Prognostic significance of endogenous erythropoietin in long‐term outcome of patients with acute decompensated heart failure

Nagai, Toshiyuki; Nishimura, Kunihiro; Honma, Takehiro; Higashiyama, Aya; Sugano, Yasuo; Nakai, Michikazu; Honda, Satoshi; Iwakami, Naotsugu; Okada, Atsushi; Kawakami, Shoji; Kanaya, Tomoaki; Asaumi, Yasuhide; Aiba, Takeshi; Nishida, Yoko; Kubota, Yoshimi; Sugiyama, Daisuke; Okamura, Tomonori; Noguchi, Teruo; Kusano, Kengo; Ogawa, Hisao; Yasuda, Satoshi; Anzai, Toshihisa

doi:10.1002/ejhf.537

Cited by 35 publications

(25 citation statements)

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“…The validation cohort for our study was the NaDEF study: an ongoing, prospective, single‐centre acute HF registry conducted at the National Cerebral and Cardiovascular Center in Osaka, Japan (West Japan), that began from January 2013. The objectives and detailed design are provided on the University Hospital Medical Information Network (UMIN000017024) …”

Section: Methodsmentioning

confidence: 99%

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Performance of the MAGGIC heart failure risk score and its modification with the addition of discharge natriuretic peptides

et al. 2018

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AimsPredictive models for heart failure patients are widely used in the clinical practice to stratify patients' mortality and enable clinicians to tailor and intensify their approach. However, such models have not been validated internationally. In addition, biomarkers are now frequently measured to obtain prognostic information, and the implications of this practice are not known. In this study, we aimed to validate the model performance of the Meta‐analysis Global Group in Chronic Heart Failure (MAGGIC) score in a Japanese acute heart failure registry and further explore the incremental prognostic value of discharge B‐type natriuretic peptide (BNP) level.Methods and ResultsIn this study, we evaluated the registered data of 2215 consecutive acute HF patients (with 694 119 person‐years follow‐up) from a prospective multicentre registry (the West Tokyo Heart Failure) conducted in Japan from April 2006 to August 2016. The mean age was 73.0 ± 13.0, and 61.2% were male. The MAGGIC score demonstrated modest discrimination (c‐index = 0.71, 95% confidence interval 0.67–0.74) and good calibration (R 2 value = 0.97); there was constant overestimation for 1 year mortality. However, when the BNP level was added to the original MAGGIC variables, the model demonstrated good discrimination (c‐index = 0.74, 95% confidence interval 0.70–0.78) with adequate calibration (R 2 value = 0.91). The modified MAGGIC BNP score was externally validated in a separate Japanese registry (NaDEF) and demonstrated moderate discrimination (c‐index = 0.69, 95% confidence interval 0.65–0.73) and calibration (R 2 value = 0.85).ConclusionThe original MAGGIC score performed modestly in Japanese patients, but the addition of discharge BNP level enhanced model performance. The addition of objective biomarkers may result in effective modification of preexisting internationally recognized risk models and aid in multinational comparisons of heart failure patients' outcomes.

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Section: Methodsmentioning

confidence: 99%

“…The objectives and detailed design are provided on the University Hospital Medical Information Network (UMIN000017024). 16,17…”

Section: Study Populationmentioning

confidence: 99%

Performance of the MAGGIC heart failure risk score and its modification with the addition of discharge natriuretic peptides

et al. 2018

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“…EPO levels were assessed at intervals of more than 72 h from the last injection of rHuEPO; therefore, the impact of rHuEPO might have been small. Several studies have reported an increased level of plasma EPO in patients with heart failure, which was correlated to a more severe outcome [10][11][12][13]. Meanwhile, female gender, inflammation, hyperphosphatemia, hyperglycemia, and dyslipidemia were identified as potential risk factors of microvascular dysfunction [14][15][16].…”

Section: Discussionmentioning

confidence: 99%

Higher reticulocyte counts are associated with higher mortality rates in hemodialysis patients: a retrospective single-center cohort study

Takagi

Ono²,

Matsuo

et al. 2017

Ren Replace Ther

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Background: We assessed laboratory data related to mortality in hemodialysis (HD) patients. In our preliminary study, we examined all of the data for HD outpatients in our facility according to whether the patient had survived. A statistically significant difference was observed for the reticulocyte count, which has not previously been considered a prognostic factor. We subsequently verified the relationship between all-cause and cardiovascular mortality and reticulocyte count. Methods: We retrospectively analyzed the data of 358 hemodialysis outpatients who were followed up for an average of 41.4 months. The patients were divided into quartiles according to the reticulocyte count levels. Results: Higher reticulocyte counts were associated with female gender, an increase in interdialytic body weight gain, serum erythropoietin level, white blood cell count, and increased levels of lactate dehydrogenase, inorganic phosphorus, non-high-density lipoprotein, and glucose. As compared with patients in the lowest quartile, those in the highest quartile showed significantly higher adjusted hazard ratios (HRs) for all-cause (HR 3.12; 95% confidence interval (CI) 1.26 to 7.74) and cardiovascular (HR 4.93; 95% CI 1.24 to 19.56) mortality. For every 10 4 cells/μL increment in the reticulocyte count, the adjusted HRs for all-cause and cardiovascular mortality were 1.33 (95% CI 1.17 to 1.51) and 1.38 (95% CI 1.17 to 1.63), respectively. The association of reticulocyte count with all-cause and cardiovascular mortality was independent of other prognostic factors. Stepwise multivariable Cox analysis indicated that only age showed stronger association with all-cause mortality than reticulocyte count. Regarding cardiovascular mortality, reticulocyte count was found as the strongest progenitor. We also examined the relationship between the reticulocyte count and the temporal hemoglobin trend (a slope of changes in hemoglobin levels over time). A statistically significant negative correlation was found. Conclusions: Higher reticulocyte counts were associated with higher mortality. We speculate that this result reflects tissue hypoxia, which results in a higher erythropoietin level, or a compensatory erythropoietic response due to the accelerated clearance of erythrocytes. Prospective studies are warranted to confirm our findings.

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“…However, there may be differences across countries due to differences in healthcare systems and ethnicities . Nagai et al . have applied five different prognostic models developed in the U.S. and Europe to HF patients prospectively enrolled in the UK and Japan.…”

Section: Patients' Outcomesmentioning

confidence: 99%

August 2018 at a glance: patients' outcomes, obesity and medical therapy

Metra

2018

European J of Heart Fail

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Prognostic significance of endogenous erythropoietin in long‐term outcome of patients with acute decompensated heart failure

Cited by 35 publications

References 30 publications

Performance of the MAGGIC heart failure risk score and its modification with the addition of discharge natriuretic peptides

Performance of the MAGGIC heart failure risk score and its modification with the addition of discharge natriuretic peptides

Higher reticulocyte counts are associated with higher mortality rates in hemodialysis patients: a retrospective single-center cohort study

August 2018 at a glance: patients' outcomes, obesity and medical therapy

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