The following is a summary of “Biomarkers and their combination in a prediction of decompensation after an index hospitalization for acute heart failure,” published in the June 2023 issue of Family Medicine and Primary Care by Durak-Nalbantic et al.

Heart failure (HF) continues to be one of the most prevalent reasons for hospitalization, with a high mortality rate. The purpose of this study is to investigate the potential prognostic role of brain natriuretic peptide (BNP), high-sensitivity (hs) cardiac troponin (cTn) I, cystatin C, and cancer antigen 125 (CA125) in the prediction of decompensation following an index hospitalization, as well as their potential additive prognostic value. About 222 hospitalized patients with acute HF were followed for 18 months. BNP has the most incredible sensitivity and specificity for predicting decompensation upon discharge.

Sensitivity was 64.3%, and specificity was 64.5% at a cutoff value of 423.3 pg/ml, with a positive predictive value of 71.6% and an area under the curve (AUC) of 0.69 (P<0.001). 2.18 was decompensation’s hazard risk (HR) when the discharge BNP exceeded the threshold value. At a cutoff value of 1.46 mg/L, the sensitivity and specificity of Cystatin C were 57% and 58%, respectively, with a positive predictive value of 65.8% and an AUC of 0.59 (P = 0.028). CA125 had a sensitivity of 60.5%, a specificity of 53.3%, a positive predictive value of 64.5%, and an area under the curve (AUC) of 0.59 (P = 0.022) in predicting decompensation in patients with acute heart failure (AHF) at a cutoff value of 80.5 IU/L. 

The time until the onset of decompensation was substantially shorter in patients with four as compared to three elevated biomarkers (P = 0.047), with five as compared to three elevated biomarkers (P = 0.026), and with four as compared to two elevated biomarkers (P = 0.026). Compared to patients with fewer positive biomarkers, the HR for decompensation was 3.7% (P= 0.001) for patients with five positive biomarkers and 2.5% (P = 0.014) for patients with four positive biomarkers. BNP, cystatin C, and CA125 are decompensation predictors, and their combined use improves the prediction of future decompensation.

Source: journals.lww.com/jfmpc/Fulltext/2023/06000/Biomarkers_and_their_combination_in_a_prediction.22.aspx