Page 23 - Biomarkers for risk stratification and guidance in heart failure

Chapter 2
ABSTRACT
Objectives: The study aim was to determine the prognostic value of a multi- marker strategy for risk-assessment in patients presenting to the emergency department (ED) with dyspnea.
Background: Combining biomarkers with different pathophysiological backgrounds may improve risk stratification in dyspneic patients in the ED.
Methods: The study prospectively investigated the prognostic value of the biomarkers N-terminal pro-B-type natriuretic peptide (NT-proBNP), high- sensitivity cardiac troponin T (hs-cTnT), Cystatin-C (Cys-C), high-sensitivity C-reactive protein (hs-CRP), and Galectin-3 (Gal-3) for 90-day mortality in 603 patients presenting to the ED with dyspnea as primary complaint.
Results: hs-CRP, hs-cTnT, Cyst-C and NT-proBNP were independent predictors of 90-day mortality. The number of elevated biomarkers was highly associated with outcome (odds ratio=2.94 per biomarker, 95% confidence interval \[CI\] 2.29-3.78, P<0.001). A multimarker approach had incremental value beyond a single-marker approach. Our multimarker emergency dyspnea-risk score (MARKED-risk score) incorporating age ≥75 years, systolic blood pressure<110 mmHg, history of heart failure, dyspnea New York Heart Association (NYHA) functional class IV, hs-cTnT ≥0.04 μg/L, hs-CRP ≥25 mg/L and Cys-C ≥1.125 mg/L had excellent prognostic performance (area under the curve: 0.85, 95% CI 0.81-0.89), was robust in internal validation analyses and could identify patients with very low (< 3 points), intermediate (≥3, <5 points) and high risk (≥5 points) of 90-day mortality (2%, 14% and 44%, respectively, P<0.001).
Conclusions: A multimarker strategy provided superior risk stratification beyond any single-marker approach. The MARKED-risk score that incorporates hs-cTnT, hs-CRP and Cys-C along with clinical risk factors accurately identifies patients with very low, intermediate and high risk.
22