Abstract 4354: Combining Amino-Terminal Pro-B Type Natriuretic Peptide with the Interleukin Receptor Family Member ST2 for Optimal Long-Term Risk Prediction in Acute Dyspnea: Multimarker Results at 4 Years from the ProBNP Investigation of Dyspnea in the Emergency Department (PRIDE) Study
Background: Acute dyspnea at presentation to the emergency department (ED) is associated with significant mortality risk. Amino-terminal pro-B type natriuretic peptide (NT-proBNP) and interleukin family member ST2, both were independent predictors of death at 4 years in the PRIDE study.
Methods: 4 year follow up was completed on 599 dyspneic subjects. The roles ofST2 and amino-terminal pro-brain natriuretic peptide (NT-proBNP) as independent predictorsof mortality were assessed using BIC (Bayesian information criterion, receiver operating characteristic curves (ROC) and Cox regression model.
Results: By 4 year, 184 (31%) subjects had died. BIC identified both NT-proBNP and ST2 as predictors of death. For 4 year mortality, ST2 had an area under the ROC of 0.76 (95% confidence interval [CI] =0.72– 0.80; P <.001) identical to NT-proBNP =0.78 (CI =0.75– 0.82; P <.001). When patients were categorized based on optimal prognostic cut-points for ST2 (0.15 ng/mL) and NT-proBNP (300 ng/L), the lowest 4 year mortality rates were observed among those with low results for both markers (4.2%), intermediate rates among those with elevation of either NT-proBNP (18.5%) or ST2 (25.3%), and the highest mortality rates among those with elevation in both biomarkers (52.5%) (Figure⇓). These results were confirmed in an age-adjusted Cox analysis, where elevation of both ST2 and NT-proBNP had significantly higher hazard ratio (HR=3.17; 95% CI=2.18- 4.62; P <.001), than either marker used alone.
Conclusions: Among dyspneic patients in ED, a combined strategy with natriuretic peptides and interleukin receptor member ST2 provides superior long-term prognostication.