Page 35 - Biomarkers for risk stratification and guidance in heart failure

Chapter 2
Table 3: Performance of biomarkers for prediction of 90-day mortality
Marker
NT-proBNP Hs-cTnT Hs-CRP Galectin-3 Cystatin-C
AUC (95% CI)
0.73 (0.67-0.78) 0.74 (0.69-0.80) 0.73 (0.68-0.79) 0.75 (0.69-0.81) 0.73 (0.68-0.78)
P Cut-off
<0.001 4500 pg/ml <0.001 0.04 μg /L <0.001 25 mg/L <0.001 25μg/L <0.001 1.125 mg/L
Sensitivity Specificity PPV NPV
72% 64% 23% 94% 74% 67% 25% 95% 67% 72% 26% 94% 76% 64% 24% 95% 83% 53% 21% 96%
AUC=area under curve from receiver operating curve analysis, PPV=positive predictive value; NPV=negative predictive value
Table 4: Performance of predictive models for 90-day mortality
Marker
Clinical risk factorsa + NT-proBNP
+ HsTnT
+ Hs-CRP
+ Cystatin-C
+ Galectin-3
Clinical risk factors + 3 markersb
Wald OR (95% CI)
- -
16.1 3.14 (1.80-5.49) 25.3 4.33 (2.45-7.67) 29.9 4.69 (2.70-8.16) 13.3 3.44 (1.77-6.67) 19.3 3.75 (2.08-6.78)
- -
Chi-Square model
72.3 89.4* 100.3* 104.3* 87.7* 93.4* 130.0*
C-statistic AUC (95% CI)
0.78 (0.73-0.83) 0.81 (0.76-0.86) 0.82 (0.78-0.87)# 0.83 (0.78-0.88)$ 0.81 (0.77-0.86)# 0.82 (0.77-0.87)# 0.86 (0.82-0.90)*
NRI IDI
Hos-Lem
Table 5: Event rates by MARKED-risk score categories
- - 0.60 7% 4%* 0.23 18%$ 6%* 0.50 21%* 7%* 0.57 10%# 2%$ 0.29 19%$ 4%* 0.62 34%* 12%* 0.78
* P<0.001 for comparison with clinical risk model. $ P<0.01 for comparison with
for comparison with clinical risk model.
a: final clinical model including age ≥75 years, sex, history of heart failure, dyspnea NYHA IV, systolic blood pressure <110. b: final prognostic model including final clinical model plus hs-cTnT, hs-CRP and cystatin-C. OR=odds ratio; AUC=area under curve; NRI = net reclassification index; IDI=integrated discrimination index; Hos-Lem=Hosmer Lemeshow statistic (a P-value close to 1 indicates excellent calibration)
clinical risk model. # P<0.05
Admission In-hospital mortality 30-day mortality 30-day CV mortality 90-day mortality 90-day CV mortality 1-year mortality 1-year CV mortality
CV=cardiovascular
MARKED score Low: 0-2 (n=287)
127 (44%) 1 (0%)
4 (1%)
2 (1%)
5 (2%) 3 (1%) 24 (8%) 13 (5%)
MARKED score Intermediate: 3-4 (n=219)
146 (67%) 11 (5%) 17 (8%) 14 (6%) 30 (14%) 22 (10%) 65 (30%) 47 (22%)
MARKED score high: 5+ (n=97)
74 (76%) 18 (19%) 32 (33%) 24 (25%) 43 (44%) 33 (34%) 56 (58%) 40 (41%)
P-value
<0.001 <0.001 <0.001 <0.001 <0.001 <0.001 <0.001 <0.001
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