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

Abstract

Introduction Heart failure (HF) is a complex syndrome involving diverse pathways and pathological processes that can manifest themselves in circulation as abnormal levels of various biomarkers. Objective The aim of the study was to assess the factors associated with a worse prognosis in patients with advanced HF awaiting heart transplant during a 1-year follow-up. Patient s and methods We prospectively assessed the data of 203 adult patients with advanced HF, who were hospitalized at our institution between 2016 and 2018. The study end point was all-cause death during a 1-year follow-up. Result s The median age of patients was 57 years (range, 52-60); 87.7% of patients were male. During follow-up, 62 patients (30.5%) died. Serum levels of procalcitonin (hazard ratio [HR], 1.027; 95% CI, 1.020-1.034; P <0.001; per 10-unit increase), high-sensitivity C-reactive protein (hs-CRP; HR, 1.099; 95% CI, 1.016-1.883; P = 0.02; per 1-unit increase), sodium (HR, 1.171; 95% CI, 1.076-1.272; P <0.001; per 1-unit increase), and N-terminal pro-B-type natriuretic peptide (NT-proBNP; HR, 1.068; 95% CI, 1.033-1.105; P <0.001; per 1000-unit increase) were independent risk factors for mortality. Procalcitonin generated the largest area under the curve (0.780; 95% CI, 0.712-0.848). Conclusions Our study showed that higher serum hs-CRP, NT-proBNP, and procalcitonin levels and lower serum sodium levels were independent risk factors for death during a 1-year follow-up in patients with advanced HF. Procalcitonin showed the strongest predictive power, sensitivity, and specificity, allowing for an effective identification of 1-year survivors and nonsurvivors awaiting heart transplant.