Predictors of 1‑year mortality in ambulatory patients with advanced heart failure awaiting heart transplant

Area of Science:

• Biomarkers in cardiovascular disease
• Heart failure prognosis
• Transplant medicine

Background:

• Heart failure (HF) is a complex syndrome with diverse pathological pathways.
• Circulating biomarkers can indicate abnormal physiological processes in HF patients.
• Identifying prognostic factors is crucial for managing advanced HF, especially for those awaiting heart transplantation.

Purpose of the Study:

• To assess factors associated with a worse prognosis in advanced heart failure patients awaiting heart transplant.
• To evaluate the predictive value of various serum biomarkers for 1-year all-cause mortality in this patient cohort.

Main Methods:

• Prospective assessment of 203 adult patients with advanced HF hospitalized between 2016 and 2018.
• 1-year follow-up to determine all-cause mortality as the study endpoint.
• Analysis of serum levels of procalcitonin, high-sensitivity C-reactive protein (hs-CRP), sodium, and N-terminal pro-B-type natriuretic peptide (NT-proBNP).

Main Results:

• A total of 62 patients (30.5%) died during the 1-year follow-up.
• Independent risk factors for mortality included elevated serum procalcitonin (HR, 1.027), hs-CRP (HR, 1.099), NT-proBNP (HR, 1.068), and decreased serum sodium (HR, 1.171).
• Procalcitonin demonstrated the highest area under the curve (0.780), indicating the strongest predictive power.

Conclusions:

• Higher serum hs-CRP, NT-proBNP, and procalcitonin levels, along with lower serum sodium levels, are independent risk factors for 1-year mortality in advanced HF patients.
• Procalcitonin exhibits the strongest predictive power, sensitivity, and specificity for identifying 1-year survivors and non-survivors.
• These findings aid in effectively identifying high-risk patients awaiting heart transplant.