Abstract 14768: The Cortisol-to-acth Ratio, a Possible Marker of Relative Corticosteroid Insufficiency, is a Prognostic Predictor in Acute Decompensated Heart Failure
Background: Clinical significance of diminished cortisol response to adrenocorticotrophic hormone (ACTH) is not clear in acute decompensated heart failure (ADHF). Therefore, we evaluated the prognostic value of a low cortisol response to ACTH.
Methods: This study was prospective prognostic study performed as part of NARA-HF3 study between April 2011 and December 2014. We measured the plasma levels of neurohumoral factors such as BNP, plasma renin activity (PRA), aldosterone (ALD), ACTH and serum levels of cortisol, and evaluated the cortisol-to-ACTH ratio (cortisol/ACTH) at admission in 348 ADHF patients. The cut-off values for each neurohumoral factor were calculated using receiver operating characteristic (ROC) analysis. The patients were divided into 2 group based on the cut-off values; High-cortisol/ACTH group (cortisol/ACTH≥0.681, n=89) and Low-cortisol/ACTH group (cortisol/ACTH<0.681, n=259).
Result: The mean ages were 73.8 years and 60.1% were male. During a mean follow-up time of 647 ± 416 days, 126 deaths (37.3%): 59 (17.5%) from cardiovascular causes and 103 heart failure (HF) hospitalizations (30.4%) were recorded. Cortisol levels were significantly lower, but ACTH was higher in Low-cortisol/ACTH group. There was no significant difference in age, eGFR, LVEF, serum sodium, BNP and aldosterone levels both groups. Kaplan-Meier survival analysis showed that Low-cortisol/ACTH had a significantly increased risk of all-cause mortality or HF hospitalization (log-rank P=0.0148). Multivariate analysis using Cox proportional hazard regression revealed that Low-cortisol/ACTH was an independent prognostic predictor for ADHF patients (HR 1.554, 95% CI 1.092-2.268, p=0.014). In addition, high levels of plasma ACTH (P=0.027), PRA (P<0.001) and ALD (p=0.017) were significant independent predictors of prognosis, but serum cortisol levels were not.
Conclusion: Low-cortisol/ACTH was associated with poor prognosis in ADHF patients.
Author Disclosures: R. Kawakami: None. Y. Nakada: None. T. Ueda: None. H. Okura: None. Y. Saito: Research Grant; Modest; Grants-in-Aid for Scientific Research (B), Challenging Exploratory Research (FY 2015), Health, Labour and Welfare Scientific Research. Research Grant; Significant; S, S, S. Other Research Support; Modest; MSD K.K. a subsidiary of Merck & Co., Inc., Daiichi Sankyo Co., Ltd., Bayer Holding Ltd., Baxter Ltd., Otsuka Pharmaceutical Co., Ltd., Kyowa Hakko Kirin Co., Ltd., Dainippon Sumitomo Pharma Co., Ltd., Astellas Pharma Inc., Takeda Pharmaceutical Co., Ltd., Ono Pharmatical Co., Ltd., Teijin Pharma Ltd., Mitsubishi Tanabe Pharma Corporation, Eisai Co., Ltd., ZERIA Pharmaceutical Co., Ltd., Nihon Medi-Physics Co.,Ltd., Chugai Pharmaceutical Co., Ltd., Genzyme Japan K.K., Medtronic, Inc., Pfizer Japan Inc.. Other Research Support; Significant; S, S, S, S, S, S, S, S, S, S, S, S, S, S, M, M, M, M, M. Honoraria; Modest; Otsuka Pharmaceutical Co., Ltd, Takeda Pharmaceutical Co., Ltd, Mitsubishi Tanabe Pharma Corporation, Daiichi Sankyo Co., Ltd, MSD K.K. a subsidiary of Merck & Co., Inc, Novartis Pharma K.K., Bayer Holding Ltd, Kyowa Hakko Kirin Co., Ltd, Astellas Pharma Inc, Ono Pharmatical Co., Ltd, Pfizer Japan Inc.. Honoraria; Significant; M, M, M, M, M, M, M, M, M, M, M. Consultant/Advisory Board; Modest; Novartis Pharma K.K., Ono Pharmatical Co., Ltd, Pfizer Japan Inc.. Consultant/Advisory Board; Significant; M, M, M.
- © 2016 by American Heart Association, Inc.