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The S2PLIT-UG score, a novel system identifying patients with a high risk of all-cause mortality following acute decompensation of heart failure, correlates with levels of sST2, hs-cTnI and NT-proBNP

Session HFA Discoveries - ePosters

Speaker Doctor Josip Andjelo Borovac

Event : HFA Discoveries 2020

  • Topic : heart failure
  • Sub-topic : Epidemiology, Prognosis, Outcome
  • Session type : ePosters

Authors : JA Borovac (Split,HR), D D'amario (Rome,IT), D Glavas (Split,HR), Z Susilovic Grabovac (Split,HR), D Supe Domic (Split,HR), K Novak (Split,HR), A Bradaric (Split,HR), D Milicic (Zagreb,HR), D Duplancic (Split,HR), J Bozic (Split,HR)

JA Borovac1 , D D'amario2 , D Glavas3 , Z Susilovic Grabovac3 , D Supe Domic4 , K Novak4 , A Bradaric4 , D Milicic5 , D Duplancic3 , J Bozic6 , 1University Hospital Center Split - Split - Croatia , 2Catholic University of the Sacred Heart - Fondazione Policlinico Universitario A. Gemelli IRCCS, Institute of Cardiology - Rome - Italy , 3University Hospital Center Split, Clinic for Cardiovascular Diseases - Split - Croatia , 4University Hospital Center Split, Department of Medical Laboratory Diagnostics - Split - Croatia , 5University Hospital Centre Zagreb, Department of Cardiovascular Diseases - Zagreb - Croatia , 6University of Split School of Medicine, Department of Pathophysiology - Split - Croatia ,

Acute Heart Failure – Epidemiology, Prognosis, Outcome

Background: The S2PLIT-UG score has been recently published as a risk stratification tool for 1-year all-cause mortality among patients discharged after an acute decompensated heart failure (ADHF) event. This score stratifies ADHF patients into low, intermediate and high-risk categories. It is calculated by combining 6 variables collected at admission including estimated glomerular filtration rate, uric acid, left ventricular ejection fraction, sodium, systolic blood pressure and the history of heart failure-related hospitalizations. The study aimed to determine if patients identified as high-risk by the S2PLIT-UG score have higher circulating levels of biomarkers associated with poor prognosis such as soluble suppressor of tumorigenicity 2 (sST2), high-sensitivity cardiac troponin I (hs-cTnI) and N-terminal pro b-type natriuretic peptide (NT-proBNP). A secondary aim was to examine correlations of the S2PLIT-UG score with the aforementioned biomarkers.

Methods: A new validation cohort consisting of 96 patients hospitalized for ADHF and without acute coronary syndrome as an underlying culprit were consecutively included in the study during 2018-2019. All patients underwent standard transthoracic echocardiography, laboratory analyses of peripheral blood, and had their S2PLIT-UG score calculated with a high-risk score being defined as having =4 points. 

Results: One-quarter of patients (25%, N=24) in analyzed cohort were identified as a high-risk while 75% of patients (N=72) were non-high risk according to the S2PLIT-UG stratification system. Out of those designated as non-high risk, vast majority were low risk (70.8%, N=51) and 29.2% (N=21) were intermediate risk. High risk group did not significantly differ from non-high risk group of patients in terms of baseline characteristics including age (p=0.161), body mass index (p=0.437), sex distribution (p=0.637), smoking (p=0.626), dyslipidemia (p=0.898), diabetes mellitus (p=0.286) and presence of atrial fibrillation (p=0.288). Patients identified as high risk had significantly higher circulating levels of sST2 (65.2±50.2 vs. 34.8±26.4 ng/mL, p<0.001), hs-cTnI (142.2±239.0 vs. 42.9±94.0 ng/L, p=0.006), and NT-proBNP (13199±15325 vs. 5189±7295 pg/mL, p=0.001), compared to patients designated as non-high risk (Figure 1). As a continuous variable, the S2PLIT-UG score was in positive and significant correlation with circulating levels of sST2 (Pearson's r=0.420, p<0.001), hs-cTnI (r=0.281, p=0.007), and NT-proBNP (r=0.344, p=0.001).

Conclusions: A present study demonstrated that patients identified as high-risk according to S2PLIT-UG score had significantly higher circulating levels of biomarkers associated with poor prognosis, compared to non-high risk patients while S2PLIT-UG score correlated positively and significantly with circulating levels of sST2, hs-cTnI and NT-proBNP. These findings suggest a possible complementary value of the S2PLIT-UG score in the risk stratification of ADHF patients.

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