The role of exhaled breath acetone and BNP in predicting outcomes in advanced heart failure
Notice bibliographique
Résumé
Abstract Introduction With the advent of new therapies, there is increasing interest in understanding cardiac metabolism in heart failure (HF). Ketone bodies may act as an alternative energy source for myocardial metabolism, and acetone serves as a marker of ketogenic activity. In this context, Exhaled Breath Acetone (EBA) has emerged as a biomarker for HF diagnosis and chronic HF prognosis. However, its role as a predictor of adverse outcomes in advanced HF remains uncertain. B-Type Natriuretic Peptide (BNP), conversely, is a biomarker of myocardial stress, playing a critical role in HF diagnosis and prognosis. Since EBA and BNP reflect distinct physiological pathways, EBA might complement BNP as a prognostic marker in HF. Objective To evaluate the prognostic value of EBA in combination with BNP as a predictor of death or urgent heart transplantation (HT) among patients with HF in hemodynamic profile C(wet and cold).A secondary objective was to assess the association of these biomarkers with overall mortality. Methods This prospective, observational, single-center study included patients with advanced HF in a quaternary care hospital. Exhaled air samples were collected upon hospital admission and analyzed using spectrophotometry by reaction with salicylaldehyde. Cox proportional hazards multivariate analysis was employed to assess the predictive value of EBA for adverse outcomes and Kaplan Meier curves were built. Results From Jan 2019 to Aug 2023, 287 patients were enrolled. The median EBA level was 5.8 (2.4–11.7) µg/L, and the median BNP level was 1708 (1033–2775) pg/mL. EBA levels were significantly higher in patients who had the primary outcome of death or urgent HT [6.6 (2.8–13.15) vs. 4.6 (2.08–9.05) µg/L, p=0.014]. (Figure 1). The AUC of EBA for death or urgent HT was 0.585(0.519–0.651), p < 0.001 and 4.3ug/L was the best cutoff to predict the primary endpoint. EBA levels > or =4.3µg/L were associated with an increased risk of death or urgent HT [HR=1.42, 95% CI(1.03–1.96), p=0.003].When EBA > or =4.3µg/L was combined with BNP > or = 2214pg/mL, the risk of the primary outcome was increased in 2.5-fold [HR=2.5, 95% CI(1.64–3.97), p<0.001],even after adjusting for other independent predictors: BNP (p<0.001), systolic blood pressure (p=0.002), urea (p=0.022), and sodium (p<0.001).This combination also increased the risk of overall mortality [HR=3.0, 95% CI(1.73–5.20), p<0.001].Figure 2 depicts Kaplan-Meier curves of death or urgent HT according with levels of EBA and BNP at admission. Patients with high levels of both biomarkers had higher cumulative incidence of death or urgent HT in six months. (Log-rank test, p < 0.001). Conclusion The combination of elevated EBA and BNP levels significantly increased the risk of death or urgent HT, as well as overall mortality. These findings suggest that EBA, a biomarker of metabolism in HF, may provide additional prognostic value to BNP in patients with advanced HF.EBA according to death or urgent HT Death or HT stratified by EBA and BNP
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Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».