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Novel biomarkers with limited predictive value for 90-day mortality in patients with acute decompensated heart failure

https://doi.org/10.1007/s00392-025-02625-4

Victoria Meretz (Bernau bei Berlin)1, C. Butter (Bernau bei Berlin)2, V. Hähnel (Bernau bei Berlin)2, C. Edlinger (Bernau bei Berlin)2, M. Bannehr (Bernau bei Berlin)2, A. Haase-Fielitz (Bernau bei Berlin)2

1Immanuel Klinikum Bernau Herzzentrum Brandenburg Bernau bei Berlin, Deutschland; 2Immanuel Klinikum Bernau Herzzentrum Brandenburg / Kardiologie Bernau bei Berlin, Deutschland

 

Objective

Inflammatory and (mal)adaptive processes are involved in pathomechanisms of acute decompensated heart failure (ADHF) as indicated by cardiac and renal biomarkers. There is evidence for the diagnostic and prognostic value of such biomarkers including NT-proBNP, troponin and serum creatinine in patients with ADHF. The aim of this study was to analyze the predictive indices of the most frequently published novel cardiac and renal biomarkers in patients with ADHF for 90-day mortality and to compare them with established biomarkers.

Methods

In this single-center, prospective cohort study, we analyzed data from 50 adult patients admitted to the University Hospital Heart Centre Brandenburg for ADHF. Concentrations of established serum biomarkers (e.g. NT-proBNP, troponin T, creatinine, cystatin C, urea, CRP, haemoglobin) and novel serum and urine biomarkers including sST2, neprilysin, IL-6, NGAL, DKK3, Galectin 3, Progranulin and GDF-15 were measured at hospital admission. We assessed such biomarkers in relation to 90-day mortality. We defined an area under the curve (AUC) of 0.60-0.69 as poor, 0.70-0.79 as fair, 0.80-0.89 as good, and 0.90-1.00 as excellent in terms of predictive value. AUC-ROC comparison was performed using MedCalc (Hanley and McNeil).

Results

Complete biomarker and clinical data were available in 44 of 50 patients. The median age was 78.0 (25th-75th percentiles 69.3-83.8) years, 50% (22/44) were female; 64% (28/44) presented with chronic kidney disease. Twelve patients (27.3%) died within 90 days after discharge. Serum urea (AUC 0.920) showed an excellent, troponin (AUC 0.821), serum-creatinine-based eGFR (AUC 0.812) as well as urine Neprilysin (AUC 0.807) a good prognostic value for 90-day mortality (Table). The predictive value of almost all novel biomarkers analyzed was poor (AUC <0.70) (Table). The AUC difference between serum urea and urine neprilysin  was 0.273 (0.048-0.497), p=0.017 (Abb.).

Conclusion

The findings of this study imply a limited prognostic value of novel cardiac and renal biomarkers for 90-day mortality, whereas commonly used serum parameters such as troponin, serum urea and eGFR may be valuable.



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