Serial Monitoring of Soluble Interleukin Family Member ST2 in Patients with Acutely Decompensated Heart Failure

Abstract

Objectives: To determine whether serial measures of the interleukin receptor family member soluble ST2 (sST2) provide additional prognostic information to baseline measures for long-term risk stratification of acutely decompensated heart failure (ADHF) patients. Methods: We prospectively enrolled 72 ADHF patients. Blood samples were collected to measure sST2 concentrations at presentation and on day 4 of hospitalization. All patients were clinically followed, and vital status was registered. Results: Between presentation and day 4, sST2 concentrations decreased from 62 ng/ml (interquartile range 38–105) to 44 ng/ml (interquartile range 26–72; p < 0.001). Both sST2 concentrations at presentation [hazard ratio (HR) 1.011, 95% confidence interval (CI) 1.005–1.016; p < 0.001] and on day 4 (HR 1.015, 95% CI 1.005–1.024; p = 0.003) were independent predictors of mortality. Patients with sST2 ≤76 ng/ml at presentation and ≤46 ng/ml on day 4 had the lowest mortality rates (3%), whereas those with both sST2 values above these cutoff points had the highest mortality (50%). C index and reclassification analyses demonstrated that the use of serial sST2 measures resulted in an improvement in the accuracy of mortality prediction. Conclusions: Among ADHF patients, sST2 concentrations tend to decrease following initiation of treatment and are prognostic both at presentation and during hospitalization. Serial sampling of sST2 adds prognostic information and may provide a basis for enhanced clinical decision making.

Role of Biomarkers for the Prevention, Assessment, and Management of Heart Failure: A Scientific Statement From the American Heart Association

“…107 Similar to chronic HF, serial measurement adds value to a baseline concentration of sST2. Several cohorts have now shown that posttreatment concentrations of sST2 more powerfully predict death compared with baseline values [182][183][184] and in general provide superior prognostic information to other markers, including BNP or NT-proBNP, in this regard. 155 In addition to the natriuretic peptides, there is a substantial literature on other biomarkers at the time of AHF hospitalization and subsequent risk.…”

Predictors of Long-Term Mortality in Patients With Acute Heart Failure

“…Similarly, the highsST2 group benefited most from beta-blocker therapy in other settings. 37,38) sST2 might be used to help clinicians with decision-making and it is also a potential therapeutic target.…”

Prognostic Value of Soluble ST2 in the Valsartan Heart Failure Trial

“…Although the sST2 levels in this study were similar to other reports of chronic HF, 7-9 levels of sST2 in patients with acute HF and post-MI are significantly higher but fall rapidly over days to weeks. 5,6,18,19 This may be part of an acute neurohormonal and inflammatory stress response that may not be present in clinically stable HF such as those enrolled in Val-HeFT.…”