sST2 levels are associated with all-cause mortality in anticoagulated patients with atrial fibrillation

Juan A. Vílchez, Montserrat Pérez-Cuellar, Francisco Marín, Pilar Gallego, Sergio Manzano-Fernández, Mariano Valdés, Vicente Vicente, José A. Noguera-Velasco, Gregory Y.H. Lip, Jordi Ordóñez-Llanos, Vanessa Roldán

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Abstract

© 2015 Stichting European Society for Clinical Investigation Journal Foundation. Background: Atrial fibrillation (AF) is associated with high morbidity and mortality, even despite the use of oral anticoagulation (OAC). Soluble suppression of tumorigenicity-2 (sST2) is a member of the interleukin-1 receptor family [interleukin-1 receptor-like 1 (IL1RL1)], which has been associated with an increased risk of mortality and morbidity in heart failure or acute coronary syndrome. We assessed the predictive value of sST2 levels in an unselected 'real-world' cohort of anticoagulated AF patients. Methods: We included 562 patients (49% male median age 77 [IQR: 71-82]) with permanent AF who were stable (for at least 6 months) on OAC (INRs 2·0-3·0). sST2 levels were quantified by ELISA. Patients were followed-up for up to 4 years, and cardiovascular events and all-cause mortality were recorded. Results: Median (IQR) of sST2 levels was 51·23 (39·09-67·40) μg/L. Median follow-up was 1587 days [IQR 1482-1617], and during this period, 91 patients died (16·2%, 3·72%/year). The c-statistic for predicting mortality with sST2 was 0·58 + 0·03; P = 0·017). On multivariate analysis, age [hazard ratio (HR) 1·09 (1·05-1·13); P < 0·001], diabetes mellitus [1·76 (1·08-2·88); P = 0·023], previous stroke [2·16 (1·29-3·60); P = 0·003] and sST2 levels [1·008 (1·002-1·14); P = 0·008] were independently associated with mortality. Concentrations of sST2 were also significantly associated with the risk of mortality, even after adjusting for the CHA<inf>2</inf>DS<inf>2</inf>-VASc score [HR: 1·007 (1·001-1·013); P = 0·014]. Conclusions: In an anticoagulated AF patient's cohort, sST2 levels are an independent predictive factor of all-cause mortality. sST2 levels could be a biomarker used to improve clinical risk assessment in anticoagulated AF patients.
Original languageEnglish
Pages (from-to)899-905
JournalEuropean Journal of Clinical Investigation
Volume45
Issue number9
DOIs
Publication statusPublished - 1 Jan 2015

Keywords

  • Atrial fibrillation
  • Biomarker
  • Mortality
  • Soluble suppression of tumorigenicity-2

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    Vílchez, J. A., Pérez-Cuellar, M., Marín, F., Gallego, P., Manzano-Fernández, S., Valdés, M., Vicente, V., Noguera-Velasco, J. A., Lip, G. Y. H., Ordóñez-Llanos, J., & Roldán, V. (2015). sST2 levels are associated with all-cause mortality in anticoagulated patients with atrial fibrillation. European Journal of Clinical Investigation, 45(9), 899-905. https://doi.org/10.1111/eci.12482