Prognostic Value of Soluble Suppression of Tumorigenicity-2 in Chronic Heart Failure A Meta-Analysis
Prognostic Value of Soluble Suppression of Tumorigenicity-2 in Chronic Heart Failure A Meta-Analysis
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DOI：
10.1016/j.jchf.2016.09.010
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发表时间：
2017-04-01
影响因子：
13
通讯作者：
Emdin, Michele
中科院分区：
文献类型：
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作者：
Aimo, Alberto;Vergaro, Giuseppe;Emdin, Michele
本研究的目的是对现有数据进行首次荟萃分析。背景：慢性心力衰竭（CHF）患者血浆可溶性抑制肿瘤发生2 （sST2）浓度升高，有助于预测这种情况下的预后，尽管证据有限。方法检索Medline、Cochrane Library和Scopus数据库。纳入标准为：随访研究；以英文发表的论文；CHF门诊患者入组；关于log(2) ST2的风险比（HR）（因此报告的HR代表sST2每翻倍的风险）和全因死亡的95%置信区间（CI），也可能包括心血管（CV）死亡的现有数据；以及标准化sST2检测的使用。排除标准是：sST2仅作为预后评分的一个因素，以及对终末期心衰患者的研究。结果：最终纳入了7项全因死亡研究，全球总人数为6372例；有5项研究的CV死亡数据，共计5051例患者。全因死亡的HR为1.75 (95% CI: 1.37 ~ 2.22)， CV死亡的HR为1.79 (95% CI: 1.22 ~ 2.63) （p均< 0.001）。在sST2预测值的量化中，各研究之间存在显著的异质性，这是由于各试验在药物治疗方面存在显著差异。当患者按照目前指南推荐的药物治疗进行管理时，sST2的预测能力更强。结论：sST2是CHF门诊患者全因死亡和CV死亡的预测因子。目前的荟萃分析支持在稳定型CHF患者中使用sST2进行风险分层。(C) 2017年由美国心脏病学会基金会发布。
OBJECTIVES The purpose of this study was to perform the first meta-analysis of currently available data.BACKGROUND Soluble suppression of tumorigenesis 2 (sST2) plasma concentration is elevated in chronic heart failure (CHF) and helps to predict prognosis in this setting, although the evidence is limited.METHODS Three databases (Medline, Cochrane Library, and Scopus) were searched. Inclusion criteria were: follow-up studies; papers published in English; enrollment of CHF outpatients; available data on hazard ratio (HR) for the log(2) ST2 (so that the reported HRs represent the risk per doubling of sST2) and 95% confidence interval (CI) for all-cause death, and possibly also for cardiovascular (CV) death; and use of standardized sST2 assay. Exclusion criteria were: sST2 considered only as an element of a prognostic score, and studies on patients with end-stage HF.RESULTS Seven studies were finally included for all-cause death, with a global population of 6,372 patients; data on CV death were available for 5 studies, totaling 5,051 patients. The HR was 1.75 (95% CI: 1.37 to 2.22) for all-cause death and 1.79 (95% CI: 1.22 to 2.63) for CV death (both p < 0.001). Significant heterogeneity among studies was detected in the quantification of sST2 predictive value, attributable to marked differences in pharmacological treatment among trials. The predictive power of sST2 was greater when patients were managed according to present guideline- recommended medical treatment.CONCLUSIONS sST2 is a predictor of both all-cause and CV death in CHF outpatients. The present meta-analysis supports the use of sST2 for risk stratification in patients with stable CHF. (C) 2017 by the American College of Cardiology Foundation.