中位随访期间,434例患者(25.1%)发生主要终点事件。在调整其他预测因子(包括NT-proBNP和hs-cTnT)后,基线sST2仍然是心力衰竭住院患者主要终点事件的独立预测因子[每对数(单位)增加,调整后的风险比(HR)(95%置信区间)(CI):1.20(1.09,1.32),P<0.001]。并且基线sST2对慢性失代偿性心力衰竭患者有更好的预后价值[每log(单位)增加,调整后的HR(95%CI):1.19(1.07,1.31)]比急性新发心力衰竭患者[每对数(单位)增加,调整后的HR(95%CI):1.28(0.94,1.75),交互作用的P值<0.001],以及纽约心脏协会(NYHA)功能I-II级患者的更好预后价值[每对数(单位)增加,调整后的HR(95%CI):1.67(1.11,2.52)]比NYHA功能等级III-IV的人[每对数(单位)增加,调整后的HR(95%CI):1.18(1.07,1.31),相互作用的P值<0.001]。基线sST2也是心力衰竭住院患者1个月时主要终点事件的良好预测因子。3个月,1年和2年(曲线下面积分别为0.789、0.775、0.736和0.733),最佳临界值为27.2ng/ml,27.1ng/ml,27.1ng/ml和25.1ng/ml,分别。此外,当将基线sST2添加到基线NT-proBNP和hs-cTnT时,可以提供额外的预后价值(所有P值<0.05)。根据升高的生物标志物的类别(包括NT-proBNP,hs-cTnT,和sST2),与1个或2个生物标志物升高的患者相比,3个生物标志物升高的患者发生主要终点事件的风险更高(所有P值<0.05).
结论:在调整了其他预测因子(包括NT-proBNP和hs-cTnT)后,基线sST2仍然是不良事件的独立预测因子,特别是慢性失代偿性心力衰竭和NYHA功能I-II级患者。在基线NT-proBNP和hs-cTnT的基础上,增加基线sST2可以为心力衰竭住院患者提供额外的预后价值.
OBJECTIVE: This study aimed to investigate the association of soluble suppression of tumorigenicity-2 (sST2) measured by point-of-care testing assay with clinical outcomes in patients hospitalized with heart failure after adjusting for other predictors including N-terminal pro-B-type natriuretic peptide (NT-proBNP) and high-sensitivity cardiac troponin T (hs-cTnT).
METHODS: A total of 1726 consecutive patients hospitalized with heart failure from July 2015 to December 2021 were enrolled. Baseline serum sST2 concentrations were measured by immunofluorescence assay. Primary endpoint event was the composite of all-cause death, heart transplantation, or left ventricular assist device.
RESULTS: During the median follow-up duration of 682 days, 434 patients (25.1%) suffered from primary endpoint events. Baseline sST2 remained an independent predictor of the primary endpoint event in patients hospitalized with heart failure after adjusting for other predictors including NT-proBNP and hs-cTnT [per log (unit) increase, adjusted hazard ratio (HR) (95% confidence interval) (CI): 1.20 (1.09, 1.32), P < 0.001]. And baseline sST2 had a better prognostic value for patients with chronic decompensated heart failure [per log (unit) increase, adjusted HR (95% CI): 1.19 (1.07, 1.31)] than for those with acute new onset heart failure [per log (unit) increase, adjusted HR (95% CI): 1.28 (0.94, 1.75), P value for interaction <0.001], as well as a better prognostic value for patients with New York Heart Association (NYHA) functional class I-II [per log (unit) increase, adjusted HR (95% CI): 1.67 (1.11, 2.52)] than for those with NYHA functional class III-IV [per log (unit) increase, adjusted HR (95% CI): 1.18 (1.07, 1.31), P value for interaction <0.001]. Baseline sST2 was also a good predictor of the primary endpoint event in patients hospitalized with heart failure at 1 month, 3 months, 1 year and 2 years (area under the curve: 0.789, 0.775, 0.736 and 0.733, respectively), and the best cut-off values were 27.2 ng/ml, 27.1 ng/ml, 27.1 ng/ml and 25.1 ng/ml, respectively. Furthermore, baseline sST2 could provide additional prognostic value when added to baseline NT-proBNP and hs-cTnT (all P values <0.05). According to the category of elevated biomarkers (including NT-proBNP, hs-cTnT, and sST2), patients with three elevated biomarkers had a higher risk of the primary endpoint event compared with those with one or two elevated biomarkers (all P values <0.05).
CONCLUSIONS: Baseline sST2 remained an independent predictor of adverse events after adjusting for other predictors including NT-proBNP and hs-cTnT, particularly in patients with chronic decompensated heart failure and NYHA functional class I-II. And in the basis of baseline NT-proBNP and hs-cTnT, adding baseline sST2 could provide additional prognostic value for patients hospitalized with heart failure.