Plasma-free 4-hydroxynonenal serves as an independent predictive biomarker for short-term prognosis in patients with heart failure complicated by renal dysfunction
Xiaoshuai Song, Fengxin Wang, Wenyi Zou, Ran Li, Ping Xu, Shuo Wu, Jianhua Gu, Ruixue Song, Xuting Wu, Huaxiang Yu, Dan Zou, Yuting Li, Yang Liu, Xinyue Zhang, Haiying Rui, Kai Chi, Lulu Liu, Rui Shang, Mengxiong Tang, Yuan Bian, Jiaojiao Pang, Jianmin Yang, Chuanbao Li, Lutao Du, Yi Zhang, Feng Xu, Wenxiao Wu, Li XueBackground:
Patients with heart failure (HF) complicated by renal dysfunction (RD) carry an exceedingly poor prognosis, and there is a lack of precise predictive biomarkers. 4-Hydroxynonenal (4-HNE) can exacerbate cardiorenal injury, but its association with HF complicated by RD remains unclear. We aimed to investigate the predictive value of plasma-free 4-HNE for adverse clinical outcomes in patients with HF complicated by RD.
Methods:
This prospective study enrolled 114 patients with HF (New York Heart Association class III–IV) and RD (estimated Glomerular Filtration Rate [eGFR] ≤ 60 mL/min/1.73 m 2 ). Plasma-free 4-HNE levels were measured upon hospital admission. The primary outcome was in-hospital mortality. Secondary outcomes included major adverse cardiovascular events (MACE) and a reduction rate in N-terminal pro-B-type natriuretic peptide (NT-proBNP) ≥30%. Predictive value was assessed using receiver operating characteristic curves and logistic regression analyses.
Results:
The area under the curves of 4-HNE for predicting in-hospital mortality, MACE, and NT-proBNP reduction ≥30% were 0.700, 0.772, and 0.639, respectively. Multivariate regression analysis showed that 4-HNE was an independent predictive factor for in-hospital mortality (odds ratios [OR]: 3.74 [1.73–9.37]), MACE (OR: 7.21 [2.28–18.38]), and failure to achieve NT-proBNP reduction ≥30% (OR: 0.40) (all
Conclusion:
Plasma-free 4-HNE can predict in-hospital mortality, MACE, and NT-proBNP reduction in patients with HF complicated by RD. This finding indicates that 4-HNE serves as an independent predictive factor for adverse short-term outcomes, thereby facilitating the clinical identification of high-risk patient populations.