Ceruloplasmin, NT-proBNP, and Clinical Data as Risk Factors of Death or Heart Transplantation in a 1-Year Follow-Up of Heart Failure Patients

Ewa Romuk; Wojciech Jacheć; Ewa Zbrojkiewicz; Alina Mroczek; Jacek Niedziela; Mariusz Gąsior; Piotr Rozentryt; Celina Wojciechowska

doi:10.3390/jcm9010137

Ceruloplasmin, NT-proBNP, and Clinical Data as Risk Factors of Death or Heart Transplantation in a 1-Year Follow-Up of Heart Failure Patients

J Clin Med. 2020 Jan 3;9(1):137. doi: 10.3390/jcm9010137.

Authors

Ewa Romuk¹, Wojciech Jacheć², Ewa Zbrojkiewicz³, Alina Mroczek³, Jacek Niedziela⁴, Mariusz Gąsior⁴, Piotr Rozentryt^{3

4}, Celina Wojciechowska²

Affiliations

¹ Department of Biochemistry, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 40-055 Katowice, Poland.
² Second Department of Cardiology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 40-055 Katowice, Poland.
³ Department of Toxicology and Health Protection, Faculty of Health Sciences in Bytom, Medical University of Silesia, 40-055 Katowice, Poland.
⁴ 3rd Department of Cardiology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Silesian Centre for Heart Disease, 41-800 Zabrze, Poland.

Abstract

We investigated whether the additional determination of ceruloplasmin (Cp) levels could improve the prognostic value of N-terminal pro-B-type natriuretic peptide (NT-proBNP) in heart failure (HF) patients in a 1-year follow-up. Cp and NT-proBNP levels and clinical and laboratory parameters were assessed simultaneously at baseline in 741 HF patients considered as possible heart transplant recipients. The primary endpoint (EP) was a composite of all-cause death (non-transplant patients) or heart transplantation during one year of follow-up. Using a cut-off value of 35.9 mg/dL for Cp and 3155 pg/mL for NT-proBNP (top interquartile range), a univariate Cox regression analysis showed that Cp (hazard ratio (HR) = 2.086; 95% confidence interval (95% CI, 1.462-2.975)), NT-proBNP (HR = 3.221; 95% CI (2.277-4.556)), and the top quartile of both Cp and NT-proBNP (HR = 4.253; 95% CI (2.795-6.471)) were all risk factors of the primary EP. The prognostic value of these biomarkers was demonstrated in a multivariate Cox regression model using the top Cp and NT-proBNP concentration quartiles combined (HR = 2.120; 95% CI (1.233-3.646)). Lower left ventricular ejection fraction, VO₂ max, lack of angiotensin-converting enzyme inhibitor or angiotensin receptor blocker therapy, and nonimplantation of an implantable cardioverter-defibrillator were also independent risk factors of a poor outcome. The combined evaluation of Cp and NT-proBNP had advantages over separate NT-proBNP and Cp assessment in selecting a group with a high 1-year risk. Thus multi-biomarker assessment can improve risk stratification in HF patients.

Keywords: NT-proBNP; ceruloplasmin; heart failure.