Prognostic Value of Elevated Serum Ceruloplasmin Levels in Patients With Heart Failure

Abstract

Background Ceruloplasmin (Cp) is a copper-binding acute-phase protein that is increased in inflammatory states and deficient in Wilson’s disease. Recent studies demonstrate increased levels of Cp are associated with increased risk of developing heart failure. Our objective is to test the hypothesis that serum Cp provides incremental and independent prediction of survival in stable patients with heart failure. Methods and Results We measured serum Cp levels in 890 patients with stable heart failure undergoing elective cardiac evaluation that included coronary angiography. We examine the role of Cp levels in predicting survival over 5-years of follow-up. Mean Cp level was 26.6±6.9 mg/dL, and demonstrated relatively weak correlation with BNP (r=0.187, p<0.001). Increased Cp levels were associated with increased 5 year all-cause mortality (Q4 vs Q1 HR 1.9, 95%CI 1.4–2.8, p<0.001). When controlled for coronary disease traditional risk factors, creatinine clearance, dialysis, body mass index, medications, history of myocardial infarction, BNP, LVEF, heart rate, QRS duration, left bundle branch blockage and ICD, higher Cp remained an independent predictor of increased mortality (Q4 vs Q1 HR1.7, 95%CI 1.1 – 2.6, p<0.05). Model quality was improved with addition of Cp to aforementioned co-variables (NRI of 9.3%, p<0.001) Conclusions Ceruloplasmin is an independent predictor of all-cause mortality in patients with heart failure. Use of Cp may help to identify patients at heightened mortality risk.

High‐density lipoprotein‐associated paraoxonase‐1 activity for prediction of adverse outcomes in outpatients with chronic heart failure

“…In clinical practice, clinicians tend to treat HF patients based on their EF, without considering the underlying mechanism. Our findings are important in the context that, among different HF patients, there is a variable involvement of different mechanisms, such as inflammation, oxidative stress, microvascular rarefaction, pressure overload, endothelial dysfunction, etc. Thus, profiling HF patients in a more mechanistically driven way may help in identifying patients at heightened risk and provide a more individualized HF therapy.…”

Correlation of Ceruloplasmin with Biomarkers of Cardiac Remodelling and Myofibrosis in Patients with Acute Decompensated Heart Failure Referred to a Tertiary Nurse Lead Heart Failure Clinic

“…Association of ceruloplasmin with other heart failure biomarkers was analyzed in several studies. In a study of patients with stable chronic HF, ceruloplasmin levels weakly correlated with B-type natriuretic peptide (r = 0.187, p < 0.001) [7].…”

“…The Atherosclerosis Risk in Communities (ARIC) Study reveals the association of elevated ceruloplasmin levels with the risk of incident heart failure (HF), HF mortality and risk of cardiovascular disease (CVD) in healthy individuals [6]. In the patients with established chronic heart failure, ceruloplasmin levels correlated with the severity of heart and weakly with B-natriuretic peptide levels, but predicted all-cause mortality [7].…”

Inflammatory and oxidative status in European captive black rhinoceroses: a link with Iron Overload Disorder?

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