Laboratory biomarkers of poor prognosis in patients admitted for acute heart failure
I Cruz, R B Ventura, D Mauricio, D Martinez, M J Primo, L Leite, D Ramos, L GoncalvesAbstract
Background
Biomarkers play a key role in the prognostic assessment of patients admitted for acute heart failure (AHF). Simple and routinely available laboratory parameters such as haemoglobin, creatinine, sodium, potassium, and NT-proBNP may provide valuable prognostic information in AHF.
Purpose
To evaluate the prognostic value of routine laboratory markers for short-, medium-, and long-term all-cause mortality in patients hospitalised for AHF.
Methods
We retrospectively analysed consecutive patients admitted for AHF to a tertiary centre between February and August 2024. Baseline laboratory data were collected at admission. Anaemia was defined as haemoglobin <13 g/dL in men or <12 g/dL in women; hyponatraemia as sodium <135 mmol/L; and elevated creatinine as >1.5 mg/dL. NT-proBNP values were log-transformed and considered high when above the sample median. All-cause mortality was assessed in-hospital and at 1, 6, and 12 months. The Mann–Whitney test, Kaplan–Meier survival analysis, and Cox proportional hazards models were applied.
Results
A total of 121 patients were included (median age 81.0 years [IQR 75.0–87.0], 56.2% male). Previous left ventricular ejection fraction (LVEF) was unknown in 25.6% of patients, preserved in 31.4%, moderately reduced in 17.4%, and reduced in 25.6%, with a median of 46.0% (IQR 32.8–56.3) among those with available data. All-cause mortality was 7.4% in-hospital, 11.6% at 1 month, 21.5% at 6 months, and 32.2% at 12 months. At admission, patients who died within 12 months had lower haemoglobin [11.6 (9.9–13.0) vs. 12.7 (10.8–13.8) g/dL], higher creatinine [1.9 (1.4–2.4) vs. 1.0 (0.9–1.4) mg/dL], and markedly higher NT-proBNP [15.9 (7.45–31.6) vs. 5.3 (2.7–10.2) pg/mL]. Serum sodium tended to be lower among non-survivors, whereas potassium levels were comparable between groups. Kaplan–Meier analysis showed worse survival for high NT-proBNP (χ²=14.9, p<0.001), elevated creatinine (χ²=25.1, p<0.001), and anaemia (χ²=6.9, p=0.009). In multivariable Cox regression, elevated creatinine (HR 3.51, 95% CI 1.58–7.80, p=0.002) and high NT-proBNP (HR 2.89, 95% CI 1.28–6.55, p=0.011) remained independent predictors of 12-month mortality, whereas anaemia lost significance after adjustment.
Conclusions
In AHF, elevated creatinine and NT-proBNP at admission are strong independent predictors of 12-month mortality, highlighting the prognostic impact of renal dysfunction and neurohormonal activation. Anaemia also contributes to adverse outcomes, while hyponatraemia shows a non-significant trend. These routinely available biomarkers may support early risk stratification and guide management in AHF.For image description, please refer to the figure legend and surrounding text.For image description, please refer to the figure legend and surrounding text.