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Prognostic value of DCTA scoring system in heart failure

Prognostischer Wert des DCTA-Scores bei Herzinsuffizienz

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Abstract

Objective

The aim of this study was to evaluate the prognostic value of a novel scoring system, based on D‑dimer, total cholesterol, high-sensitivity cardiac troponin T (hs-cTnT), and serum albumin levels, in patients with heart failure.

Methods

A total of 221 patients diagnosed with heart failure between May 2016 to January 2020 were enrolled in this retrospective study. The prognostic significance of the biomarkers D‑dimer, total cholesterol, hs-cTnT, and serum albumin was determined with univariate and multivariate Cox proportional hazard models. A novel prognostic score based on these predictors was established. The Kaplan–Meier method and log-rank test were used to compare the adverse outcomes of patients in different risk groups.

Result

Results from univariate and multivariate analyses showed that high D‑dimer, low serum albumin, high hs-cTnT, and low total cholesterol levels were independent prognostic factors for adverse outcomes (D-dimer >0.63 mg/l, HR = 1.84, 95% CI = 1.16–2.94, p = 0.010; serum albumin >34 g/l, HR = 0.67, 95% CI = 0.45–0.99, p = 0.046; hs-cTnT >24.06 pg/ml, HR = 1.65, 95% CI = 1.08–2.53, p = 0.020; total cholesterol >3.68 mmol/l, HR = 0.63, 95% CI = 0.43–0.92, p = 0.017). Moreover, all the patients were stratified into low-risk or high-risk group according to a scoring system based on these four markers. Kaplan–Meier analyses demonstrated that patients in the high-risk group were more prone to having adverse outcomes compared with patients in the low-risk group.

Conclusion

D‑dimer, total cholesterol, hs-cTnT, and serum albumin levels were independent prognostic factors in the setting of heart failure. A novel and comprehensive scoring system based on these biomarkers is an easily available and effective tool for predicting the adverse outcomes of patients with heart failure.

Zusammenfassung

Ziel der Arbeit

Ziel der vorliegenden Studie war es, den prognostischen Wert eines neuen Score-Systems zu untersuchen, der auf den Werten für D‑Dimere, Gesamtcholesterin, hochsensitives kardiales Troponin (hs-cTnT) und Serumalbumin bei Patienten mit Herzinsuffizienz beruht.

Methoden

In diese retrospektive Studie wurden 221 Patienten mit Diagnosestellung einer Herzinsuffizienz zwischen Mai 2016 und Januar 2020 einbezogen. Die prognostische Bedeutung der Biomarker D‑Dimere, Gesamtcholesterin, hs-cTnT und Serumalbumin wurde anhand univariater und multivariater Cox-Proportional-Hazard-Modelle ermittelt. Es wurde ein neuer prognostischer Score auf der Grundlage dieser Prädiktoren etabliert. Um unerwünschte Ereignisse zwischen den Patienten in verschiedenen Risikogruppen zu vergleichen, wurden die Kaplan-Meier-Methode und der Log-Rank-Test eingesetzt.

Ergebnisse

Die Ergebnisse der univariaten und multivariaten Analysen zeigten, dass hohe Werte für D‑Dimere und hs-cTnT sowie niedrige Werte für Gesamtcholesterin und Serumalbumin unabhängige prognostische Faktoren für ungünstige Outcomes waren (D-Dimere >0,63 mg/l; Hazard Ratio, HR = 1,84; 95%-Konfidenzintervall, 95%-KI = 1,16–2,94; p = 0,010; Serumalbumin >34 g/l; HR = 0,67; 95%-KI = 0,45–0,99; p = 0,046; hs-cTnT >24,06 pg/ml; HR = 1,65; 95%-KI = 1,08–2,53; p = 0,020; Gesamtcholesterin >3,68 mmol/l; HR = 0,63; 95%-KI = 0,43–0,92; p = 0,017). Darüber hinaus wurden alle Patienten gemäß einem Scoring-System auf Grundlage dieser 4 Parameter in eine Niedrigrisikogruppe oder Hochrisikogruppe eingeteilt. Die Kaplan-Meier-Analysen ergaben, dass bei den Patienten in der Hochrisikogruppe eine höhere Tendenz zu ungünstigen Outcomes als bei den Patienten in der Niedrigrisikogruppe bestand.

Schlussfolgerung

Die Werte für D‑Dimere, Gesamtcholesterin, hs-cTnT sowie Serumalbumin stellten sich als unabhängige prognostische Faktoren bei Vorliegen einer Herzinsuffizienz heraus. Ein neues und umfassendes Scoring-System auf der Basis dieser Biomarker erwies sich als leicht verfügbares und effektives Instrument zur Vorhersage ungünstiger Outcomes bei Patienten mit Herzinsuffizienz.

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Acknowledgements

The authors thank Dr. Jin Meng for his continuous support in data collection.

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Authors and Affiliations

  1. Department of Cardiology, The People’s Hospital of China Medical University, The People’s Hospital of Liaoning Province, No.33 Wenyi Road, Shenhe District, 110016, Shenyang, China

    Tian-Jun Zhao, Li-Dan Bi, Jie Li, Chun-Yu Tan &  Zhi-Lin Miao

  2. Department of Bone and Soft Tissue Surgery, Cancer Hospital of China Medical University, Liaoning Cancer Hospital & Institute, 110042, Shenyang, China

    Qian-Kun Yang

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  1. Tian-Jun Zhao
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Corresponding author

Correspondence to Zhi-Lin Miao.

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Conflict of interest

T.‑J. Zhao, Q.‑K. Yang, L.‑D. Bi, J. Li, C.‑Y. Tan and Z.‑L. Miao declare that they have no competing interests.

The present study was performed in accordance with the World Medical Association Declaration of Helsinki and was approved by the Ethics Board of The People’s Hospital of China Medical University. This study was a retrospective study and all the data used in the final analysis was anonymous. Therefore, the informed consent from the enrolled patients was waived. The institutional review board of our hospital gave the ethical approval for this study.

Additional information

Tian-Jun Zhao and Qian-Kun Yang contributed equally to this work and shared the co-authorship.

Author contributions

Tian-Jun Zhao and Qian-Kun Yang performed the experiment and wrote the manuscript. Tian-Jun Zhao was responsible for the design of the experiment. Li-Dan Bi and Chun-Yu Tan analyzed the data. Jie Li helped with the statistical analysis. Zhi-Lin Miao provided professional support and revised the manuscript. All authors read and approved the final manuscript.

Availability of data and materials

The datasets used and/or analyzed during the present study are available from the corresponding author on reasonable request.

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Zhao, TJ., Yang, QK., Bi, LD. et al. Prognostic value of DCTA scoring system in heart failure. Herz 46 (Suppl 2), 243–252 (2021). https://doi.org/10.1007/s00059-020-04993-1

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