The BCN Bio-HF calculator, incorporating clinical variables and three biomarkers (NT-proBNP, hs-cTnT, and ST2), accurately predicted mortality with a C-statistic of 0.794.
Cohort (n=864)
No
Does the BCN Bio-HF calculator accurately predict 1-, 2-, and 3-year mortality in heart failure outpatients?
The BCN Bio-HF calculator, incorporating clinical variables and up to three biomarkers (NT-proBNP, hs-cTnT, ST2), provides good discrimination (C-statistic 0.79) for predicting 1- to 3-year mortality in heart failure outpatients.
Effect estimate: C-statistic 0.794 (95% CI 0.77-0.817)
Absolute Event Rate: 0.794% vs 0.771%
p-value: p=0.001
BACKGROUND: A combination of clinical and routine laboratory data with biomarkers reflecting different pathophysiological pathways may help to refine risk stratification in heart failure (HF). A novel calculator (BCN Bio-HF calculator) incorporating N-terminal pro B-type natriuretic peptide (NT-proBNP, a marker of myocardial stretch), high-sensitivity cardiac troponin T (hs-cTnT, a marker of myocyte injury), and high-sensitivity soluble ST2 (ST2), (reflective of myocardial fibrosis and remodeling) was developed. METHODS: Model performance was evaluated using discrimination, calibration, and reclassification tools for 1-, 2-, and 3-year mortality. Ten-fold cross-validation with 1000 bootstrapping was used. RESULTS: The BCN Bio-HF calculator was derived from 864 consecutive outpatients (72% men) with mean age 68.2 ± 12 years (73%/27% New York Heart Association (NYHA) class I-II/III-IV, LVEF 36%, ischemic etiology 52.2%) and followed for a median of 3.4 years (305 deaths). After an initial evaluation of 23 variables, eight independent models were developed. The variables included in these models were age, sex, NYHA functional class, left ventricular ejection fraction, serum sodium, estimated glomerular filtration rate, hemoglobin, loop diuretic dose, β-blocker, Angiotensin converting enzyme inhibitor/Angiotensin-2 receptor blocker and statin treatments, and hs-cTnT, ST2, and NT-proBNP levels. The calculator may run with the availability of none, one, two, or the three biomarkers. The calculated risk of death was significantly changed by additive biomarker data. The average C-statistic in cross-validation analysis was 0.79. CONCLUSIONS: A new HF risk-calculator that incorporates available biomarkers reflecting different pathophysiological pathways better allowed individual prediction of death at 1, 2, and 3 years.
Lupón et al. (Wed,) conducted a cohort in Heart failure (n=864). BCN Bio-HF Calculator (clinical variables + NT-proBNP, hs-cTnT, ST2) vs. Clinical model without biomarkers was evaluated on Model discrimination for mortality (C-statistic) (C-statistic 0.794, 95% CI 0.77-0.817, p=0.001). The BCN Bio-HF calculator, incorporating clinical variables and three biomarkers (NT-proBNP, hs-cTnT, and ST2), accurately predicted mortality with a C-statistic of 0.794.