Serum beta2-microglobulin concentration as a novel marker to distinguish levels of risk in acute heart failure patients

• Published in: Journal of cardiology Vol. 55; no. 1; pp. 99 - 107
• Main Authors: Kawai, Keisuke, MD, Kawashima, Seinosuke, MD, Miyazaki, Toshiyuki, MD, Tajiri, Eiichi, MD, Mori, Masuki, MD, Kitazaki, Kazuhisa, MD, Shirotani, Tomohiko, MD, Inatome, Tetsuya, MD, Yamabe, Hiroshi, MD, Hirata, Ken-ichi, MD, Yokoyama, Mitsuhiro, MD, FJCC
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 01.01.2010
• Subjects: Aged; beta 2-Microglobulin - blood; Biomarkers - blood; Blood Pressure; Body Mass Index; Cardiovascular; Creatinine - blood; Creatinine - metabolism; Echocardiography; Female; Glomerular Filtration Rate; Heart Failure - blood; Heart Failure - mortality; Humans; Male; Mortality; Nedocromil; Outcome; Predictor; Prognosis; Pulmonary Disease, Chronic Obstructive - complications; Recurrence; Prognosis; Predictor; Mortality; Outcome
• ISSN: 0914-5087; 1876-4738
• DOI: 10.1016/j.jjcc.2009.10.003

Summary Background Recently, serum beta2-microglobulin, an endogenous marker for renal function, has been shown to be an independent predictor of mortality in older adults. However, the prognostic role of beta2-microglobulin in heart failure has not been elucidated. Methods We prospectively evaluated serum beta2-microglobulin and creatinine concentrations, creatinine-based renal parameters (estimated glomerular filtration rate and creatinine clearance), and echocardiographic data in 131 patients with acute heart failure and creatinine concentrations ≤3.0 mg/dL admitted to our hospitals. Results During 2.3 ± 1.3 years, 42 patients died of cardiovascular causes and 12 died of noncardiac causes. Cardiovascular events were observed in 63 patients: 53 were readmitted due to worsening heart failure, 5 readmitted for cerebral embolism, and 5 died from sudden cardiac death. According to multivariate stepwise Cox proportional hazard analysis, higher baseline serum beta2-microglobulin concentrations ( X2 = 16, p < 0.0001), previous congestive heart failure ( X2 = 11, p < 0.001), presence of chronic obstructive pulmonary disease ( X2 = 8, p < 0.01), and lower diastolic blood pressure ( X2 = 6, p < 0.05) were independent predictors of increased cardiovascular events. Also, higher baseline serum beta2-microglobulin ( X2 = 20, p < 0.0001), lower systolic blood pressure ( X2 = 11, p < 0.001), higher relative left ventricular wall thickness ( X2 = 6, p < 0.05), and lower body mass index ( X2 = 5, p < 0.05) were independent predictors of increased cardiac mortality. The adjusted hazard ratio for cardiovascular events increased with baseline serum beta2-microglobulin above 2.1 mg/L: 2.9 with beta2-microglobulin of 2.2–2.6 mg/L (95%CI 1.2–6.9, p < 0.05), 2.9 with beta2-microglobulin of 2.7–3.9 mg/L (95%CI 1.2–7.2, p < 0.05), and 4.7 with beta2-microglobulin of ≥4.0 mg/L (95%CI 2.0–11, p < 0.001). Conclusions Higher baseline serum beta2-microglobulin concentration could be a promising risk marker in acute heart failure patients with creatinine ≤3.0 mg/dL.