AUTHOR=Mo Ran , Yang Yan-min , Yu Li-tian , Tan Hui-qiong , Zhu Jun 

TITLE=Elevated Plasma Big Endothelin-1 at Admission Is Associated With Poor Short-Term Outcomes in Patients With Acute Decompensated Heart Failure

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=8

YEAR=2021

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2021.629268

DOI=10.3389/fcvm.2021.629268

ISSN=2297-055X

ABSTRACT=<p><bold>Objective:</bold> We aimed to evaluate the association between plasma big endothelin-1 (ET-1) at admission and short-term outcomes in acute decompensated heart failure (ADHF) patients.</p><p><bold>Methods:</bold> In this single-center, retrospective study, a total of 746 ADHF patients were enrolled and divided into three groups according to baseline plasma big ET-1 levels: tertile 1 (&lt;0.43 pmol/L, <italic>n</italic> = 250), tertile 2 (between 0.43 and 0.97 pmol/L, <italic>n</italic> = 252), and tertile 3 (&gt;0.97 pmol/L, <italic>n</italic> = 244). The primary outcomes were all-cause death, cardiac arrest, or utilization of mechanical support devices during hospitalization. Logistic regression analysis and net reclassification improvement approach were applied to assess the predictive power of big ET-1 on short-term outcomes.</p><p><bold>Results:</bold> During hospitalization, 92 (12.3%) adverse events occurred. Etiology, arterial pH, lactic acid, total bilirubin, serum creatine, serum uric acid, presence of atrial fibrillation and N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels were positively correlated with plasma big ET-1 level, whereas systolic blood pressure, serum sodium, hemoglobin, albumin, and estimated glomerular filtration rate were negatively correlated. In multivariate logistic regression, tertile 3 compared with tertile 1 had a 3.68-fold increased risk of adverse outcomes [odds ratio (OR) = 3.681, 95% confidence interval (CI) 1.410–9.606, <italic>p</italic> = 0.008]. However, such adverse effect did not exist between tertile 2 and tertile 1 (OR = 0.953, 95% CI 0.314–2.986, <italic>p</italic> = 0.932). As a continuous variable, big ET-1 level was significantly associated with primary outcome (OR = 1.756, 95% CI 1.413–2.183, <italic>p</italic> &lt; 0.001). The C statistic of baseline big ET-1 was 0.66 (95% CI 0.601–0.720, <italic>p</italic> &lt; 0.001). Net reclassification index (NRI) analysis showed that big ET-1 provided additional predictive power when combining it to NT-proBNP (NRI = 0.593, <italic>p</italic> &lt; 0.001).</p><p><bold>Conclusion:</bold> Elevated baseline big ET-1 is an independent predictor of short-term adverse events in ADHF patients and may provide valuable information for risk stratification.</p>