Establishing the Optimal sST2 Cut-off for Predicting 5-Year All-Cause Mortality in Hospitalized Patients with Heart Failure with Reduced Ejection Fraction

Abstract

Background: Hospitalized patients with chronic heart failure (HF) may experience adverse left ventricular remodeling, systemic and pulmonary congestion, and changes in sST2. Thus, they may require an sST2 cutoff for predicting long-term mortality different from that of patients with stable chronic HF. This study aimed to determine the optimal cutoff value of sST2 predictive of long-term mortality in patients with heart failure with reduced ejection fraction (HFrEF).

Methods: This prospective cohort study included 162 hospitalized patients with HFrEF. Plasma sST2 levels were analyzed. Statistical analyses were performed to evaluate the predictive utility of sST2 levels for all-cause mortality and the optimal cutoff value.

Results: During follow-up, 99 of 162 patients (61.1%) died. The median admission sST2 concentration was 35.3 [19.1-57.3] ng/mL. The cohort-derived cutoff was >27.1 ng/mL (sensitivity, 89.9%; specificity, 84.1%). Patients above this threshold had a higher hazard of 5-year mortality than those with sST2 <=27.1 ng/mL (HR, 6.27; 95% CI, 3.02-13.05; P<0.001). In the reported multivariable model, each 1-unit increase in ln(sST2) was also associated with mortality (adjusted HR, 7.52; 95% CI, 4.07-13.90; P<0.001).

Conclusion: In hospitalized patients with HFrEF, sST2 levels were an independent and associated with 5-year all-cause mortality, and the optimal sST2 cutoff for predicting long-term survival is 27.1 ng/mL.