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Serum Human Epididymis Protein 4 Has Diagnostic and Prognostic Capability for Type 1 Cardio-Renal Syndrome from Acute Heart Failure Alone
30 Pages Posted: 27 Jun 2019
More...Abstract
Background: Recently serum human epididymis protein 4 (HE4) showed an association with renal insufficiency. The study aimed to assess the performance of HE4 in the early detection of type 1 cardio-renal syndrome (type 1 CRS) in acute HF patients. Prognostic value of serum HE4 for predicting cardiac events in patients with type 1 CRS was also analyzed.
Methods: Serum HE4 levels were measured in 199 patients with acute HF. All HF patients with were prospectively followed up for a median period of 36 months (range=3-38).
Results:Serum HE4 levels were higher in acute HF with type 1 CRS compared with acute HF without type 1 CRS (187.5 pmol/L[146.9-282.4] vs 111.0 pmol/L [104.8-117.1]; P<0.001). The multivariate logistic regression model revealed that HE4 (OR=2.312; 95%CI, 1.823-5.352; P<0.001) was independently associated with type 1 CRS. At a cutoff value of 126.2 pmol/L, HE4 (AUC=0.956) determined type 1 CRS in acute HF with a sensitivity of 90.4% and a specificity of 98.8%. The multivariate Cox proportional hazard analysis revealed that HE4 (HR=2.612, 95% CI 1.773-7.469, P<0.001) was an independent prognostic factor for cardiac events. The Kaplan-Meier analysis demonstrated that in patients with type 1 CRS, the rate of cardiac events was higher in patients with HE4 levels above the median compared with those with HE4 levels below the median.
Conclusions: Serum HE4 might be used as a potential biomarker to distinguish type 1 CRS from acute HF patients and is an independent prognostic factor of cardiac events.
Funding Statement: The authors state: "No."
Declaration of Interests: All the authors declared no conflict of interest and nothing to disclose.
Ethics Approval Statement: According to Declaration of Helsinki guidelines, the Ethics Committee of Renmin Hospital of Wuhan University approved this prospective study and all patients gave written informed consent.
Keywords: human epididymis protein 4, acute heart failure, type 1 cardiorenal syndrome
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