Evaluating three biomarkers as prognostic factors of in-hospital mortality and severity in heart failure: A prospective cohort

Abstract

Objective: To identify the relationship between red blood cell distribution width (RDW, %), interleukin-6 (IL-6) (pg/ml), high sensitivity-c-reactive protein (hs-CRP) (mg/l), in-hospital mortality and disease severity among patients with heart failure (HF).

Methods: Prospective cohort. We included adults diagnosed with acute non-ischemic HF in 2015. The dependent variables were in-hospital mortality (yes or no) and disease severity. The latter was assessed with the Get With The Guidelines-HF score. We used hierarchical regression models to describe the pattern of association between biomarkers, mortality, and severity. We used the Youden index to identify the best cut-off for mortality prediction.

Results: We included 167 patients; the mean age was 72.61 (SD: 11.06). The majority of patients presented with New York Heart Association classification II (40.12%) or III (43.11%). After adjusting for age and gender, all biomarkers were associated with mortality. After adding comorbidities, only IL-6 was associated. The final model with all clinical variables showed no effect from any biomarker. The best cut-off for RDW, hs-CRP and IL-6 for mortality were 14.8, 68.7 and 52.9, respectively. IL-6 presented the highest sensitivity (100%), specificity (75.35%) and area under the curve (0.91).

Conclusions: No biomarker is independent from the most important clinical variables; therefore it should not be used for management modifications.

Keywords: Biomarcadores; Biomarkers; C-reactive protein; Contagem de eritrócitos; Erythrocyte count; Heart failure; Insuficiência cardíaca; Interleukin-6; Interleuquina-6; Mortalidade; Mortality; Proteína C-reativa.