Ann Lab Med.  2016 Sep;36(5):420-426. 10.3343/alm.2016.36.5.420.

The Prognostic Value of Serum Levels of Heart-Type Fatty Acid Binding Protein and High Sensitivity C-Reactive Protein in Patients With Increased Levels of Amino-Terminal Pro-B Type Natriuretic Peptide

• Jeong JH
• Seo YH
• Ahn JY
• Kim KH
• Seo JY
• Kim MJ
• Lee HT
• Park PW

• KMID: 2373571
• DOI: http://doi.org/10.3343/alm.2016.36.5.420

Abstract

BACKGROUND
Amino-terminal pro-B type natriuretic peptide (NT-proBNP) is a well-established prognostic factor in heart failure (HF). However, numerous causes may lead to elevations in NT-proBNP, and thus, an increased NT-proBNP level alone is not sufficient to predict outcome. The aim of this study was to evaluate the utility of two acute response markers, high sensitivity C-reactive protein (hsCRP) and heart-type fatty acid binding protein (H-FABP), in patients with an increased NT-proBNP level.
METHODS
The 278 patients were classified into three groups by etiology: 1) acute coronary syndrome (ACS) (n=62), 2) non-ACS cardiac disease (n=156), and 3) infectious disease (n=60). Survival was determined on day 1, 7, 14, 21, 28, 60, 90, 120, and 150 after enrollment.
RESULTS
H-FABP (P<0.001), NT-proBNP (P=0.006), hsCRP (P<0.001) levels, and survival (P<0.001) were significantly different in the three disease groups. Patients were divided into three classes by using receiver operating characteristic curves for NT-proBNP, H-FABP, and hsCRP. Patients with elevated NT-proBNP (≥3,856 pg/mL) and H-FABP (≥8.8 ng/mL) levels were associated with higher hazard ratio for mortality (5.15 in NT-proBNP and 3.25 in H-FABP). Area under the receiver operating characteristic curve analysis showed H-FABP was a better predictor of 60-day mortality than NT-proBNP.
CONCLUSIONS
The combined measurement of H-FABP with NT-proBNP provides a highly reliable means of short-term mortality prediction for patients hospitalized for ACS, non-ACS cardiac disease, or infectious disease.

Keyword

Amino-terminal pro-B type natriuretic peptide; Heart-type fatty acid binding protein; High sensitivity C-reactive protein; Prognostic marker

MeSH Terms

Acute Coronary Syndrome/blood/*diagnosis/mortality
Aged
Area Under Curve
Biomarkers/blood
C-Reactive Protein/*analysis
Fatty Acid-Binding Proteins/*blood
Female
Humans
Kaplan-Meier Estimate
Male
Middle Aged
Natriuretic Peptide, Brain/*blood
Peptide Fragments/*blood
Prognosis
Proportional Hazards Models
ROC Curve
Biomarkers
C-Reactive Protein
Fatty Acid-Binding Proteins
Natriuretic Peptide, Brain
Peptide Fragments

Figure

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  Fig. 1 Kaplan-Meier analysis of survival in patients in the ACS group (n=62) stratified into three groups based on (A) NT-proBNP, (B) H-FABP, and (C) hsCRP levels. Kaplan-Meier analysis of survival in the non-ACS group (n=156) classified by (D) NT-proBNP, (E) H-FABP, and (F) hsCRP levels. Kaplan-Meier analysis of survival in patients with infection & sepsis (n=60) for (G) NT-proBNP, (H) H-FABP, and (I) hsCRP levels.Abbreviations: ACS, acute coronary syndrome; NT-ProBNP, amino-terminal pro-B type natriuretic peptide; H-FABP, heart-type fatty acid binding protein; hsCRP, high sensitivity C-reactive protein.

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