Key result
Adding troponin T, cystatin C-based eGFR, and uNGAL to the ELAN-HF risk score increased the AUC for predicting 90-day mortality from 0.792 to 0.933, though the absolute difference did not reach statistical significance.
Why the study?
Several risk scores predict mortality in acute decompensated heart failure, but whether adding novel cardiorenal biomarkers improves their predictive value remained to be evaluated.
Does the addition of novel cardiorenal biomarkers improve the predictive value of established risk scores for 90-day mortality in patients with acute decompensated heart failure?
Cohort (n=44)
No
Does the addition of novel cardiorenal biomarkers improve the predictive value of established risk scores for 90-day mortality in patients with acute decompensated heart failure?
Effect estimate: AUC difference 0.134 (95% CI -0.037-0.306)
Absolute Event Rate: 0.933% vs 0.792%
p-value: p=0.124
Adding a panel of cardiorenal biomarkers (troponin T, cystatin C-based eGFR, and uNGAL) to established risk scores may excellently predict 90-day mortality in patients with acute decompensated heart failure.
May support refined risk stratification in acute decompensated heart failure; leaves open incremental value pending larger prospective validation.
Study Objective: There are several risk scores for mortality in patients with acute decompensated heart failure (ADHF) such as the European Collaboration on Acute Decompensated Heart Failure Score (ELAN-HF Score), the ADHF/NT-proBNP-Score or A2B-Score (age, anemia, BNP). The aim of this study was to evaluate the predictive value of such risk scores with and without addition of novel cardiorenal biomarkers. Design & Setting: Single-center, exploratory prospective cohort study at the University Hospital Heart Centre Brandenburg. Participants: Forty-four adult patients hospitalized for ADHF. Interventions: Measurement of established and novel biomarkers at hospital admission including N-terminal-pro brain natriuretic peptide (NT-pro-BNP), troponin T, creatinine, cystatin C, soluble suppression of tumorigenicity 2 (sST2), Neprilysin, Dickkopf-3 (DKK3), interleukin-6 (IL-6), growth differentiation factor-15 (GDF-15), Galectin-3, Progranulin and urine neutrophil gelatinase-associated lipocalin (uNGAL). Main Outcome Measures: Analysis of predictive indices of ELAN-HF, ADHF/NT-proBNP and A2B-Scores for 90-day mortality with and without adding biomarkers. AUC <0.8 was considered as fair, ≥0.8 as good and > 0.9 as excellent predictive value. Results: Median age was 78.0 (25th-75th percentiles 69.3-83.8) years, 50 % (22/44) were female. Twelve patients (27.3 %) died within 90 days after discharge. All three risk scores were higher in non-survivors and showed fair AUC for 90-day mortality (ELAN-HF: 0.792 [0.639-0.901], p = 0.003; ADHF-NT-proBNP score: 0.749 [0.559-0.938], p = 0.012; A2B score: 0.734 [0.541-0.927], p = 0.017). Adding troponin T, cystatin C-based estimated glomerular filtration rate (eGFR) or uNGAL to risk scores was associated with an area under the curve (AUC) >0.80 for all models. Combination of troponin T, cystatin C-based eGFR and uNGAL increased risk scores to AUC >0.91. Conclusion: These findings imply that further evaluation of the addition of a panel of cardiorenal biomarkers to ADHF risk scores is warranted.
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Hähnel et al. (2025) conducted a cohort in Acute decompensated heart failure (n=44). Addition of troponin T, cystatin C-based eGFR, and uNGAL to risk scores vs. Risk scores alone (e.g., ELAN-HF) was evaluated on Absolute difference in AUC for predicting 90-day mortality (ELAN-HF score) (AUC difference 0.134, 95% CI -0.037-0.306, p=0.124). Adding troponin T, cystatin C-based eGFR, and uNGAL to the ELAN-HF risk score increased the AUC for predicting 90-day mortality from 0.792 to 0.933, though the absolute difference did not reach statistical significance.
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