Diagnostic and Prognostic Properties of Osteoprotegerin in Patients with Acute Dyspnoea: Observations from the Akershus Cardiac Examination (ACE) 2 Study

• Published in: PloS one Vol. 11; no. 7; p. e0160182
• Main Authors: Røysland, Ragnhild, Pervez, Mohammed Osman, Pedersen, Marit Holmefjord, Brynildsen, Jon, Høiseth, Arne Didrik, Hagve, Tor-Arne, Røsjø, Helge, Omland, Torbjørn
• Format: Journal Article
• Language: English; Norwegian
• Published: United States Public Library of Science 27.07.2016; Public Library of Science (PLoS)
• Subjects: Aged; Analysis; Biocompatibility; Biology and Life Sciences; Biomarkers; Biomarkers - blood; Brain natriuretic peptide; Cardiac patients; Cardiology; Cardiovascular disease; Care and treatment; Chronic obstructive pulmonary disease; Clinical medicine; Coronary vessels; Diagnosis; Diagnostic systems; Dyspnea; Enzyme-linked immunosorbent assay; Female; Health aspects; Heart; Heart attacks; Heart diseases; Heart failure; Heart Failure - blood; Heart Failure - epidemiology; Heart Failure - pathology; Hospitals; Humans; Male; Medical diagnosis; Medical prognosis; Medical records; Medicine; Medicine and Health Sciences; Middle Aged; Mortality; Osteoporosis; Osteoprotegerin; Osteoprotegerin - blood; Patients; People and Places; Predictive Value of Tests; Prognosis; Respiration; Systematic review; Tumor necrosis factor; Norway
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0160182

Circulating osteoprotegerin (OPG) levels are increased in patients with chronic heart failure (HF). The diagnostic and prognostic merit of OPG measurement in patients admitted with acute dyspnoea is unknown. To evaluate the diagnostic and prognostic value of measuring OPG in patients admitted to hospital with acute dyspnoea. OPG was analysed by ELISA in 308 patients admitted due to acute dyspnoea. Investigators blinded to OPG results adjudicated the diagnosis for the index hospitalization. Clinical outcomes were obtained from hospital records. In total, 139 patients (45%) were hospitalized with acute HF. OPG levels on hospital admission were higher in patients with acute HF vs. no acute HF, 7.8 (5.5-10.4) vs. 5.4 (3.8-7.2) pmol/L, p<0.001. The area under the receiver operator characteristic curve (ROC AUC) of OPG to discriminate between HF vs. non-HF was 0.695 [95% CI 0.636-0.754]. OPG did not provide incremental information to the ED physician's prediction or N-terminal pro-B-type natriuretic peptide regarding the diagnosis of acute HF. OPG levels (log transformed) were associated with mortality in crude analysis (HR (95% CI) 1.87 (1.34 to 2.61), p<0.001), but this association was attenuated and no longer significant after including established cardiac biomarkers into the model. In patients admitted to hospital with acute dyspnoea, OPG levels are higher in patients with acute HF than in those with dyspnoea from other causes. However, OPG does not provide incremental information beyond ED physician assessment for the diagnosis of acute HF or beyond clinical risk variables and established cardiac biomarkers concerning prognosis.