Clinical value of pre-discharge bio-adrenomedullin as a marker of residual congestion and high risk of heart failure hospital readmission

被引:45
作者
Pandhi, Paloma [1 ]
ter Maaten, Jozine M. [1 ]
Emmens, Johanna E. [1 ]
Struck, Joachim [2 ]
Bergmann, Andreas [2 ]
Cleland, John G. [3 ]
Givertz, Michael M. [4 ]
Metra, Marco [5 ]
O'Connor, Christopher M. [6 ]
Teerlink, John R. [7 ,8 ]
Ponikowski, Piotr [9 ]
Cotter, Gad [10 ]
Davison, Beth [10 ]
van Veldhuisen, Dirk J. [1 ]
Voors, Adriaan A. [1 ]
机构
[1] Univ Groningen, Univ Med Ctr Groningen, Dept Cardiol, Groningen, Netherlands
[2] Sphingotec GmbH, Hennigsdorf, Germany
[3] Univ Glasgow, Robertson Ctr Biostat & Clin Trials, Glasgow, Lanark, Scotland
[4] Harvard Med Sch, Brigham & Womens Hosp, Boston, MA 02115 USA
[5] Univ Brescia, Brescia, Italy
[6] Inova Heart & Vasc Inst, Falls Church, VA USA
[7] Univ Calif San Fransisco, San Francisco, CA USA
[8] San Fransisco Vet Affairs Med Ctr, San Francisco, CA USA
[9] Med Univ, Clin Mil Hosp, Wroclaw, Poland
[10] Momentum Res, Durham, NC USA
关键词
Bio-adrenomedullin; Loop diuretics; Acute heart failure; DIURETIC RESPONSE; PATHOPHYSIOLOGY; ROLOFYLLINE; PREDICTORS; ANTAGONIST; MORTALITY; BIOMARKER;
D O I
10.1002/ejhf.1693
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Aims Recently, bio-adrenomedullin (bio-ADM) was proposed as a congestion marker in heart failure (HF). In the present study, we aimed to study whether bio-ADM levels at discharge from a hospital admission for worsening HF could provide additional information on (residual) congestion status, diuretic dose titration and clinical outcomes. Methods and results Plasma bio-ADM was measured in 1236 acute HF patients in the PROTECT trial at day 7 or discharge. Median discharge bio-ADM was 33.7 [21.5-61.5] pg/mL. Patients with higher discharge bio-ADM levels were hospitalised longer, had higher brain natriuretic peptide levels, and poorer diuretic response (all P < 0.001). Bio-ADM was the strongest predictor of discharge residual congestion (clinical congestion score > 3) (odds ratio 4.35, 95% confidence interval 3.37-5.62; P < 0.001). Oedema at discharge was one of the strongest predictors of discharge bio-ADM (beta = 0.218; P < 0.001). Higher discharge loop diuretic doses were associated with a poorer diuretic response during hospitalisation (beta = 0.187; P < 0.001) and higher bio-ADM levels (beta = 0.084; P = 0.020). High discharge bio-ADM levels combined with higher use of loop diuretics were independently associated with a greater risk of 60-day HF rehospitalisation (hazard ratio 4.02, 95% confidence interval 2.23-7.26; P < 0.001). Conclusion In hospitalised HF patients, elevated pre-discharge bio-ADM levels were associated with higher discharge loop diuretic doses and reflected residual congestion. Patients with combined higher bio-ADM levels and higher loop diuretic use at discharge had an increased risk of rehospitalisation. Assessment of discharge bio-ADM levels may be a readily applicable marker to identify patients with residual congestion at higher risk of early hospital readmission.
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收藏
页码:683 / 691
页数:9
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