Proenkephalin, Renal Dysfunction, and Prognosis in Patients With Acute Heart Failure
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Proenkephalin, Renal Dysfunction, and Prognosis in Patients With Acute Heart Failure : A GREAT Network Study. / Ng, Leong L.; Squire, Iain B.; Jones, Donald J.L.; Cao, Thong Huy; Chan, Daniel C.S.; Sandhu, Jatinderpal K.; Quinn, Paulene A.; Davies, Joan E.; Struck, Joachim; Hartmann, Oliver; Bergmann, Andreas; Mebazaa, Alexandre; Gayat, Etienne; Arrigo, Mattia; Akiyama, Eiichi; Sabti, Zaid; Lohrmann, Jens; Twerenbold, Raphael; Herrmann, Thomas; Schumacher, Carmela; Kozhuharov, Nikola; Mueller, Christian.
in: J AM COLL CARDIOL, Jahrgang 69, Nr. 1, 03.01.2017, S. 56-69.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - Proenkephalin, Renal Dysfunction, and Prognosis in Patients With Acute Heart Failure
T2 - A GREAT Network Study
AU - Ng, Leong L.
AU - Squire, Iain B.
AU - Jones, Donald J.L.
AU - Cao, Thong Huy
AU - Chan, Daniel C.S.
AU - Sandhu, Jatinderpal K.
AU - Quinn, Paulene A.
AU - Davies, Joan E.
AU - Struck, Joachim
AU - Hartmann, Oliver
AU - Bergmann, Andreas
AU - Mebazaa, Alexandre
AU - Gayat, Etienne
AU - Arrigo, Mattia
AU - Akiyama, Eiichi
AU - Sabti, Zaid
AU - Lohrmann, Jens
AU - Twerenbold, Raphael
AU - Herrmann, Thomas
AU - Schumacher, Carmela
AU - Kozhuharov, Nikola
AU - Mueller, Christian
N1 - Publisher Copyright: © 2017 American College of Cardiology Foundation
PY - 2017/1/3
Y1 - 2017/1/3
N2 - Background Proenkephalin A (PENK) and its receptors are widely distributed. Enkephalins are cardiodepressive and difficult to measure directly. PENK is a stable surrogate analyte of labile enkephalins that is correlated inversely with renal function. Cardiorenal syndrome is common in acute heart failure (HF) and portends poor prognosis. Objectives This study assessed the prognostic value of PENK in acute HF, by identifying levels that may be useful in clinical decisions, and evaluated its utility for predicting cardiorenal syndrome. Methods This multicenter study measured PENK in 1,908 patients with acute HF (1,186 male; mean age 75.66 ± 11.74 years). The primary endpoint was 1-year all-cause mortality; secondary endpoints were in-hospital mortality, all-cause mortality or HF rehospitalization within 1 year, and in-hospital worsening renal function, defined as a rise in plasma creatinine ≥26.5 μmol/l or 50% higher than the admission value within 5 days of presentation. Results During 1-year follow-up, 518 patients died. Measures of renal function were the major determinants of PENK levels. PENK independently predicted worsening renal function (odds ratio: 1.58; 95% confidence interval [CI]: 1.24 to 2.00; p < 0.0005) with a model receiver-operating characteristic area of 0.69. PENK was associated with the degree of worsening renal function. Multivariable Cox regression models showed that PENK level was an independent predictor of 1-year mortality (p < 0.0005) and 1-year death and/or HF (hazard ratio: 1.27; 95% CI: 1.10 to 1.45; p = 0.001). PENK levels independently predicted outcomes at 3 or 6 months and were independent predictors of in-hospital mortality, predominantly down-classifying risk in survivors when added to clinical scores; levels <133.3 pmol/l and >211.3 pmol/l detected low-risk and high-risk patients, respectively. Conclusions PENK levels reflect cardiorenal status in acute HF and are prognostic for worsening renal function and in-hospital mortality as well as mortality during follow-up.
AB - Background Proenkephalin A (PENK) and its receptors are widely distributed. Enkephalins are cardiodepressive and difficult to measure directly. PENK is a stable surrogate analyte of labile enkephalins that is correlated inversely with renal function. Cardiorenal syndrome is common in acute heart failure (HF) and portends poor prognosis. Objectives This study assessed the prognostic value of PENK in acute HF, by identifying levels that may be useful in clinical decisions, and evaluated its utility for predicting cardiorenal syndrome. Methods This multicenter study measured PENK in 1,908 patients with acute HF (1,186 male; mean age 75.66 ± 11.74 years). The primary endpoint was 1-year all-cause mortality; secondary endpoints were in-hospital mortality, all-cause mortality or HF rehospitalization within 1 year, and in-hospital worsening renal function, defined as a rise in plasma creatinine ≥26.5 μmol/l or 50% higher than the admission value within 5 days of presentation. Results During 1-year follow-up, 518 patients died. Measures of renal function were the major determinants of PENK levels. PENK independently predicted worsening renal function (odds ratio: 1.58; 95% confidence interval [CI]: 1.24 to 2.00; p < 0.0005) with a model receiver-operating characteristic area of 0.69. PENK was associated with the degree of worsening renal function. Multivariable Cox regression models showed that PENK level was an independent predictor of 1-year mortality (p < 0.0005) and 1-year death and/or HF (hazard ratio: 1.27; 95% CI: 1.10 to 1.45; p = 0.001). PENK levels independently predicted outcomes at 3 or 6 months and were independent predictors of in-hospital mortality, predominantly down-classifying risk in survivors when added to clinical scores; levels <133.3 pmol/l and >211.3 pmol/l detected low-risk and high-risk patients, respectively. Conclusions PENK levels reflect cardiorenal status in acute HF and are prognostic for worsening renal function and in-hospital mortality as well as mortality during follow-up.
KW - acute kidney injury
KW - B-type natriuretic peptide
KW - mortality
KW - net reclassification improvement
KW - opioids
UR - http://www.scopus.com/inward/record.url?scp=85009144911&partnerID=8YFLogxK
U2 - 10.1016/j.jacc.2016.10.038
DO - 10.1016/j.jacc.2016.10.038
M3 - SCORING: Journal article
C2 - 28057251
AN - SCOPUS:85009144911
VL - 69
SP - 56
EP - 69
JO - J AM COLL CARDIOL
JF - J AM COLL CARDIOL
SN - 0735-1097
IS - 1
ER -