Use of Biomarkers to Predict Readmission for Congestive Heart Failure

• Published in: The American journal of cardiology Vol. 119; no. 3; pp. 445 - 451
• Main Authors: Sudharshan, Sangita, MD, Novak, Eric, MS, Hock, Karl, MS, Scott, Mitchell G., Ph.D, Geltman, Edward M., MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.02.2017; Elsevier Limited
• Subjects: Aged; Area Under Curve; Biomarkers; Biomarkers - blood; Cardiomyopathy; Cardiovascular; Enzymes; Female; Galectin 3 - blood; Heart attacks; Heart failure; Heart Failure - blood; Hospitalization; Humans; Male; Medical prognosis; Medicare; Medicine; Middle Aged; Natriuretic Peptide, Brain - blood; Patient Discharge; Patient Readmission - statistics & numerical data; Peptides; Prognosis; Risk Assessment; ROC Curve; Troponin I - blood; congestive heart failure; BNP; galectin-3; biomarkers; re-admission
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/j.amjcard.2016.10.022

Abstract Acute decompensated heart failure (ADHF) is a major reason for repeated hospitalizations. Identifying those patients with ADHF at risk for readmission is critical so that preventive interventions can be implemented. Biomarkers such as B-type Natriuretic Peptide (BNP), high-sensitivity troponin I (Hs-cTnI), and galectin-3 (Gal-3) assessed at discharge may be useful, though their role in predicting short-term readmission is not well defined in the literature. We enrolled and had follow up data for 101 participants admitted to our facility between 4/2013 and 3/2015 with a primary diagnosis of ADHF. Gal-3, Hs-cTnI, and BNP were obtained within 48 hours prior to hospital discharge after management of ADHF. Gal-3 was assessed using two commercially available assays. We compared subjects who were and were not readmitted. Discharge BNP was found to be a significant predictor of 30 and 60 day readmission [AUC 0.69 (p=0.046), AUC 0.7 (p=0.005) respectively]. The addition of Gal-3 to discharge BNP provided significantly improved prediction of 60 day re-admission. Gal-3 alone was found to be a significant predictor of 60 day re-admission in patients with preserved ejection fraction (AUC 0.85, p<0.001. The net reclassification improvement (NRI) was 55.2 (p=0.037). Using multivariate analysis, for every 100 pg/L BNP increase, the probability of re-admission increased by approximately 10%, and for every 1 ng/mL Gal-3 increase, the probability further increased 8%. A statistically significant NRI was not found upon examination of 30 day readmission. In conclusion, measurement of both Gal-3 and BNP at hospital discharge provides significant prediction of hospital re-admission within 60 days. When combined, the prediction of re-admission is significantly improved.