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Zhang H, Jie Y, Sun Y, Wang X, Gong D, Fan Y. Association of cognitive impairment with mortality and readmission in patients with heart failure: A meta-analysis. Curr Probl Cardiol 2022; 47:101354. [PMID: 35970299 DOI: 10.1016/j.cpcardiol.2022.101354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 08/05/2022] [Accepted: 08/07/2022] [Indexed: 12/01/2022]
Abstract
Cognitive impairment is a frequent condition in patients with heart failure (HF). This meta-analysis aimed to evaluate the prognostic impact of cognitive impairment on all-cause mortality and readmission among HF patients. We systematically searched articles indexing in PubMed and Embase databases until August 5, 2022. Original studies investigating the association of cognitive impairment with mortality and/or readmission for more than 3-month follow-up in patients with HF were selected. Twelve studies including 9556 patients were eligible. The prevalence of cognitive impairment ranged from 13.5% to 63.4% in HF patients. For patients with cognitive impairment versus those without, the pooled adjusted risk ratio (RR) was 1.88 (95% confidence intervals [CI] 1.42-2.48) for all-cause mortality, 1.48 (95% CI 1.19-1.84) for readmission, and 1.53 (95% CI 1.35-1.73) for combined endpoints of all-cause mortality/readmission, respectively. Cognitive impairment is a significant predictor of all-cause mortality/readmission in patients with HF, even after adjustment for the conventional confounding. Evaluation of cognitive function may help to improve risk classification of HF patients.
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Affiliation(s)
- Hailing Zhang
- Center of Clinical Medical Research, The Affiliated Suqian First People's Hospital of Xuzhou Medical University, Suqian, Jiangsu, China (223800)
| | - Yu Jie
- Institute of Molecular Biology & Translational Medicine, The Affiliated People's Hospital, Jiangsu University, Zhenjiang, Jiangsu, China (212002)
| | - Yimeng Sun
- Institute of Molecular Biology & Translational Medicine, The Affiliated People's Hospital, Jiangsu University, Zhenjiang, Jiangsu, China (212002)
| | - Xiaoyan Wang
- Center of Clinical Medical Research, The Affiliated Suqian First People's Hospital of Xuzhou Medical University, Suqian, Jiangsu, China (223800).
| | - Dandan Gong
- Institute of Molecular Biology & Translational Medicine, The Affiliated People's Hospital, Jiangsu University, Zhenjiang, Jiangsu, China (212002).
| | - Yu Fan
- Institute of Molecular Biology & Translational Medicine, The Affiliated People's Hospital, Jiangsu University, Zhenjiang, Jiangsu, China (212002).
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Wang K, Ni G, Wu Q, Zhou Y, Yao W, Zhang H, Li X. Prognostic Value of N-Terminal Pro-B-Type Natriuretic Peptide and Glomerular Filtration Rate in Patients With Acute Heart Failure. Front Cardiovasc Med 2020; 7:123. [PMID: 32793638 PMCID: PMC7385066 DOI: 10.3389/fcvm.2020.00123] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 06/15/2020] [Indexed: 01/01/2023] Open
Abstract
Aims: To investigate the relationship between N-terminal pro-B-type natriuretic peptide (NT-proBNP), Glomerular Filtration Rate (GFR), and outcomes in patients hospitalized with acute heart failure (AHF). Methods: The trial was registered at http://www.chictr.org/cn/. (ChiCTR - ONC - 12001944). A total of 493 patients hospitalized for AHF in cardiology department of the First Affiliated Hospital of Nanjing Medical University from March 2012 to October 2016 were enrolled into registry. The end event was the occurrence of all-cause death within an 18-month follow-up. The data collected from the participants in admission were used to calculate the GFR by chronic kidney disease epidemiology collaboration equation (CKD-EPI) and performed the according statistical analysis. Results: There were 74 participants (13.8%) dropped out and 91 (21.7%) passed away within the 18-month follow up. Comparison of clinical indicators between survival and death group were analyzed for the long-term prognosis of patients with AHF. In the single factor analysis, both NT-proBNP and GFR were statistically significant (P < 0.001). Combined NT-proBNP and GFR in multi-factor COX regression analysis showed significant predictive value (P < 0.001). In receiver operator characteristics (ROC) analyses, the area under the curves (AUC) for NT-proBNP was 0.648 [95%CI: 0.598-0.695, P < 0.001] and for GFR was 0.677 [95%CI: 0.627-0.723, P < 0.001]. According to the Youden index, the best prediction point of NT-proBNP was 2,137 pg/ml and GFR was 61.7 ml/(min·1.73 m2). After using the Binary Logistic Regression to combine the two indicators, the AUC was 0.711, which was significantly compared to the AUC of either single factor. The sensitivity of the combined indicators were 0.535, the specificity were 0.853. According to the cut-off point, these two indexes were separated into four groups for further analysis by Kaplan-Meier survival curve comparison (log-rank test), which showed that patients in the group with higher NT-proBNP and lower GFR had the worst prognosis. Conclusions: In patients with NT-proBNP > 2,137 pg/ml and GFR < 61.7 ml/(min·1.73 m2), the risk of death was significantly higher. The combination of GFR and NT-proBNP improved the predictive value for the long-term prognosis of AHF patients.
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Affiliation(s)
| | | | | | | | | | - Haifeng Zhang
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xinli Li
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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Al-Hayali MA, Sozer V, Durmus S, Erdenen F, Altunoglu E, Gelisgen R, Atukeren P, Atak PG, Uzun H. Clinical Value of Circulating Microribonucleic Acids miR-1 and miR-21 in Evaluating the Diagnosis of Acute Heart Failure in Asymptomatic Type 2 Diabetic Patients. Biomolecules 2019; 9:biom9050193. [PMID: 31109008 PMCID: PMC6571732 DOI: 10.3390/biom9050193] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 05/10/2019] [Accepted: 05/15/2019] [Indexed: 12/14/2022] Open
Abstract
To investigate whether the circulating miR-1 (microRNA-1) and miR-21 expression might be used in the diagnosis of heart failure (HF) and silent coronary artery disease (SCAD) in asymptomatic type 2 diabetes mellitus (T2DM) patients and to explore the relationship of these miRs with N-terminal pro-brain natriuretic peptide (NT-proBNP) and galectin-3. One hundred thirty-five consecutive patients with T2DM and 45 matched control subjects were enrolled in the study. This study consisted of the following four groups: control group (mean age: 60.23 ± 6.27 years, female/male (F/M): 23/22); diabetic group (DM) (mean age: 61.50 ± 5.08, F/M: 23/22); DM + SCAD group (mean age: 61.61 ± 6.02, F/M: 20/25); and DM + acute HF group (mean age: 62.07 ± 5.26 years, F/M: 20/25). miR-1 was downregulated in the DM, CAD + DM and HF + DM groups by 0.54, 0.54, and 0.12 fold as compared with controls, respectively. The miR-1 levels were significantly lower in HF + DM than DM with 0.22 fold changes (p < 0.001); and in patients with CAD + DM group with 0.22 fold changes (p < 0.001). Similarly, miR-21 was overexpressed in patients with DM, CAD + DM, and HF + DM with 1.30, 1.79 and 2.21 fold changes as compared with controls, respectively. An interesting finding is that the miR-21 expression was significantly higher in the HF + DM group as compared with the CAD + DM group; miR-1 was negatively correlated with NT-proBNP (r = −0.891, p < 0.001) and galectin-3 (r = −0.886, p < 0.001) in the HF + DM group; and miR-21 showed a strongly positive correlation with (r = 0.734, p < 0.001) and galectin-3 (r = 0.764. p < 0.001) in the HF + DM group. These results suggest that the circulating decreased miR-1 and increased miR-21 expression are associated with NT-proBNP and galectin-3 levels in acute HF + DM. Especially the miR-21 expression might be useful in predicting the onset of acute HF in asymptomatic T2DM patients. The miR-21 expression is more valuable than the miR-1 expression in predicting cardiovascular events of acute HF and the combined analysis of miR-21 expression, galectin-3, and NT-proBNP can increase the predictive value of miR-21 expression.
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Affiliation(s)
- Mutaa Abdalmutaleb Al-Hayali
- Department of Biochemistry, Yildiz Technical University, Istanbul 34220, Turkey.
- Department of Physiology, Biochemistry and Pharmacology College of Veterinary Medicine, Mosul University, Mosul 09334, Iraq.
| | - Volkan Sozer
- Department of Biochemistry, Yildiz Technical University, Istanbul 34220, Turkey.
| | - Sinem Durmus
- Department of Biochemistry, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul 34098, Turkey.
| | - Fusun Erdenen
- Istanbul Training and research Hospital, Department of Internal Medicine, Istanbul 34098, Turkey.
| | - Esma Altunoglu
- Istanbul Training and research Hospital, Department of Internal Medicine, Istanbul 34098, Turkey.
| | - Remise Gelisgen
- Department of Biochemistry, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul 34098, Turkey.
| | - Pınar Atukeren
- Department of Biochemistry, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul 34098, Turkey.
| | - Palmet Gun Atak
- Department of Biochemistry, Faculty of Medicine, Istanbul Bilim University, Istanbul 34394, Turkey.
| | - Hafize Uzun
- Department of Biochemistry, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul 34098, Turkey.
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Dai Z, Zhang Y, Ye H, Zhang G, Jin H, Chen Z, Yao Y, Tian X, Zhou J, Li P, Liang X, Xie H, Ge S, Zhang Z. Adiponectin is valuable in the diagnosis of acute heart failure with renal insufficiency. Exp Ther Med 2018; 16:2725-2734. [PMID: 30210613 DOI: 10.3892/etm.2018.6511] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Accepted: 03/27/2018] [Indexed: 01/06/2023] Open
Abstract
Acute heart failure (AHF) is a major public health issue due to its high incidence and poor prognosis; thus, efficient and timely diagnosis is critical for improving the prognosis and lowering the mortality rate. Amino-terminal pro-brain natriuretic peptide (NT-proBNP) is widely used in the diagnosis of AHF; however, its efficacy is controversial in diagnosing AHF with renal insufficiency. There were numerous studies reporting the association of adiponectin (ADPN) and heart diseases. Therefore, the present study aimed to investigate whether ADPN is helpful in identifying AHF with renal insufficiency. A total of 407 participants (218 AHF patients and 189 controls) were enrolled into the current study. The plasma levels of ADPN and NT-proBNP were measured using a sandwich enzyme-linked immunosorbent assay and an electrochemiluminescence immunoassay, respectively. In addition, these levels were compared among the various New York Health Association classes, as well as the ischemic and non-ischemic AHF cases. The correlation between the two biomarkers and the renal function was analyzed by Spearman's correlation, while the diagnostic efficiency of ADPN and NT-proBNP was evaluated in AHF patients with and without renal insufficiency. The results revealed that NT-proBNP exhibited a higher diagnostic efficiency as compared with ADPN in patients without renal insufficiency [area under the receiver operating characteristic curve (AUC), 0.905 vs. 0.775]. By contrast, the ADPN presented a better diagnostic value in comparison with NT-proBNP in AHF with renal insufficiency (AUC, 0.872 vs. 0.828). Therefore, a combination of these two biomarkers may provide an excellent efficacy in the diagnosis of AHF with renal insufficiency (AUC, 0.904; sensitivity, 71.2%; specificity, 98.3%). In conclusion, ADPN is a valuable biomarker for diagnosing AHF, particularly in patients with impaired renal function.
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Affiliation(s)
- Zhang Dai
- Department of Clinical Laboratory, Zhongshan Hospital Xiamen University, Xiamen, Fujian 361001, P.R. China
| | - Yan Zhang
- Department of Clinical Laboratory, Zhongshan Hospital Xiamen University, Xiamen, Fujian 361001, P.R. China
| | - Huiming Ye
- State Key Laboratory of Molecular Vaccine and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, Fujian 361002, P.R. China.,Department of Clinical Laboratory, Xiamen Maternal and Child Health Hospital, Teaching Hospital of Medical College Xiamen University, Xiamen, Fujian 361003, P.R. China
| | - Guoqiang Zhang
- Department of Clinical Laboratory, Zhongshan Hospital Xiamen University, Xiamen, Fujian 361001, P.R. China
| | - Hongwei Jin
- Department of Clinical Laboratory, Zhongshan Hospital Xiamen University, Xiamen, Fujian 361001, P.R. China
| | - Ziming Chen
- Department of Reagent Research, Xiamen Innovax Biotech Co., Ltd., Xiamen, Fujian 361022, P.R. China
| | - Yihui Yao
- Department of Clinical Laboratory, Zhongshan Hospital Xiamen University, Xiamen, Fujian 361001, P.R. China
| | - Xuebing Tian
- Department of Clinical Laboratory, Xiamen Cardiovascular Hospital, Medical College Xiamen University, Xiamen, Fujian 361001, P.R. China
| | - Jianfeng Zhou
- Department of Clinical Laboratory, Zhongshan Hospital Xiamen University, Xiamen, Fujian 361001, P.R. China
| | - Peihua Li
- Department of Clinical Laboratory, Zhongshan Hospital Xiamen University, Xiamen, Fujian 361001, P.R. China
| | - Xianming Liang
- Department of Clinical Laboratory, Zhongshan Hospital Xiamen University, Xiamen, Fujian 361001, P.R. China
| | - Huabing Xie
- Department of Clinical Laboratory, Xiamen Cardiovascular Hospital, Medical College Xiamen University, Xiamen, Fujian 361001, P.R. China
| | - Shengxiang Ge
- State Key Laboratory of Molecular Vaccine and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, Fujian 361002, P.R. China
| | - Zhongying Zhang
- Department of Clinical Laboratory, Zhongshan Hospital Xiamen University, Xiamen, Fujian 361001, P.R. China.,State Key Laboratory of Molecular Vaccine and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, Fujian 361002, P.R. China.,Department of Clinical Laboratory, Zhongshan Teaching Hospital, Fujian Medical University, Xiamen, Fujian 361001, P.R. China
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Marchetti M, Benedetti A, Mimoz O, Lardeur JY, Guenezan J, Marjanovic N. Predictors of 30-day mortality in patients admitted to ED for acute heart failure. Am J Emerg Med 2016; 35:444-447. [PMID: 27912923 DOI: 10.1016/j.ajem.2016.11.050] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2016] [Revised: 11/16/2016] [Accepted: 11/21/2016] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVES Acute heart failure (AHF) is a leading cause of admission in emergency departments (ED). It is associated with significant in-hospital mortality, suggesting that there is room for improvement of care. Our aims were to investigate clinical patterns, biological characteristics and determinants of 30-day mortality. METHODS We conducted a single site, retrospective review of adult patients (≥18years) admitted to ED for AHF over a 12-month period. Data collected included demographics, clinical, biological and outcomes data. Epidemiologic data were collected at baseline, and patients were followed up during a 30-day period. RESULTS There were a total of 322 patients. Mean age was 83.9±9.1years, and 47% of the patients were men. Among them, 59 patients (18.3%) died within 30days of admission to the ED. The following three characteristics were associated with increased mortality: age>85years (OR=1.5[95%CI:0.8-2.7], p=0.01), creatinine clearance <30mL/min (OR=2.6[95%CI:1.4-5], p<0.001) and Nt-proBNP >5000pg/mL (OR=2.2[95%CI:1.2-4], p<0.001). The best Nt-proBNP cut-off value to predict first-day mortality was 9000pg/mL (area under the curve (AUC) [95%CI] of 0.790 [0.634-0.935], p<0.001). For 7-day mortality, it was 7900pg/mL (0.698 [0.578-0.819], p<0.001) and for 30-day mortality, 5000pg/mL (0.667 [0.576-0.758], p<0.001). CONCLUSIONS Nt-proBNP level on admission, age and creatinine clearance, are predictive of 30-day mortality in adult patients admitted to ED for AHF.
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Affiliation(s)
- Matthieu Marchetti
- Emergency Department, University Hospital of Poitiers, 86000 Poitiers, France.
| | - Antoine Benedetti
- Emergency Department, University Hospital of Poitiers, 86000 Poitiers, France
| | - Olivier Mimoz
- Emergency Department, University Hospital of Poitiers, 86000 Poitiers, France; University of Poitiers, Medical School, 86000 Poitiers, France
| | - Jean-Yves Lardeur
- Emergency Department, University Hospital of Poitiers, 86000 Poitiers, France
| | - Jérémy Guenezan
- Emergency Department, University Hospital of Poitiers, 86000 Poitiers, France; University of Poitiers, Medical School, 86000 Poitiers, France
| | - Nicolas Marjanovic
- Emergency Department, University Hospital of Poitiers, 86000 Poitiers, France; University of Poitiers, Medical School, 86000 Poitiers, France
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