Abstract 15345: Soluble Isoforms of St2 and Galectin-3 Have Independent and Incremental Prognostic Value in Patients With Hemodialysis
Introduction: End-stage renal disease is a major clinical and public health problem, and cardiovascular disease accounts for half of the mortality in hemodialysis patients. An existing mortality risk score (AROii score) or N-terminal pro-brain natriuretic peptide (NT-proBNP) level have modest predictive power, but there is room for improvement. There are emerging cardiac biomarkers (soluble isoforms of ST2 [sST2], galectin-3 [Gal-3]), and uremic toxicity (indoxyl sulfate [IS]).
Hypothesis: We hypothesized that these biomarkers would better predict future adverse cardiovascular events and provide additional prognostic information compared with the clinical risk score and NT-proBNP in hemodialysis patients.
Methods: A total of 423 hemodialysis patients were prospectively followed for primary (all-cause death) and secondary endpoints (a composite of all-cause death or cerebro-cardiovascular events).
Results: During a mean follow-up of 2.1 ± 0.4 years, there were 48 all-cause deaths and 78 composite outcomes. sST2, Gal-3, and NT-proBNP were associated with all-cause deaths but IS was not in both log-rank test and receiver operating characteristic analysis, with area under the curves (AUCs) of 0.72 (p<0.001), 0.74 (p<0.001), 0.70 (p<0.001), and 0.47 (p=0.437). Both sST2 and Gal-3 had independent and incremental prognostic value for both outcomes over the AROii score and NT-proBNP. Although adding sST2 did not reclassify over the model based AROii score and NT-proBNP for all-cause death, further addition of Gal-3 did. Subgroup analyses of patients with left ventricular ejection fraction measurement (n=301) corroborated these results, where the two biomarkers remained independent and incremental for both all-cause death and composite outcome after adjusting for the risk score and the ejection fraction.
Conclusions: We demonstrated that both sST2 and Gal-3 had independent and incremental predictive value for all-cause mortality and the composite events over the AROii score and NT-proBNP in patients with hemodialysis. These findings suggest that these two novel biomarkers for fibrosis may enhance risk stratification.
Author Disclosures: H. Sunaga: None. M. Obokata: None. H. Ishida: None. K. Ito: None. T. Ogawa: None. Y. Ando: None. K. Negishi: None. M. Kurabayashi: None.
- © 2016 by American Heart Association, Inc.