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Fast and Specific Assessment of the Halogenating Peroxidase Activity in Leukocyte-enriched Blood Samples
Published on: July 28, 2016
Use of myeloperoxidase for risk stratification in acute heart failure
Tobias Reichlin1, Thenral Socrates, Patrick Egli
1Department of Internal Medicine, University Hospital Basel, Switzerland.
Background:
Myeloperoxidase (MPO) is a biomarker of inflammation and oxidative stress produced by neutrophils, monocytes, and endothelial cells. Concentrations of MPO predict mortality in patients with chronic heart failure. This study sought to investigate the diagnostic accuracy and prognostic value of MPO in patients with acute heart failure (AHF).
Methods:
We prospectively enrolled 667 patients presenting to the emergency department with dyspnea and observed them for 1 year. MPO and B-type natriuretic peptide (BNP) were measured at presentation. Two independent cardiologists adjudicated final discharge diagnoses.
Results:
MPO concentrations were similar in patients with AHF (n = 377, median 139 pmol/L) and patients with noncardiac causes of dyspnea (n = 290, median 150 pmol/L, P = 0.26). The diagnostic accuracy of MPO for AHF was limited [area under the ROC curve (AUC) 0.53] and inferior to that of BNP (AUC 0.95, P < 0.001). In patients with AHF, MPO concentrations above the lowest tertile (MPO >99 pmol/L) were associated with significantly increased 1-year mortality (hazard ratio 1.58, P = 0.02). The combination of MPO (< or = 99 vs >99 pmol/L) and BNP (median of < or = 847 vs >847 ng/L) improved the prediction of 1-year mortality (hazard ratio 2.80 for both variables increased vs both low, P < 0.001). After adjustment for cardiovascular risk factors in multivariable Cox proportional hazard analysis, increases in MPO contributed significantly toward the prediction of 1-year mortality (hazard ratio 1.51, P = 0.045).
Conclusions:
MPO is an independent predictor of 1-year mortality in AHF, is additive to BNP, and could be helpful in identifying patients with a favorable prognosis despite increased BNP concentrations.
Insights
Myeloperoxidase (MPO) predicts mortality in acute heart failure (AHF) patients, independent of B-type natriuretic peptide (BNP). Elevated MPO levels indicate a higher risk of 1-year mortality in AHF.
Area of Science:
- Cardiology
- Biomarker Research
- Clinical Diagnostics
Background:
- Myeloperoxidase (MPO) is a key biomarker for inflammation and oxidative stress.
- Elevated MPO levels are linked to mortality in chronic heart failure.
- The role of MPO in acute heart failure (AHF) requires further investigation.
Purpose of the Study:
- To evaluate the diagnostic accuracy of MPO in AHF.
- To determine the prognostic value of MPO in AHF patients.
- To assess the additive value of MPO to B-type natriuretic peptide (BNP) in predicting mortality.
Main Methods:
- Prospective enrollment of 667 patients with dyspnea in the emergency department.
- Measurement of MPO and BNP at presentation, with 1-year follow-up.
- Independent adjudication of diagnoses by two cardiologists.
Main Results:
- MPO levels were similar in AHF and non-cardiac dyspnea groups, with limited diagnostic accuracy for AHF (AUC 0.53) compared to BNP (AUC 0.95).
- Higher MPO concentrations (>99 pmol/L) in AHF patients were associated with increased 1-year mortality (HR 1.58).
- The combination of MPO and BNP improved 1-year mortality prediction (HR 2.80). MPO independently predicted mortality after risk factor adjustment (HR 1.51).
Conclusions:
- MPO serves as an independent predictor of 1-year mortality in AHF.
- MPO provides additive prognostic information to BNP.
- MPO may help identify AHF patients with a favorable prognosis despite elevated BNP levels.
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