Syndecan-1 na insuficiência cardíaca descompensada : associação com a função renal e mortalidade

Abstract

Introduction: In recent decades, heart failure (HF) has emerged as a global public health problem. Data from the Ministry of Health, 2006, suggest prevalence of two million patients with HF, thus representing one of the major causes of hospitalization among cardiovascular diseases in the Unified Health System (SUS). Acute kidney injury (AKI) is a common complication in patients admitted for HF. Therefore, it is known that the decrease of renal function is associated with increased risk of death, hospitalization, and cardiovascular events with significant socioeconomic implications. Despite the advanced therapy for HF, the prognosis of patients with HF remains guarded. Objective: To evaluate the biomarker syndecan-1 at admission in patients hospitalized for decompensated HF and its association with acute/chronic renal injury. Methods: This is a prospective observational study conducted with 201 patients with decompensated HF at the emergency department. The study took place in a public hospital in the city of Fortaleza-CE, Brazil, between April and September 2013. The Research Ethics Committee of the Hospital de Messejana Doutor Carlos Alberto Studart Gomes approved the study. We compared the patients with a control group of 15 healthy individuals. The analysis happened through serum samples applying the enzyme-linked immunosorbent assay (ELISA) technique and through biochemical assays. For statistical analysis, we used the SPSS 19.0 for Windows. Results: The mean age was 64.2 ± 13.5 years and the ejection fraction (EF) calculated was 41.5 ± 14.4 at the time of admission. Considering all the patients, 80 (39.8%) had chronic kidney disease (CKD) and 62 (37.8%) developed or worsening AKI during hospitalization. Of the patients with CKD, 43 maintained stable renal function during hospitalization. The average length of hospital stay was 8.7 ± 4.9 days and the in-hospital mortality was 5.5%. The patients with decompensated HF had increased serum syndecan-1 at admission (133.7 ± 95.0 vs. 18.3 ± 9.2, p<0.001) compared with the control group. We observed an increased level of syndecan-1 in patients with AKI (mean of 248.7 ± 165.6ng/mL). Patients with AKI stage 2/3 (n=13) had higher level of syndecan-1 compared with patients with AKI stage 1 (n=63) (443.2 ± 281.1 vs. 178.9 ± 100.8 ng/mL, p <0.001). The ROC curve for AKI prediction was 0.741 (95% CI 0.669-0.812, p<0.001). The results were even better when considering only the highest levels of AKI severity (stage 2/3) – ROC curve 0.840 (95% CI 0.733-0.948, p<0.001). In the univariate analysis, the concentration of syndecan-1 as a continuous variable was significantly correlated with hospital mortality (OR=1.046 95% CI 1.025-1.067, p<0.001 for each 10ng/mL). Additionally, the level of syndecan-1 at admission on emergency had good discriminative ability to predict hospital mortality (AUC 0.788 95% CI 0.673-0.903, p<0.001). Conclusion: In patients with decompensated HF, syndecan-1 measured in the pre-hospital admission can be considered as an effective biomarker to predict AKI and mortality.