| Objects :To explore the predictive value of soluble ST2(sST2 )on the prognosis of acute decompensated heart failure(ADHF)and renal insufficiency,and to provide an objective basis for the application of sST2 in patients with ADHF and renal insufficiency.Methods: 140 caces of ADHF in our hospital were selected from August 2015 to June 2016 in the Department of cardiovascular medicine.At the same time,30 healthy persons were selected as healthy control group.According to the estimated glomerular filtration rate(e GFR),the patients were divided into 2 groups,there were 61 cases as A group(e GFR<60(m L·min-1·1.73 m-2)),and 79 cases as B group(e GFR≥60(m L·min-1·1.73 m-2)).The fasting venous blood of patients at admission and at discharge were collected,the basic data and laboratory parameters were collected.The levels of sST2 were detected by ELISA method.The levels of sST2 were compared between the ADHF group and the healthy control group,and the changes of sST2 levels in patients at admission and at discharge between A and B were compared.The follow-up time was 6 months.The events of the occurrence of all cause of death or readmission due to heart failure were observed.Univariate and multivariate logistic regression analysis was used to analyze the risk factors of short-term adverse outcomes in patients with ADHF and renal insufficiency.According to the receiver characteristic(ROC)curve,the area under the ROC curve(AUC)and the optima-1 cut-off value of sST2 and NT-pro BNP were caculated to predict the short term prognosis of patients in group A and group B.The AUC of sST2 and NT-pro BNP in the two groups were compared.The A and B two groups were grouped according to the best diagnostic cut-off values,and the short-termadverse events were assessed using the Kaplan-Meier survival curve.Results:1.There was no significant difference in age,sex,heart rate,ejection fraction(LVEF),left ventricular end diastolic volume(LV),left ventricular posterior-wall(LVPW)and the use of drugs between A and B groups(P >0.05).There was a significant difference in the urea nitrogen,creatinine(Scr),hemoglobin(HGB)between the two groups(P <0.05),and the HGB in the A group was lower.There was no significant difference between the two groups in terms of hypertension,atrial fibrillation and other diseases(P >0.05).However,compared with B group,the patients in group A were more likely to have diabetes.2.The level of sST2 at admission in the ADHF group was significantly higher than in the healthy control group,the difference was statistically significant(P <0.05).3.The Lg(NT-pro BNP)values in A group were higher than in B group,there was a significant difference between the two groups(P =0.001 for admission;P <0.001 for discharge).However,there was no statistically significant difference in sST2 levels between A group and B group(P =0.143 for admission;P =0.08 for discharge).The level of serum sST2 and NT-pro BNP in patients with NYHA cardiac functional class IV was higher than NYHA cardiac functional class III.4.Pearson correlation analysis showed that serum sST2 and Lg(NT-pro BNP)were positively correlated in ADHF group(r =0.509,P <0.001 for admission;r =0.501,P <0.001 for discharge).There was a slight positive correlation between serum sST2 and Lg(NT-pro BNP)in A group(r =0.338,P <0.001 for admission;r =0.398,P =0.002 for discharge).Serum sST2 and Lg(NT-pro BNP)were positively correlated in B group(r =0.675,P <0.001 for admission;r =0.549,P <0.001 for discharge).5.Follow up results: A total of 68 cases had an end point event,there were 37 cases in A group and 31 cases in B group.The end point events were compared between the two groups,the difference was statistically significant(P =0.01).6.Univariate logistic regression analysis showed that HGB,Scr,urea nitrogen,sST2 and NT-pro BNP at admission were risk factors for predicting adverse events in ADHF with renal insufficiency(P<0.05).Multivariate logistic regression analysis showed that sST2 at discharge and HGB levels were an independent risk factor for predicting readmisson due to heart failure or all-cause mortality with in 6 months after hospital discharge for ADHF with renal insufficiency.7.Followed up for 6 months,in group A,the ROC curve indicates that the AUC of sST2 and NT-pro BNP at admission and at discharge to predict the end point events were 0.731(P=0.002),0.748(P =0.001)and 0.697(P =0.010),0.722(P=0.004).In B group,the ROC curve indicates that the AUC of sST2 at admission and at discharge to predict the end point events were 0.733(P = 0.001),0.752(P <0.001)and 0.758(P <0.001),0.771(P <0.001).8.Survival analysis results:survival analysis showed that high levels of sST2 (> 0.49ng/ml for admission;>0.20ng/ml for discharge)have a higher risk of end point events than Low level of sST2 (≤0.49ng/ml for admission;≤0.20ng/ml for discharge),lower survival rate in the A group(log-rank chi square values were 12.202,P <0.001 for admission;log-rank chi square values were 10.244,P =0.001 for discharge).Survival analysis showed that high levels of sST2 (>0.47 ng/ml for admission;>0.23ng/ml for discharge)have a higher risk of end point events than Low level of sST2 (≤0.47ng/ml for admission;≤0.23ng/ml for discharge),lower survival rate in the B group(log-rank chi square values were30.675,P <0.001 for admission;log-rank chi square values were 30.707,P < 0.001).Conclusion:1.Compared with NT-pro BNP,sST2 was not affected by renal function.2.sST2 at admission is an independent risk factor for short-term adverse outcomes in patients with ADHF and renal insufficiency.3.sST2 has better short term predictive value in ADHF patients with renal insufficiency due to heart failure readmission or all-cause death. |
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