Measurement of the interleukin family member ST2 in patients with acute dyspnea : Results from the PRIDE (pro-brain natriuretic peptide investigation of dyspnea in the emergency department) study

• Published in: Journal of the American College of Cardiology Vol. 50; no. 7; pp. 607 - 613
• Main Authors: JANUZZI, James L, PEACOCK, W. Frank, LEWANDROWSKI, Kent B, LLOYD-JONES, Donald M, WU, Alan H. B, MAISEL, Alan S, CHAE, Claudia U, JESSE, Robert L, BAGGISH, Aaron L, O'DONOGHUE, Michelle, SAKHUJA, Rahul, CHEN, Annabel A, VAN KIMMENADE, Roland R. J
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Science 14.08.2007; Elsevier Limited
• Subjects: Aged; Aged, 80 and over; Biological and medical sciences; Biomarkers - blood; Cardiology; Cardiology. Vascular system; Cardiovascular disease; Case-Control Studies; Cohort Studies; Confidence intervals; Cytokines; Dyspnea - blood; Dyspnea - etiology; Family medical history; Female; Heart failure; Heart Failure - blood; Heart Failure - complications; Heart Failure - mortality; Humans; Interleukin-1 Receptor-Like 1 Protein; Male; Medical prognosis; Medical sciences; Middle Aged; Mortality; Peptides; Pneumology; Predictive Value of Tests; Receptors, Cell Surface - blood; Respiratory system : syndromes and miscellaneous diseases; Software; Studies; Survival Rate; Variables; Human; Measurement; Brain natriuretic peptide; Respiratory disease; Family study; Acute; Interleukin; Cytokine; Patient; Phlebology; Result; Dyspnea; Emergency department; Family environment; Circulatory system; Cardiology
• ISSN: 0735-1097; 1558-3597; 1558-3597
• DOI: 10.1016/j.jacc.2007.05.014

The aim of this study was to examine the value of measurement of the interleukin-1 receptor family member ST2 in patients with dyspnea. Concentrations of ST2 have been reported to be elevated in patients with heart failure (HF). Five hundred ninety-three dyspneic patients with and without acute destabilized HF presenting to an urban emergency department were evaluated with measurements of ST2 concentrations. Independent predictors of death at 1 year were identified. Concentrations of ST2 were higher among those with acute HF compared with those without (0.50 vs. 0.15 ng/ml; p < 0.001), although amino-terminal pro-brain natriuretic peptide (NT-proBNP) was superior to ST2 for diagnosis of acute HF. Median concentrations of ST2 at presentation to the emergency department were higher among decedents than survivors at 1 year (1.08 vs. 0.18 ng/ml; p < 0.001), and in multivariable analyses, an ST2 concentration > or =0.20 ng/ml strongly predicted death at 1 year in dyspneic patients as a whole (HR = 5.6, 95% confidence interval [CI] 2.2 to 14.2; p < 0.001) as well as those with acute HF (hazard ratio [HR] = 9.3, 95% CI 1.3 to 17.8; p = 0.03). This risk associated with an elevated ST2 in dyspneic patients with and without HF appeared early and was sustained at 1 year after presentation (log-rank p value <0.001). A multi-marker approach with both ST2 and NT-proBNP levels identified subjects with the highest risk for death. Among dyspneic patients with and without acute HF, ST2 concentrations are strongly predictive of mortality at 1 year and might be useful for prognostication when used alone or together with NT-proBNP.