Òscar Miró1,2, Bernardino González de la Presa3, Pablo Herrero-Puente4, Rosa Fernández Bonifacio3, Martin Möckel5, Christian Mueller6, Gregori Casals7, Silvia Sandalinas3, Pere Llorens8, Francisco Javier Martín-Sánchez9, Javier Jacob10, José Luis Bedini3, Víctor Gil1. 1. a Emergengy Department , Hospital Clínic; "Emergencies: processes and pathologies" Research Group, IDIBAPS , Barcelona , Spain. 2. b University of Barcelona , Barcelona , Spain. 3. c Core Laboratory , Hospital Clínic , Barcelona , Spain. 4. d Emergency Department , Hospital Universitario Central de Asturias , Oviedo , Spain. 5. e Department of Cardiology, Division of Emergency Medicine , Charité-University Medicine Berlin , Berlin , Germany. 6. f Department of Cardiology & Cardiovascular Research Institute Basel , University Hospital Basel, University of Basel , Basel , Switzerland. 7. g Biochemistry and Molecular Genetics Department , Hospital Clínic de Barcelona , Barcelona , Spain. 8. h Emergency Department, Home Hospitalization and Short Stay Unit , Hospital General de Alicante , Alicante , Spain. 9. i Emergency Department , Hospital Clínico San Carlos, Madrid, Universidad Complutense de Madrid , Madrid , Spain. 10. j Emergency Department , Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat , Barcelona , Spain.
Abstract
OBJECTIVE: We tested the hypothesis that early measurement of galectin-3 at the emergency department (ED) during an episode of acute heart failure (AHF) allows predicting short- and long-term outcomes. METHODS: We performed an exploratory study including 115 patients consecutively diagnosed with AHF in a single ED. Clinical and analytical variables were recorded. The primary endpoint was 30-day all-cause mortality, and secondary endpoints were 30-day composite outcome (death, rehospitalization or ED reconsultation, whichever first) and 1-year mortality. RESULTS: Seven patients (6.1%) died within 30 days and 43 (37.4%) within 1 year. The 30-day composite endpoint was observed in 21.1% of patients. Galectin-3 was correlated with NT-proBNP and the glomerular filtration rate but not with age and s-cTnI. Measured at time of ED arrival, galectin-3 showed good discriminatory capacity for 30-day mortality (AUC ROC: 0.732; 95% CI 0.512-0.953; p = 0.041) but not for 1-year mortality (0.521; 0.408-0.633; p = 0.722). Patients with galectin-3 concentrations >42 μg/L had an OR = 7.67(95%CI = 1.57-37.53; p = 0.012) for 30-day mortality. Conversely, NT-proBNP only showed predictive capacity for 1-year mortality (0.642; 0.537-0.748; p = 0.014). Patients with NT-proBNP concentrations >5400 ng/L had an OR = 4.34 (95%CI = 1.93-9.77; p < 0.001) for 1-year mortality. These increased short- (galectin-3) and long-term (NT-proBNP) risks remained significant after adjustment for age or renal function. s-cTnI failed in both short- and long term death prediction. No biomarker predicted the short-term composite endpoint. CONCLUSION: These results suggest that galectin-3 could help to monitor the risk of short-term mortality in unselected patients with AHF attended in the ED.
OBJECTIVE: We tested the hypothesis that early measurement of galectin-3 at the emergency department (ED) during an episode of acute heart failure (AHF) allows predicting short- and long-term outcomes. METHODS: We performed an exploratory study including 115 patients consecutively diagnosed with AHF in a single ED. Clinical and analytical variables were recorded. The primary endpoint was 30-day all-cause mortality, and secondary endpoints were 30-day composite outcome (death, rehospitalization or ED reconsultation, whichever first) and 1-year mortality. RESULTS: Seven patients (6.1%) died within 30 days and 43 (37.4%) within 1 year. The 30-day composite endpoint was observed in 21.1% of patients. Galectin-3 was correlated with NT-proBNP and the glomerular filtration rate but not with age and s-cTnI. Measured at time of ED arrival, galectin-3 showed good discriminatory capacity for 30-day mortality (AUC ROC: 0.732; 95% CI 0.512-0.953; p = 0.041) but not for 1-year mortality (0.521; 0.408-0.633; p = 0.722). Patients with galectin-3 concentrations >42 μg/L had an OR = 7.67(95%CI = 1.57-37.53; p = 0.012) for 30-day mortality. Conversely, NT-proBNP only showed predictive capacity for 1-year mortality (0.642; 0.537-0.748; p = 0.014). Patients with NT-proBNP concentrations >5400 ng/L had an OR = 4.34 (95%CI = 1.93-9.77; p < 0.001) for 1-year mortality. These increased short- (galectin-3) and long-term (NT-proBNP) risks remained significant after adjustment for age or renal function. s-cTnI failed in both short- and long term death prediction. No biomarker predicted the short-term composite endpoint. CONCLUSION: These results suggest that galectin-3 could help to monitor the risk of short-term mortality in unselected patients with AHF attended in the ED.
Entities:
Keywords:
ED revisit; Galectin-3; acute heart failure; biomarker; mortality; rehospitalization
Authors: Nisha Bansal; Leila R Zelnick; Elsayed Z Soliman; Amanda Anderson; Robert Christenson; Christopher DeFilippi; Rajat Deo; Harold I Feldman; Jiang He; Bonnie Ky; John Kusek; James Lash; Stephen Seliger; Tariq Shafi; Myles Wolf; Alan S Go; Michael G Shlipak Journal: Am J Kidney Dis Date: 2020-12-09 Impact factor: 11.072
Authors: Nisha Bansal; Leila Zelnick; Alan Go; Amanda Anderson; Robert Christenson; Rajat Deo; Christopher Defilippi; James Lash; Jiang He; Bonnie Ky; Stephen Seliger; Elsayed Soliman; Michael Shlipak Journal: J Am Heart Assoc Date: 2019-10-24 Impact factor: 5.501