Novel and established biomarkers to complement risk scores in patients with acute decompensated heart failure - a pilot study

Valentin Hähnel; Victoria Meretz; Christian Butter; Vera Paar; Christoph Edlinger; Michael Lichtenauer; Ronald Biemann; Berend Isermann; Meike Hoffmeister; Michael Haase; Anja Haase-Fielitz; Marwin Bannehr

doi:10.1016/j.ahjo.2025.100544

Novel and established biomarkers to complement risk scores in patients with acute decompensated heart failure - a pilot study

Am Heart J Plus. 2025 Apr 10:53:100544. doi: 10.1016/j.ahjo.2025.100544. eCollection 2025 May.

Authors

Valentin Hähnel^{1

2}, Victoria Meretz^{1

2}, Christian Butter^{1

2}, Vera Paar³, Christoph Edlinger^{1

2}, Michael Lichtenauer³, Ronald Biemann⁴, Berend Isermann⁴, Meike Hoffmeister^{2

5}, Michael Haase^{6

7

8}, Anja Haase-Fielitz^{1

2

8}, Marwin Bannehr^{1

2}

Affiliations

¹ Department of Cardiology, University Hospital Heart Centre Brandenburg, Brandenburg Medical School Theodor Fontane, Bernau 16321, Germany.
² Faculty of Health Sciences (FGW), Joint Faculty of the University of Potsdam, the Brandenburg Medical School Theodor Fontane and the Brandenburg Technical University Cottbus-Senftenberg 16816, Germany.
³ Clinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University of Salzburg, 5020, Austria.
⁴ Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University Hospital Leipzig, Leipzig 04103, Germany.
⁵ Institute of Biochemistry, Brandenburg Medical School Theodor Fontane, Brandenburg a.d.H. 14770, Germany.
⁶ Department of Nephrology & Hypertension, Hannover Medical School, Hannover 30625, Germany.
⁷ Diamedikum Kidney Care Centre, Potsdam 14473, Germany.
⁸ Institute of Social Medicine and Health System Research, Otto von Guericke University Magdeburg, 39120, Germany.

Abstract

Study objective: There are several risk scores for mortality in patients with acute decompensated heart failure (ADHF) such as the European Collaboration on Acute Decompensated Heart Failure Score (ELAN-HF Score), the ADHF/NT-proBNP-Score or A2B-Score (age, anemia, BNP). The aim of this study was to evaluate the predictive value of such risk scores with and without addition of novel cardiorenal biomarkers.

Design & setting: Single-center, exploratory prospective cohort study at the University Hospital Heart Centre Brandenburg.

Participants: Forty-four adult patients hospitalized for ADHF.

Interventions: Measurement of established and novel biomarkers at hospital admission including N-terminal-pro brain natriuretic peptide (NT-pro-BNP), troponin T, creatinine, cystatin C, soluble suppression of tumorigenicity 2 (sST2), Neprilysin, Dickkopf-3 (DKK3), interleukin-6 (IL-6), growth differentiation factor-15 (GDF-15), Galectin-3, Progranulin and urine neutrophil gelatinase-associated lipocalin (uNGAL).

Main outcome measures: Analysis of predictive indices of ELAN-HF, ADHF/NT-proBNP and A2B-Scores for 90-day mortality with and without adding biomarkers. AUC <0.8 was considered as fair, ≥0.8 as good and > 0.9 as excellent predictive value.

Results: Median age was 78.0 (25th-75th percentiles 69.3-83.8) years, 50 % (22/44) were female. Twelve patients (27.3 %) died within 90 days after discharge. All three risk scores were higher in non-survivors and showed fair AUC for 90-day mortality (ELAN-HF: 0.792 [0.639-0.901], p = 0.003; ADHF-NT-proBNP score: 0.749 [0.559-0.938], p = 0.012; A2B score: 0.734 [0.541-0.927], p = 0.017). Adding troponin T, cystatin C-based estimated glomerular filtration rate (eGFR) or uNGAL to risk scores was associated with an area under the curve (AUC) >0.80 for all models. Combination of troponin T, cystatin C-based eGFR and uNGAL increased risk scores to AUC >0.91.

Conclusion: These findings imply that further evaluation of the addition of a panel of cardiorenal biomarkers to ADHF risk scores is warranted.

Keywords: Cardiorenal biomarker; Cystatin C; Heart failure; Risk scores; Troponin; Urine neutrophil gelatinase-associated lipocalin.