Use of Biomarkers to Predict Readmission for Congestive Heart Failure
| Autor: | Eric Novak, Mitchell G. Scott, Edward M. Geltman, Sangita Sudharshan, Karl G. Hock |
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| Rok vydání: | 2016 |
| Předmět: |
Male
medicine.medical_specialty Acute decompensated heart failure medicine.drug_class Galectin 3 030204 cardiovascular system & hematology Patient Readmission Risk Assessment 03 medical and health sciences 0302 clinical medicine Internal medicine Troponin I Natriuretic Peptide Brain Hospital discharge medicine Natriuretic peptide Humans 030212 general & internal medicine Aged Heart Failure Ejection fraction business.industry Area under the curve Middle Aged medicine.disease Prognosis Patient Discharge Hospitalization ROC Curve Heart failure Area Under Curve Cardiology Female Cardiology and Cardiovascular Medicine Risk assessment business Biomarkers |
| Zdroj: | The American journal of cardiology. 119(3) |
| ISSN: | 1879-1913 |
| Popis: | Acute decompensated heart failure (ADHF) is a major reason for repeated hospitalizations. Identifying those patients with ADHF at risk for readmission is critical so that preventive interventions can be implemented. Biomarkers such as B-type natriuretic peptide (BNP), high-sensitivity troponin I, and galectin-3 (Gal-3) assessed at discharge may be useful, although their role in predicting short-term readmission is not well defined in the literature. We enrolled and had follow-up data for 101 participants admitted to our facility from April 2013 to March 2015 with a primary diagnosis of ADHF. Gal-3, high-sensitivity troponin I, and BNP were obtained within 48 hours before hospital discharge after management of ADHF. Gal-3 was assessed using 2 commercially available assays. We compared subjects who were and were not readmitted. Discharge BNP was found to be a significant predictor of 30- and 60-day readmission (area under the curve [AUC] 0.69 [p = 0.046], AUC 0.7 [p = 0.005], respectively). The addition of Gal-3 to discharge BNP provided significantly improved prediction of 60-day readmission. Gal-3 alone was found to be a significant predictor of 60-day readmission in patients with preserved ejection fraction (AUC 0.85, p0.001). The net reclassification improvement was 55.2 (p = 0.037). Using multivariate analysis, for every 100 pg/L BNP increase, the probability of readmission increased by approximately 10%, and for every 1-ng/ml Gal-3 increase, the probability further increased 8%. A statistically significant net reclassification improvement was not found on examination of 30-day readmission. In conclusion, measurement of both Gal-3 and BNP at hospital discharge provides significant prediction of hospital readmission within 60 days. When combined, the prediction of readmission is significantly improved. |
| Databáze: | OpenAIRE |
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