Coagulation biomarkers as prognostic indicators in heart failure: A systematic review and meta- analysis of 14,773 patients

Introduction and objectives: Heart failure (HF) patients are at risk of developing thrombosis due to low cardiac output, systemic inflammatory response, and endothelial dysfunction. Thromboembolic complications in HF patients most commonly lead to fatal consequences. Methods: The protocol for this study was registered in PROSPERO with identification number CRD42024532861. We performed random-effects meta-analyses on extracted data of hazard ratios (HR) and odds ratios (OR) using Review Manager 5.4. Results: Twenty-two studies with a total population of 14,773 patients were included. INR was associated with risk of mortality (per 0.1 increase, univariate HR = 1.17, 95% CI: 1.08– 1.28, p = 0.0004; multivariate HR = 1.35, 95% CI: 0.80–2.29, p = 0.26). Increased D-dimer significantly increased risk of mortality (per 1 ng/mL increase; univariate HR = 1.87, 95% CI: 1.22–2.89, p = 0.004; multivariate HR = 1.90, 95% CI: 1.09–3.32, p = 0.02), and fibrinogen did not increase risk of mortality (per 1 mg/dL increase; HR = 0.93, 95% CI: 0.77–1.13, p = 0.45). Substantial heterogeneity was observed in D-dimer analyses. Cautious interpretation, noting 95% prediction intervals: 0.75–4.67 (univariate) and 0.58–6.19 (multivariate), should be implemented. Several analyses had insufficient data. Conclusion: Low-certainty evidence weakly supports the potential of D-dimer as an independent prognostic marker in predicting HF mortality.