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Plasma growth hormone is a strong predictor of risk at 1 year in acute heart failure
Author(s) -
Bhandari Sanjay S.,
Narayan Hafid,
Jones Donald J.L.,
Suzuki Toru,
Struck Joachim,
Bergmann Andreas,
Squire Iain B.,
Ng Leong L.
Publication year - 2016
Publication title -
european journal of heart failure
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.149
H-Index - 133
eISSN - 1879-0844
pISSN - 1388-9842
DOI - 10.1002/ejhf.459
Subject(s) - medicine , heart failure , hazard ratio , cardiology , cohort , proportional hazards model , prospective cohort study , confidence interval , acute decompensated heart failure
Aims We sought to compare the prognostic utility of growth hormone ( GH ) with NT‐proBNP ) and the ADHERE score in a large cohort of acute heart failure ( HF ) patients, subcategorized into HF with reduced EF <50% ( HFrEF ) and preserved EF ≥50% ( HFpEF ). Methods and results GH and NTproBNP levels were measured in 537 patients ( HFrEF n = 415; HFpEF n = 122) with acute HF recruited into this prospective cohort study. The main outcome measure was death or HF readmission at 1 year. GH levels were higher in both HFrEF [1.26 (0.54–2.62) vs. 0.8 (0.26–1.94) ng/ mL , P < 0.001] and HFpEF [1.04 (0.48–2.92) vs. 0.53 (0.18–1.94) ng/ mL , P = 0.020] patients with the outcome compared with event‐free survivors. GH levels were independently predictive for the outcome at 1 year in the entire cohort [ HR 1.47, 95% confidence interval ( CI ) 1.16–1.86, P = 0.001] and those with HFrEF ( HR 1.54, 95% CI 1.19–1.99, P = 0.001) in multivariate Cox hazard analysis. GH improved risk classification as measured by continuous net reclassification improvement ( NRI ) when added to the ADHERE multivariate logistic model of age, sex, urea, heart rate, and systolic blood pressure, for all patients [ NRI 29.6 (12.1–47.1), P = 0.001] and HFrEF NRI 21.7 (1.9–41.6), P = 0.034] patients, as well as in addition to the ADHERE model combined with NT‐proBNP for all patients [ NRI 25.4 (7.8–43.1), P = 0.005]. Conclusions GH offers incremental prognostic information over the ADHERE score clinical predictors and NT‐proBNP for risk stratification of acute HF patients.