Abstract
Background
Osteoprotegerin (OPG) is promising as a predictor of adverse prognosis in patients
with acute coronary syndromes and chronic heart failure. Its prognostic value in acute
heart failure (AHF) is unknown. The aim of this study was to assess the prognostic
value provided by serum OPG levels at discharge after an admission for AHF.
Methods
In a prospective study, we enrolled 338 patients consecutively admitted with AHF to
the internal medicine department of a tertiary care university hospital in Porto,
Portugal between March 2009 and December 2010. OPG was measured using a commercial
enzyme-linked immunosorbent assay and was both analyzed as a continuous variable and
categorized by quartiles. Patients were followed for up to 6 months after discharge
to ascertain the occurrence of all-cause death or hospital readmission resulting from
AHF.
Results
During follow-up, 119 patients died or were readmitted for AHF. A graded increase
in the risk of the combined end point was observed across quartiles of OPG. At 6 months,
the cumulative risk of the end point was 25% for the first quartile and 50% for the
fourth quartile. The multivariable adjusted risk of death or hospitalization for AHF
increased progressively across categories of OPG up to a statistically significant
2.44-fold increase in risk in the highest category (P for linear trend = 0.002, ie, by 5% per 10 pg/mL increase in OPG).
Conclusions
Serum OPG was directly associated with a higher probability of death or readmission
for AHF within 6 months, irrespective of other known prognostic markers. This was
true both when the ejection fraction was preserved and when it was reduced.
Résumé
Introduction
L’ostéoprotégérine (OPG) s’avère prometteuse comme prédicteur de pronostic défavorable
chez les patients souffrant de syndromes coronariens aigus et d’insuffisance cardiaque
chronique. On ignore sa valeur pronostique dans l’insuffisance cardiaque aiguë (ICA).
Le but de cette étude était d’évaluer la valeur pronostique des concentrations sériques
d’OPG au congé après une admission pour une ICA.
Méthodes
Dans une étude prospective, nous avons inscrit 338 patients souffrant d’une ICA admis
de manière consécutive au service de médecine interne d’un hôpital universitaire de
soins tertiaires de Porto, au Portugal, entre mars 2009 et décembre 2010. L’OPG était
mesurée à l’aide d’une trousse commerciale de dosage d’immunoabsorption par enzyme
lié et l’avons à la fois analysée comme une variable continue et catégorisée en quartiles.
Les patients étaient suivis jusqu’à 6 mois après le congé pour vérifier la survenue
de décès toutes causes confondues ou la réadmission à l’hôpital en raison d’une ICA.
Résultats
Durant le suivi, 119 patients sont morts ou étaient réadmis en raison d’une ICA. Une
augmentation graduelle des risques du critère de jugement combiné était observée dans
tous les quartiles de l’OPG. À 6 mois, le risque cumulatif du critère de jugement
était de 25 % pour le premier quartile et de 50 % pour le quatrième quartile. Le risque
ajusté multivarié de décès ou d’hospitalisation pour une ICA augmentait progressivement
dans toutes les catégories d’OPG jusqu’à une augmentation statistiquement significative
des risques de 2,44 fois dans la catégorie la plus élevée (P pour la tendance linéaire = 0,002, c.-à-d. de 5 % par augmentation de l’OPG de 10
pg/ml).
Conclusions
Les concentrations sériques d’OPG étaient directement associées à une probabilité
plus élevée de décès ou de réadmission pour une ICA dans les 6 mois, quels que soient
les autres marqueurs pronostiques connus. Cela était vrai tant pour la fraction d’éjection
préservée que pour la fraction d’éjection réduite.
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Article info
Publication history
Published online: April 09, 2015
Accepted:
April 3,
2015
Received:
January 12,
2015
Footnotes
See page 1270 for disclosure information.
Identification
Copyright
© 2015 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
