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Yu Z, Nian C, Sun W, Liu X, Nian X. Elevated serum HE4 levels as a novel biomarker of disease severity and hepatic fibrosis in autoimmune hepatitis. Clin Chim Acta 2024; 559:119682. [PMID: 38643819 DOI: 10.1016/j.cca.2024.119682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 04/11/2024] [Accepted: 04/18/2024] [Indexed: 04/23/2024]
Abstract
BACKGROUND Human epididymis protein 4 (HE4) has been identified as a biomarker for renal fibrosis. This study aimed to evaluate the role of HE4 in the diagnosis and determination of disease severity and hepatic fibrosis in autoimmune hepatitis (AIH). METHODS Serum HE4 levels were determined via electrochemiluminescence immunoassays in 60 healthy controls and 109 AIH patients (43 without liver cirrhosis and 66 with liver cirrhosis). Liver biopsy was performed on 56 of 109 enrolled patients. We conducted a 5-year follow-up survey of 53 enrolled patients. All continuous variables were reported as median (25th-75th percentile). RESULTS Serum HE4 levels were significantly elevated in autoimmune hepatitis with liver cirrhosis (AIH-LC) patients compared with AIH patients and healthy controls [98.60 (74.15-139.08) vs 73.50 (59.88-82.00) vs 48.75 (43.38-52.93) pmol/L, p = 0.004]. The serum HE4 levels showed a positive correlation with the METAVIR scoring system in patients with liver biopsy (r = 0.711, p < 0.001). Serum HE4 levels were significantly elevated in Child-Pugh class C patients compared with Child-Pugh class B patients and Child-Pugh class A patients [106.50 (83.46-151.25) vs 110.00 (73.83-166.75) vs 77.03 (72.35-83.33) pmol/L, p = 0.006]. The diagnostic sensitivity and specificity of serum HE4 for evaluating liver cirrhosis were 69.7 % and 79.07 %, respectively, with a cutoff value of 82.34 pmol/L in enrolled patients. The logistic regression analysis showed that high levels of HE4 (≥82.34 pmol/L) were associated with AIH-LC (OR = 8.751, 95 % CI = 1.412-54.225, p = 0.020). The Kaplan-Meier curves demonstrated that high levels of serum HE4 (≥82.34 pmol/L) were associated with poor outcome (log-rank p = 0.037, HR = 0.372, 95 % CI = 0.146-0.946). CONCLUSIONS Serum HE4 levels were found to be elevated in AIH-LC patients and exhibited a strong correlation with the severity of hepatic fibrosis, thus supporting their potential clinical value as a novel biomarker of disease severity and hepatic fibrosis in AIH.
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Affiliation(s)
- Zhi Yu
- Department of Gastroenterology, Yantai Yuhuangding Hospital, Affiliated with the Medical College of Qingdao, Yantai, Shandong 264200, China
| | - Caina Nian
- Department of Interventional Therapy, Yantai Municipal Laiyang Central Hospital, Yantai, Shandong 265200, China
| | - Wenmei Sun
- Department of Gastroenterology, Yantai Yuhuangding Hospital, Affiliated with the Medical College of Qingdao, Yantai, Shandong 264200, China
| | - Xinhua Liu
- Department of Gastroenterology, Yantai Yuhuangding Hospital, Affiliated with the Medical College of Qingdao, Yantai, Shandong 264200, China.
| | - Xueyuan Nian
- Department of Gastroenterology, Yantai Yuhuangding Hospital, Affiliated with the Medical College of Qingdao, Yantai, Shandong 264200, China.
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2
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Ogata F, Hanatani S, Nakashima N, Yamamoto M, Shirahama Y, Ishii M, Tabata N, Kusaka H, Yamanaga K, Kanazawa H, Hoshiyama T, Takashio S, Usuku H, Matsuzawa Y, Yamamoto E, Soejima H, Kawano H, Hayashi H, Oda S, Hirai T, Tsujita K. Human epididymis protein 4 is a useful predictor of post-operative prognosis in patients with severe aortic stenosis. ESC Heart Fail 2024. [PMID: 38803046 DOI: 10.1002/ehf2.14845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 04/07/2024] [Accepted: 04/24/2024] [Indexed: 05/29/2024] Open
Abstract
AIMS The human epididymis protein 4 (HE4), a novel fibrosis marker, is expressed only in activated fibroblasts and is thought to reflect ongoing left ventricular (LV) fibrosis. LV fibrosis is a feature of severe aortic stenosis (AS) and is related to the post-operative outcome of patients with AS. We investigated the relationship between serum levels of HE4 and the post-operative prognosis of patients with severe AS. METHODS AND RESULTS We measured the serum HE4 levels of 55 participants (80.8 ± 8.0 years old, male n = 26, 46%) with severe AS prior to surgical aortic valve replacement (n = 31, 56%) or transcatheter aortic valve implantation (n = 24, 44%) at Kumamoto University Hospital in 2018. We followed them for cardiovascular (CV) death or hospitalization for heart failure (HF) for 3 years. Serum HE4 levels were positively correlated with computed tomography-extracellular volume (CT-ECV) values (r = 0.53, P = 0.004). Kaplan-Meier curves demonstrated a significantly higher probability of hospitalization for HF or CV-related death in the patients with high HE4 (greater than the median HE4 value) compared with the patients with low HE4 (lower than the median HE4 value) (log-rank P = 0.003). Multivariate analysis showed HE4 (log(HE4)) to be an independent prognostic factor [hazard ratio (HR): 7.50; 95% confidence interval (CI): 1.81-31.1; P = 0.005]. Receiver operating characteristic (ROC) curve analysis suggested that HE4 is a marker of increased risk of CV-related death or hospitalization for HF at 3 years after surgery, with an area under the curve (AUC) of 0.76 (95% CI: 0.62-0.90; P = 0.003). CONCLUSIONS We found that HE4 is a potentially useful biomarker for predicting future CV events in patients scheduled for AS surgery. Measuring serum HE4 values could help consider AS surgery.
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Affiliation(s)
- Fumihiko Ogata
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Shinsuke Hanatani
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Naoya Nakashima
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Masahiro Yamamoto
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Yuichiro Shirahama
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Masanobu Ishii
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Noriaki Tabata
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Hiroaki Kusaka
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Kenshi Yamanaga
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Hisanori Kanazawa
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Tadashi Hoshiyama
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Seiji Takashio
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Hiroki Usuku
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Yasushi Matsuzawa
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Eiichiro Yamamoto
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Hirofumi Soejima
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Hiroaki Kawano
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Hidetaka Hayashi
- Department of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Seitaro Oda
- Department of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Toshinori Hirai
- Department of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Kenichi Tsujita
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
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3
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Dubin RF, Deo R, Ren Y, Wang J, Pico AR, Mychaleckyj JC, Kozlitina J, Arthur V, Lee H, Shah A, Feldman H, Bansal N, Zelnick L, Rao P, Sukul N, Raj DS, Mehta R, Rosas SE, Bhat Z, Weir MR, He J, Chen J, Kansal M, Kimmel PL, Ramachandran VS, Waikar SS, Segal MR, Ganz P. Incident heart failure in chronic kidney disease: proteomics informs biology and risk stratification. Eur Heart J 2024:ehae288. [PMID: 38757788 DOI: 10.1093/eurheartj/ehae288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 04/09/2024] [Accepted: 04/25/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND AND AIMS Incident heart failure (HF) among individuals with chronic kidney disease (CKD) incurs hospitalizations that burden patients and health care systems. There are few preventative therapies, and the Pooled Cohort equations to Prevent Heart Failure (PCP-HF) perform poorly in the setting of CKD. New drug targets and better risk stratification are urgently needed. METHODS In this analysis of incident HF, SomaScan V4.0 (4638 proteins) was analysed in 2906 participants of the Chronic Renal Insufficiency Cohort (CRIC) with validation in the Atherosclerosis Risk in Communities (ARIC) study. The primary outcome was 14-year incident HF (390 events); secondary outcomes included 4-year HF (183 events), HF with reduced ejection fraction (137 events), and HF with preserved ejection fraction (165 events). Mendelian randomization and Gene Ontology were applied to examine causality and pathways. The performance of novel multi-protein risk models was compared to the PCP-HF risk score. RESULTS Over 200 proteins were associated with incident HF after adjustment for estimated glomerular filtration rate at P < 1 × 10-5. After adjustment for covariates including N-terminal pro-B-type natriuretic peptide, 17 proteins remained associated at P < 1 × 10-5. Mendelian randomization associations were found for six proteins, of which four are druggable targets: FCG2B, IGFBP3, CAH6, and ASGR1. For the primary outcome, the C-statistic (95% confidence interval [CI]) for the 48-protein model in CRIC was 0.790 (0.735, 0.844) vs. 0.703 (0.644, 0.762) for the PCP-HF model (P = .001). C-statistic (95% CI) for the protein model in ARIC was 0.747 (0.707, 0.787). CONCLUSIONS Large-scale proteomics reveal novel circulating protein biomarkers and potential mediators of HF in CKD. Proteomic risk models improve upon the PCP-HF risk score in this population.
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Affiliation(s)
- Ruth F Dubin
- Division of Nephrology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, H5.122E, Dallas, TX 75390, USA
| | - Rajat Deo
- Division of Cardiovascular Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Yue Ren
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Jianqiao Wang
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Alexander R Pico
- Institute of Data Science and Biotechnology, Gladstone Institutes, San Francisco, CA, USA
| | - Josyf C Mychaleckyj
- Center for Public Health Genomics, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Julia Kozlitina
- McDermott Center for Human Growth and Development, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Victoria Arthur
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Hongzhe Lee
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Amil Shah
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Harold Feldman
- Patient-Centered Outcomes Research Institute, Washington, DC, USA
| | - Nisha Bansal
- Division of Nephrology, University of Washington Medical Center, Seattle, WA, USA
| | - Leila Zelnick
- Division of Nephrology, University of Washington Medical Center, Seattle, WA, USA
| | - Panduranga Rao
- Division of Nephrology, University of Michigan, Ann Arbor, MI, USA
| | - Nidhi Sukul
- Division of Nephrology, University of Michigan, Ann Arbor, MI, USA
| | - Dominic S Raj
- Division of Kidney Diseases and Hypertension, George Washington University School of Medicine, Washington, DC, USA
| | - Rupal Mehta
- Division of Nephrology and Hypertension, Northwestern University Feinberg School of Medicine, USA
| | - Sylvia E Rosas
- Joslin Diabetes Center, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Zeenat Bhat
- Division of Nephrology, University of Michigan, Ann Arbor, MI, USA
| | - Matthew R Weir
- Division of Nephrology, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Jiang He
- Department of Epidemiology, Tulane University, New Orleans, LA, USA
| | - Jing Chen
- Department of Epidemiology, Tulane University, New Orleans, LA, USA
| | - Mayank Kansal
- Division of Cardiology, University of Illinois College of Medicine, Chicago, IL, USA
| | - Paul L Kimmel
- Division of Kidney, Urologic, and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Vasan S Ramachandran
- University of Texas School of Public Health San Antonio and the University of Texas Health Sciences Center in San Antonio, Section of Preventive Medicine and Epidemiology, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Sushrut S Waikar
- Section of Nephrology, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Mark R Segal
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - Peter Ganz
- Division of Cardiology, University of California San Francisco, San Francisco, CA, USA
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4
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Tang Y, Hu Z, Liu Z, Peng S, Liu T, Xiao Y, Peng J, Pan H, Zheng Z, He J. HE4 Serum Levels are Associated with Poor Prognosis in Patients with Acute Heart Failure Combined with Chronic Kidney Disease. Int J Gen Med 2024; 17:1273-1280. [PMID: 38590999 PMCID: PMC10999502 DOI: 10.2147/ijgm.s444680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Accepted: 03/13/2024] [Indexed: 04/10/2024] Open
Abstract
Purpose The levels of human epididymis protein 4 (HE4) is associated not only with the prognosis of patients with acute heart failure (AHF), but also with chronic kidney disease (CKD). Our study aims to understand the prediction value of HE4 on prognosis in patients with AHF combined with CKD. Patients and Methods This study prospectively enrolled patients diagnosed with AHF combined with CKD at the Department of Cardiology of Hunan Provincial People's Hospital from March 2019 to December 2022. Serum levels of HE4 were measured using a chemiluminescence microparticle immunoassay. The endpoint events included heart failure readmission and cardiovascular death. Results A total of 130 patients with AHF combined with CKD were included in the stud. The median age is 73 years (interquartile range: 65-79 years). Among the patients, 94 experienced the endpoint events. The multivariable Cox analysis reveals that LnHE4 (HR=2.280, 95% CI 1.300-3.998, P = 0.004) and age (HR=1.024, 95% CI 1.003-1.045, P = 0.025) are independent predictors of the endpoint events. The Kaplan-Meier survival curve demonstrates that patients with HE4 levels>276.15 pmol/L has a significantly higher incidence of endpoint events compared to those with HE4 levels≤276.15 pmol/L (Log rank test: χ2=19.689, P < 0.001). After adjusting for age and gender, the HR is 2.520 (95% CI: 1.626-3.906, P < 0.001). Conclusion HE4 is an independent predictor of heart failure readmission and cardiovascular death in patients with AHF combined with CKD.
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Affiliation(s)
- Yi Tang
- Department of Cardiology, Hunan Provincial People’s Hospital, the First Affiliated Hospital of Hunan Normal University, Clinical Medicine Research Center of Heart Failure of Hunan Province, Hunan Normal University, Changsha, People’s Republic of China
| | - Zhengqi Hu
- Department of Cardiology, Hunan Provincial People’s Hospital, the First Affiliated Hospital of Hunan Normal University, Changsha, People’s Republic of China
| | - Zhibin Liu
- Department of Cardiology, Hunan Provincial People’s Hospital, the First Affiliated Hospital of Hunan Normal University, Changsha, People’s Republic of China
| | - Siling Peng
- Department of Cardiology, Hunan Provincial People’s Hospital, the First Affiliated Hospital of Hunan Normal University, Changsha, People’s Republic of China
| | - Tiancheng Liu
- Department of Cardiology, Hunan Provincial People’s Hospital, the First Affiliated Hospital of Hunan Normal University, Changsha, People’s Republic of China
| | - Yaoyuan Xiao
- Department of Cardiology, Hunan Provincial People’s Hospital, the First Affiliated Hospital of Hunan Normal University, Changsha, People’s Republic of China
| | - Jianqiang Peng
- Department of Cardiology, Hunan Provincial People’s Hospital, the First Affiliated Hospital of Hunan Normal University, Clinical Medicine Research Center of Heart Failure of Hunan Province, Hunan Normal University, Changsha, People’s Republic of China
| | - Hongwei Pan
- Department of Cardiology, Hunan Provincial People’s Hospital, the First Affiliated Hospital of Hunan Normal University, Clinical Medicine Research Center of Heart Failure of Hunan Province, Hunan Normal University, Changsha, People’s Republic of China
| | - Zhaofen Zheng
- Department of Cardiology, Hunan Provincial People’s Hospital, the First Affiliated Hospital of Hunan Normal University, Clinical Medicine Research Center of Heart Failure of Hunan Province, Hunan Normal University, Changsha, People’s Republic of China
| | - Jin He
- Department of Cardiology, Hunan Provincial People’s Hospital, the First Affiliated Hospital of Hunan Normal University, Clinical Medicine Research Center of Heart Failure of Hunan Province, Hunan Normal University, Changsha, People’s Republic of China
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5
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Attanasio U, Di Sarro E, Tricarico L, Di Lisi D, Armentaro G, Miceli S, Fioretti F, Deidda M, Correale M, Novo G, Sciacqua A, Nodari S, Cadeddu C, Tocchetti CG, Palazzuoli A, Mercurio V. Cardiovascular Biomarkers in Cardio-Oncology: Antineoplastic Drug Cardiotoxicity and Beyond. Biomolecules 2024; 14:199. [PMID: 38397436 PMCID: PMC10887095 DOI: 10.3390/biom14020199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 01/29/2024] [Accepted: 02/03/2024] [Indexed: 02/25/2024] Open
Abstract
Serum biomarkers represent a reproducible, sensitive, minimally invasive and inexpensive method to explore possible adverse cardiovascular effects of antineoplastic treatments. They are useful tools in risk stratification, the early detection of cardiotoxicity and the follow-up and prognostic assessment of cancer patients. In this literature review, we aim at describing the current state of knowledge on the meaning and the usefulness of cardiovascular biomarkers in patients with cancer; analyzing the intricate relationship between cancer and cardiovascular disease (especially HF) and how this affects cardiovascular and tumor biomarkers; exploring the role of cardiovascular biomarkers in the risk stratification and in the identification of chemotherapy-induced cardiotoxicity; and providing a summary of the novel potential biomarkers in this clinical setting.
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Affiliation(s)
- Umberto Attanasio
- Department of Translational Medical Sciences, Federico II University, Via Sergio Pansini 5, 80131 Naples, Italy (E.D.S.); (C.G.T.)
| | - Elena Di Sarro
- Department of Translational Medical Sciences, Federico II University, Via Sergio Pansini 5, 80131 Naples, Italy (E.D.S.); (C.G.T.)
| | - Lucia Tricarico
- Cardiology Unit, Department of Medical and Surgical Sciences, University of Foggia, Viale Pinto 1, 71122 Foggia, Italy; (L.T.); (M.C.)
| | - Daniela Di Lisi
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Piazza delle Cliniche 2, 90127 Palermo, Italy; (D.D.L.); (G.N.)
- Division of Cardiology, University Hospital Paolo Giaccone, Via del Vespro 129, 90127 Palermo, Italy
| | - Giuseppe Armentaro
- Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, Campus Universitario di Germaneto, V.le Europa, 88100 Catanzaro, Italy; (G.A.); (S.M.); (A.S.)
| | - Sofia Miceli
- Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, Campus Universitario di Germaneto, V.le Europa, 88100 Catanzaro, Italy; (G.A.); (S.M.); (A.S.)
| | - Francesco Fioretti
- Cardiology Section, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Spedali Civili Hospital and University of Brescia, Piazzale Spedali Civili 1, 25123 Brescia, Italy; (F.F.); (S.N.)
| | - Martino Deidda
- Department of Medical Sciences and Public Health, University of Cagliari, 09042 Monserrato, Italy (C.C.)
| | - Michele Correale
- Cardiology Unit, Department of Medical and Surgical Sciences, University of Foggia, Viale Pinto 1, 71122 Foggia, Italy; (L.T.); (M.C.)
| | - Giuseppina Novo
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Piazza delle Cliniche 2, 90127 Palermo, Italy; (D.D.L.); (G.N.)
- Division of Cardiology, University Hospital Paolo Giaccone, Via del Vespro 129, 90127 Palermo, Italy
| | - Angela Sciacqua
- Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, Campus Universitario di Germaneto, V.le Europa, 88100 Catanzaro, Italy; (G.A.); (S.M.); (A.S.)
| | - Savina Nodari
- Cardiology Section, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Spedali Civili Hospital and University of Brescia, Piazzale Spedali Civili 1, 25123 Brescia, Italy; (F.F.); (S.N.)
| | - Christian Cadeddu
- Department of Medical Sciences and Public Health, University of Cagliari, 09042 Monserrato, Italy (C.C.)
| | - Carlo Gabriele Tocchetti
- Department of Translational Medical Sciences, Federico II University, Via Sergio Pansini 5, 80131 Naples, Italy (E.D.S.); (C.G.T.)
- Interdepartmental Center of Clinical and Translational Sciences (CIRCET), Federico II University, Via Sergio Pansini 5, 80131 Naples, Italy
- Interdepartmental Hypertension Research Center (CIRIAPA), Federico II University, Via Sergio Pansini 5, 80131 Naples, Italy
- Center for Basic and Clinical Immunology Research (CISI), Federico II University, Via Sergio Pansini 5, 80131 Naples, Italy
| | - Alberto Palazzuoli
- Cardiovascular Diseases Unit, Cardio-thoracic and Vascular Department Le Scotte Hospital, University of Siena, Strada delle Scotte 14, 53100 Siena, Italy;
| | - Valentina Mercurio
- Department of Translational Medical Sciences, Federico II University, Via Sergio Pansini 5, 80131 Naples, Italy (E.D.S.); (C.G.T.)
- Interdepartmental Center of Clinical and Translational Sciences (CIRCET), Federico II University, Via Sergio Pansini 5, 80131 Naples, Italy
- Interdepartmental Hypertension Research Center (CIRIAPA), Federico II University, Via Sergio Pansini 5, 80131 Naples, Italy
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6
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Kuku KO, Oyetoro R, Hashemian M, Livinski AA, Shearer JJ, Joo J, Psaty BM, Levy D, Ganz P, Roger VL. Proteomics for heart failure risk stratification: a systematic review. BMC Med 2024; 22:34. [PMID: 38273315 PMCID: PMC10809595 DOI: 10.1186/s12916-024-03249-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 01/05/2024] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND Heart failure (HF) is a complex clinical syndrome with persistently high mortality. High-throughput proteomic technologies offer new opportunities to improve HF risk stratification, but their contribution remains to be clearly defined. We aimed to systematically review prognostic studies using high-throughput proteomics to identify protein signatures associated with HF mortality. METHODS We searched four databases and two clinical trial registries for articles published from 2012 to 2023. HF proteomics studies measuring high numbers of proteins using aptamer or antibody-based affinity platforms on human plasma or serum with outcomes of all-cause or cardiovascular death were included. Two reviewers independently screened articles, extracted data, and assessed the risk of bias. A third reviewer resolved conflicts. We assessed the risk of bias using the Risk Of Bias In Non-randomized Studies-of Exposure tool. RESULTS Out of 5131 unique articles identified, nine articles were included in the review. The nine studies were observational; three used the aptamer platform, and six used the antibody platform. We found considerable heterogeneity across studies in measurement panels, HF definitions, ejection fraction categorization, follow-up duration, and outcome definitions, and a lack of risk estimates for most protein associations. Hence, we proceeded with a systematic review rather than a meta-analysis. In two comparable aptamer studies in patients with HF with reduced ejection fraction, 21 proteins were identified in common for the association with all-cause death. Among these, one protein, WAP four-disulfide core domain protein 2 was also reported in an antibody study on HFrEF and for the association with CV death. We proposed standardized reporting criteria to facilitate the interpretation of future studies. CONCLUSIONS In this systematic review of nine studies evaluating the association of proteomics with mortality in HF, we identified a limited number of proteins common across several studies. Heterogeneity across studies compromised drawing broad inferences, underscoring the importance of standardized approaches to reporting.
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Affiliation(s)
- Kayode O Kuku
- Heart Disease Phenomics Laboratory, Epidemiology and Community Health Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Rebecca Oyetoro
- Heart Disease Phenomics Laboratory, Epidemiology and Community Health Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Maryam Hashemian
- Heart Disease Phenomics Laboratory, Epidemiology and Community Health Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Alicia A Livinski
- Office of Research Services, Office of the Director, National Institutes of Health Library, National Institutes of Health, Bethesda, MD, USA
| | - Joseph J Shearer
- Heart Disease Phenomics Laboratory, Epidemiology and Community Health Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Jungnam Joo
- Office of Biostatistics Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Bruce M Psaty
- Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology and Health Systems and Population Health, University of Washington, Seattle, WA, USA
| | - Daniel Levy
- Laboratory for Cardiovascular Epidemiology and Genomics, Population Sciences Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Peter Ganz
- Zuckerberg San Francisco General Hospital, University of California, San Francisco, San Francisco, CA, USA
| | - Véronique L Roger
- Heart Disease Phenomics Laboratory, Epidemiology and Community Health Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA.
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7
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Yan Q, Ye L, Zhang Q, Song J, Zhang X, Wu L, Wang L. Nomogram to predict the incidence of new-onset heart failure after acute coronary syndrome among women. Front Cardiovasc Med 2023; 10:1131813. [PMID: 37034347 PMCID: PMC10080589 DOI: 10.3389/fcvm.2023.1131813] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 03/08/2023] [Indexed: 04/11/2023] Open
Abstract
Background Although great progress has been made in caring for patients with acute coronary syndrome (ACS), the incidence of heart failure (HF) after discharge remains high after ACS. Aims We aimed to investigate the risk predictors for new-onset HF and build a simple nomogram to optimize the clinical management of female patients. Methods The clinical data of 319 female patients with ACS between January 1, 2021 and January 1, 2022, were obtained from the Zhejiang Provincial People's Hospital. Multivariate logistic regression analysis was carried out to build the prediction model among all participants and then verified by 10-fold cross-validation. The discrimination, calibration, and clinical usefulness of the prediction model were assessed using receiver operating characteristic curve, calibration curve, and decision curve analyses. Results This study analyzed 15 potential independent risk predictors of new-onset HF in 319 female patients with ACS. The incidence of HF onset was 23.2%. The following 5 independent risk predictors were filtered out as most relevant for predicting 12-month HF onset: left ventricular ejection fraction ≤ 60.5%, high-density lipoprotein ≤ 1.055 mmol/L, human epididymal protein 4 > 69.6 pmol/L, creatinine > 71.95 µmol/L, and diagnosis of myocardial infarction (MI). Conclusion Our nomogram, which used five easily obtained clinical variables, could be a useful tool to help identify female individuals with ACS who are at high risk of developing HF after discharge and facilitate communication between female patients and physicians.
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Affiliation(s)
- Qiqi Yan
- Heart Center, Department of Cardiovascular Medicine, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College), Hangzhou, China
- The Second School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, China
| | - Lifang Ye
- Heart Center, Department of Cardiovascular Medicine, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College), Hangzhou, China
| | - Qinggang Zhang
- Heart Center, Department of Cardiovascular Medicine, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College), Hangzhou, China
| | - Jikai Song
- Zhejiang Provincial People's Hospital, Qingdao University, Hangzhou, China
| | - Xin Zhang
- Heart Center, Department of Cardiovascular Medicine, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College), Hangzhou, China
| | - Liuyang Wu
- Heart Center, Department of Cardiovascular Medicine, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College), Hangzhou, China
- The Second School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, China
| | - Lihong Wang
- Heart Center, Department of Cardiovascular Medicine, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College), Hangzhou, China
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Yan Q, Wu L, Song J, Ye L, Zhang Q, Che X, Zhang X, Wang L. Serum Human Epididymis Protein 4 as a Prognostic Predictor of New-Onset Heart Failure among Women after Acute Coronary Syndrome: A Single-Center Retrospective Study. Cardiology 2023; 148:230-238. [PMID: 36720203 DOI: 10.1159/000529365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 01/11/2023] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Little is known about the prognostic factors among women with acute coronary syndrome (ACS), partly due to the small number of women included in heart failure (HF) clinical trials. Human epididymis protein 4 (HE4) has been proven to be a new biomarker for acute and chronic HF over the years. We hypothesize that HE4 could be a promising predictor. METHODS This retrospective study analyzed data from Zhejiang Provincial People's Hospital. This study included 302 female patients with ACS between January 1, 2021, and December 1, 2021. The primary outcome was new-onset HF after ACS during the 12-month follow-up period. We used a logistic regression model to evaluate the association between serum HE4 levels and the incidence of HF. Serum HE4 levels were measured at baseline (within 24 h after admission). RESULTS Of the 302 female patients, 70 (23.2%) developed new-onset HF within 12 months. Serum HE4 levels in patients with adverse events were significantly higher than those in patients without events (8.9 [7.3-11.5] pmol/dL versus 5.9 [5.0-6.8] pmol/dL, p < 0.001). The levels of HE4, troponin I peak, left ventricular ejection fraction (LVEF), and estimated glomerular filtration rate (eGFR) were validated as independent predictors, with HE4 being the best laboratory predictor (area under the curve, 0.863; 95% confidence interval, 0.817-0.909). Serum HE4 concentrations of >6.93 pmol/dL distinguished patients at risk of HF with 82.9% sensitivity and 78.0% specificity (maximum Youden index J, 0.609). Moreover, HE4 levels were associated with an increased risk of HF. DISCUSSION We found a strong relationship between HE4 and the occurrence of HF after ACS among women, which might help identify patients at high risk of HF for whom close or intense management should be mandatory.
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Affiliation(s)
- Qiqi Yan
- The Second School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, China,
- Heart Center, Department of Cardiovascular Medicine, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, China,
| | - Liuyang Wu
- The Second School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, China
- Heart Center, Department of Cardiovascular Medicine, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, China
| | - Jikai Song
- Heart Center, Department of Cardiovascular Medicine, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, China
- Zhejiang Provincial People's Hospital, Qingdao University, Hangzhou, China
| | - Lifang Ye
- Heart Center, Department of Cardiovascular Medicine, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, China
| | - Qinggang Zhang
- Heart Center, Department of Cardiovascular Medicine, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, China
| | - Xiaoru Che
- Heart Center, Department of Cardiovascular Medicine, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, China
| | - Xin Zhang
- Heart Center, Department of Cardiovascular Medicine, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, China
| | - Lihong Wang
- The Second School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, China
- Heart Center, Department of Cardiovascular Medicine, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, China
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Yang Q, Niu Y, Wen JX, Yang DN, Han YL, Wen XH, Yan L, Huang JH, Chen H, Zheng WQ, Jiang TW, Hu ZD. Value of human epididymis secretory protein 4 in differentiating malignant from benign pleural effusion: an analysis of two cohorts. Ther Adv Respir Dis 2023; 17:17534666231216566. [PMID: 38084849 PMCID: PMC10722922 DOI: 10.1177/17534666231216566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 11/08/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Lung cancer is the most common cause of malignant pleural effusion (MPE). Serum human epididymis secretory protein 4 (HE4) is a useful diagnostic marker for lung cancer. OBJECTIVE This study aimed to evaluate the diagnostic accuracy of pleural fluid HE4 for MPE. DESIGN A prospective, double-blind diagnostic test accuracy study. METHODS Patients with undiagnosed pleural effusion were enrolled in two cohorts (Hohhot and Changshu). Electrochemiluminescence immunoassay was used to detect pleural fluid HE4. The diagnostic accuracy of HE4 was evaluated by a receiver operating characteristic (ROC) curve, and the net benefit of HE4 was assessed by a decision curve analysis (DCA). RESULTS A total of 66 MPEs and 86 benign pleural effusions (BPEs) were enrolled in the Hohhot cohort. In the Changshu cohort, 26 MPEs and 32 BPEs were enrolled. In both cohorts, MPEs had significantly higher pleural fluid HE4 than BPEs. The area under the ROC curve (AUC) of HE4 was 0.73 (95% CI: 0.64-0.81) in the Hohhot cohort and 0.79 (95% CI: 0.67-0.91) in the Changshu cohort. At a threshold of 1300 pmol/L, HE4 had sensitivities of 0.44 (95% CI: 0.33-0.56) in the Hohhot cohort and 0.54 (95% CI: 0.35-0.73) in the Changshu cohort. The corresponding specificities were 0.90 (95% CI: 0.83-0.95) in the Hohhot cohort and 0.94 (95% CI: 0.84-1.00) in the Changshu cohort. In subgroup analyses, HE4 had an AUC (95% CI) of 0.78 (0.71-0.85) in exudates and an AUC of 0.69 (0.57-0.81) in patients with negative effusion cytology. The DCA revealed that HE4 determination had a net benefit in both cohorts. CONCLUSION Pleural fluid HE4 has moderate diagnostic accuracy for MPE and has net benefit in pleural effusion patients with unknown etiology.
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Affiliation(s)
- Qian Yang
- Department of Laboratory Medicine, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
| | - Yan Niu
- Department of Medical Experiment Center, The Basic Medical Sciences College of Inner Mongolia Medical University, Hohhot, China
| | - Jian-Xun Wen
- Department of Medical Experiment Center, The Basic Medical Sciences College of Inner Mongolia Medical University, Hohhot, China
| | - Dan-Ni Yang
- Department of Laboratory Medicine, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
| | - Yu-Ling Han
- Department of Laboratory Medicine, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
- Department of Parasitology, The Basic Medical Sciences College of Inner Mongolia Medical University, Hohhot, China
| | - Xu-Hui Wen
- Department of Laboratory Medicine, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
- Department of Parasitology, The Basic Medical Sciences College of Inner Mongolia Medical University, Hohhot, China
| | - Li Yan
- Department of Respiratory and Critical Care Medicine, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
| | - Jin-Hong Huang
- Department of Pulmonary and Critical Care Medicine, Affiliated Changshu Hospital of Nantong University, Changshu, China
| | - Hong Chen
- Department of Pulmonary and Critical Care Medicine, Affiliated Changshu Hospital of Nantong University, Changshu, China
| | - Wen-Qi Zheng
- Department of Laboratory Medicine, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, ChinaDepartment of Parasitology, The Basic Medical Sciences College of Inner Mongolia Medical University, Hohhot, China
| | - Ting-Wang Jiang
- Department of Key Laboratory, Affiliated Changshu Hospital of Nantong University, Changshu 215500, China
| | - Zhi-De Hu
- Department of Laboratory Medicine, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot 010050, China
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10
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Luo J, Liang J, Wang S, Huang S, Zhou L, Shi Y, Zhang J, Wang Y, Wu BQ, Li L. Serum human epididymis secretory protein 4 correlates with sepsis-associated acute respiratory distress syndrome and 28-day mortality in critically ill patients. Ann Clin Biochem 2022; 59:338-346. [PMID: 35549539 DOI: 10.1177/00045632221103805] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Acute respiratory distress syndrome (ARDS) is a severe disease with high mortality, and its primary cause is sepsis. The aim of this study was to detect and evaluate the role of Human epididymis protein 4 (HE4) in sepsis-related ARDS. METHODS One hundred and twenty-three critically ill sepsis patients with/without ARDS and 102 healthy controls were enrolled in this study. Blood samples were collected upon admission for quantitative testing of HE4 by chemiluminescent microparticle immunoassay (CMIA). ROC curve analysis and Spearman's correlation analysis were conducted to determine the diagnostic and prognostic value of HE4. RESULTS Compared with controls, the serum HE4 concentrations of sepsis patients were elevated, and levels in sepsis patients with ARDS were significantly higher (all p < 0.0001). Moreover, HE4 concentrations were strongly correlated with the clinical severity characteristics of sepsis patients, and ROC curve suggested that the AUC of HE4 applied to discriminate sepsis-ARDS patients from sepsis patients was 0.903. HE4 was also found to be a prognostic biomarker of clinical severity and 28-day mortality among critically ill sepsis patients. Logistic regression analysis showed that HE4 was an independent factor for diagnosis of ARDS. Meanwhile, ROC curve analysis showed that the cut-off value of serum HE4 to discriminate 28-day mortality from sepsis patients (AUC: 0.782) was 646.5 pmol/L. CONCLUSIONS The concentration of serum HE4 in patients with sepsis-related ARDS was markedly increased and was significantly correlated with mortality, which suggests that serum HE4 could be a promising diagnostic and prognostic biomarker for ARDS in sepsis patients.
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Affiliation(s)
- Jinmei Luo
- Department of Internal Medicine, Medical Intensive Care Unit and Division of Respiratory Diseases, 144991The Third Affiliated Hospital of Sun Yat-sen University, People's Republic of China
| | - Jingjing Liang
- Department of Emergency, 144991The Third Affiliated Hospital of Sun Yat-sen University, People's Republic of China
| | - Shaofang Wang
- Department of Internal Medicine, Medical Intensive Care Unit and Division of Respiratory Diseases, 144991The Third Affiliated Hospital of Sun Yat-sen University, People's Republic of China
| | - Shaoqiong Huang
- Department of Internal Medicine, Medical Intensive Care Unit and Division of Respiratory Diseases, 144991The Third Affiliated Hospital of Sun Yat-sen University, People's Republic of China
| | - Laizhi Zhou
- Department of Internal Medicine, Medical Intensive Care Unit and Division of Respiratory Diseases, 144991The Third Affiliated Hospital of Sun Yat-sen University, People's Republic of China
| | - Yunfeng Shi
- Department of Internal Medicine, Medical Intensive Care Unit and Division of Respiratory Diseases, 144991The Third Affiliated Hospital of Sun Yat-sen University, People's Republic of China
| | - Jingcong Zhang
- Department of Internal Medicine, Medical Intensive Care Unit and Division of Respiratory Diseases, 144991The Third Affiliated Hospital of Sun Yat-sen University, People's Republic of China
| | - Yanhong Wang
- Department of Internal Medicine, Medical Intensive Care Unit and Division of Respiratory Diseases, 144991The Third Affiliated Hospital of Sun Yat-sen University, People's Republic of China
| | - Ben-Quan Wu
- Department of Internal Medicine, Medical Intensive Care Unit and Division of Respiratory Diseases, 144991The Third Affiliated Hospital of Sun Yat-sen University, People's Republic of China
| | - Laisheng Li
- Department of Laboratory Medicine, 71068The First Affiliated Hospital of Sun Yat-sen University, People's Republic of China
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Influence of Health Education Based on IMB on Prognosis and Self-Management Behavior of Patients with Chronic Heart Failure. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:8517802. [PMID: 35432589 PMCID: PMC9012616 DOI: 10.1155/2022/8517802] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 02/22/2022] [Accepted: 03/05/2022] [Indexed: 01/30/2023]
Abstract
As the contemporary society is increasingly entering an aging society, heart failure, as a common disease in the elderly population, has an increasing impact on people. The common one is mainly chronic heart failure. Coupled with the influence of various complications, such as hypostatic pneumonia and venous thrombosis, the mortality and hospital admission rates of patients are very high. Moreover, the current technology is not very effective for the prevention and treatment of chronic heart failure. The per capita consumption level of ordinary people in China is low, and it is not suitable to promote high-cost treatment programs. Based on this, this paper proposes the intervention management of mental failure patients under the intervention of health education based on IMB, in order to explore the impact of the intervention of health education on patients. The research in this paper selected 112 patients with chronic heart failure who were admitted to the cardiovascular ward of a city public hospital in 2017 and divided the patients into two groups. One group received health education intervention, which was the intervention group. The other group was the control group. The control group was given routine education and nursing. The experimental results of this paper show that the satisfaction of the intervention group is higher, accounting for 85.3%, and the satisfaction of the control group is lower than that of the intervention group, about 67.9%. Dissatisfaction with health education and the probability of short-term readmission were higher than those in the intervention group.
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12
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Savarese G, Uijl A, Ouwerkerk W, Tromp J, Anker SD, Dickstein K, Hage C, Lam CS, Lang CC, Metra M, Ng LL, Orsini N, Samani NJ, van Veldhuisen DJ, Cleland JG, Voors AA, Lund LH. Biomarker changes as surrogate endpoints in early-phase trials in heart failure with reduced ejection fraction. ESC Heart Fail 2022; 9:2107-2118. [PMID: 35388650 PMCID: PMC9288797 DOI: 10.1002/ehf2.13917] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 03/04/2022] [Accepted: 03/14/2022] [Indexed: 12/03/2022] Open
Abstract
AIMS No biomarker has achieved widespread acceptance as a surrogate endpoint for early-phase heart failure (HF) trials. We assessed whether changes over time in a panel of plasma biomarkers were associated with subsequent morbidity/mortality in HF with reduced ejection fraction (HFrEF). METHODS AND RESULTS In 1040 patients with HFrEF from the BIOSTAT-CHF cohort, we investigated the associations between changes in the plasma concentrations of 30 biomarkers, before (baseline) and after (9 months) attempted optimization of guideline-recommended therapy, on top of the BIOSTAT risk score and the subsequent risk of HF hospitalization/all-cause mortality using Cox regression models. C-statistics were calculated to assess discriminatory power of biomarker changes/month-nine assessment. Changes in N-terminal pro-B-type natriuretic peptide (NT-proBNP) and WAP four-disulphide core domain protein HE4 (WAP-4C) were the only independent predictors of the outcome after adjusting for their baseline plasma concentration, 28 other biomarkers (both baseline and changes), and BIOSTAT risk score at baseline. When adjusting for month-nine rather than baseline biomarkers concentrations, only changes in NT-proBNP were independently associated with the outcome. The C-statistic of the model including the BIOSTAT risk score and NT-proBNP increased by 4% when changes were considered on top of baseline concentrations and by 1% when changes in NT-proBNP were considered on top of its month-nine concentrations and the BIOSTAT risk score. CONCLUSIONS Among 30 relevant biomarkers, a change over time was significantly and independently associated with HF hospitalization/all-cause death only for NT-proBNP. Changes over time were modestly more prognostic than baseline or end-values alone. Changes in biomarkers should be further explored as potential surrogate endpoints in early phase HF trials.
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Affiliation(s)
- Gianluigi Savarese
- Division of Cardiology, Department of MedicineKarolinska InstitutetStockholmSweden
| | - Alicia Uijl
- Division of Cardiology, Department of MedicineKarolinska InstitutetStockholmSweden,Julius Center for Health Sciences and Primary Care, University Medical Center UtrechtUtrecht UniversityUtrechtThe Netherlands
| | - Wouter Ouwerkerk
- National Heart Centre SingaporeSingapore,Department of Dermatology, Amsterdam UMCUniversity of Amsterdam, Amsterdam Infection & Immunity InstituteAmsterdamThe Netherlands
| | - Jasper Tromp
- National Heart Centre SingaporeSingapore,Saw Swee Hock School of Public HealthNational University of SingaporeSingapore,Duke‐NUS Medical SchoolSingapore,Department of Cardiology, University Medical Center GroningenUniversity of GroningenGroningenThe Netherlands
| | - Stefan D. Anker
- Department of Cardiology (CVK); and Berlin Institute of Health Center for Regenerative Therapies (BCRT); German Centre for Cardiovascular Research (DZHK) partner site BerlinCharité Universitätsmedizin BerlinBerlinGermany
| | - Kenneth Dickstein
- Stavanger University HospitalStavangerNorway,University of BergenBergenNorway
| | - Camilla Hage
- Division of Cardiology, Department of MedicineKarolinska InstitutetStockholmSweden
| | - Carolyn S.P. Lam
- National Heart Centre SingaporeSingapore,Duke‐NUS Medical SchoolSingapore
| | - Chim C. Lang
- Division of Molecular and Clinical MedicineUniversity of DundeeDundeeUK
| | - Marco Metra
- Cardiology Unit, ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Sciences and Public HealthUniversity of BresciaBresciaItaly
| | - Leong L. Ng
- Department of Cardiovascular SciencesUniversity of Leicester, Glenfield Hospital, and NIHR Leicester Biomedical Research CentreLeicesterUK
| | - Nicola Orsini
- Department of Global Public HealthKarolinska InstitutetStockholmSweden
| | - Nilesh J. Samani
- Department of Cardiovascular SciencesUniversity of Leicester, Glenfield Hospital, and NIHR Leicester Biomedical Research CentreLeicesterUK
| | - Dirk J. van Veldhuisen
- Department of Cardiology, University Medical Center GroningenUniversity of GroningenGroningenThe Netherlands
| | - John G.F. Cleland
- Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, Glasgow and National Heart & Lung InstituteImperial CollegeLondonUK
| | - Adriaan A. Voors
- Department of Cardiology, University Medical Center GroningenUniversity of GroningenGroningenThe Netherlands
| | - Lars H. Lund
- Division of Cardiology, Department of MedicineKarolinska InstitutetStockholmSweden
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Cheng Z, Cai K, Xu C, Zhan Q, Xu X, Xu D, Zeng Q. Prognostic Value of Serum Galectin-3 in Chronic Heart Failure: A Meta-Analysis. Front Cardiovasc Med 2022; 9:783707. [PMID: 35252382 PMCID: PMC8894589 DOI: 10.3389/fcvm.2022.783707] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Accepted: 01/21/2022] [Indexed: 11/13/2022] Open
Abstract
Objective To evaluate the association between serum galectin-3 and all-cause death (ACD) and cardiovascular death (CVD) in patients with chronic heart failure (CHF). Methods The PubMed and Embase databases and Clinical Trials Registry (www.clinicaltrials.gov) were searched for studies with data on serum galectin-3 and ACD and CVD in CHF patients. The hazard ratios (HRs) of ACD and CVD were calculated and presented with 95% CIs. HRs were pooled using fixed effects or random effects models when appropriate. Sensitivity analysis, meta-regression and subgroup analysis were applied to find the origin of heterogeneity. Visual inspection of Begg's funnel plot and Egger's test were performed to assess the possibility publication bias. Results Pooled data included the results from 6,440 patients from 12 studies in the meta-analysis. Higher serum galectin-3 was associated with a higher risk of ACD (HR, 1.38; 95% CI, 1.14–1.67) and CVD (HR, 1.13; 95% CI, 1.02–1.25) in CHF patients. In the subgroup analyses, higher serum galectin-3 was associated with an increased risk of ACD in all subgroups. The pooled HR of the shorter follow-up group (1.78; 95% CI, 1.50–2.11) was significantly higher than the pooled HR of the longer follow-up group (1.15; 95% CI, 1.05–1.25). Sensitivity analysis of eliminating one study in each turn indicated that Koukoui et al.'s study had the largest influence on the risk of all-cause death. All-cause death publication bias was not detected (Pr>|z| = 0.35 for Begg's test and P>|t| = 0.15 for Egger's test). Conclusions Serum galectin-3 has prognostic value of both all-cause death and cardiovascular death in CHF. Serum galectin-3 could be useful for risk classification in patients with CHF. Systematic Review Registration https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=193399.
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Affiliation(s)
- Zhendong Cheng
- State Key Laboratory of Organ Failure Research, Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, China
- Department of Cardiology, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Kefeng Cai
- Department of Cardiology, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Chaoxian Xu
- Department of Cardiology, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Qiong Zhan
- State Key Laboratory of Organ Failure Research, Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Shock and Microcirculation, Southern Medical University, Guangzhou, China
- Bioland Laboratory (Guangzhou Regenerative Medicine and Health Guangdong Laboratory), Guangzhou, China
| | - Xingbo Xu
- Department of Cardiology and Pneumology, University Medical Center of Göttingen, Georg-August-University, Göttingen, Germany
| | - Dingli Xu
- State Key Laboratory of Organ Failure Research, Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Shock and Microcirculation, Southern Medical University, Guangzhou, China
- Bioland Laboratory (Guangzhou Regenerative Medicine and Health Guangdong Laboratory), Guangzhou, China
- Dingli Xu
| | - Qingchun Zeng
- State Key Laboratory of Organ Failure Research, Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Shock and Microcirculation, Southern Medical University, Guangzhou, China
- Bioland Laboratory (Guangzhou Regenerative Medicine and Health Guangdong Laboratory), Guangzhou, China
- *Correspondence: Qingchun Zeng
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Wu Y, Cao L, Qi J. Elevated Serum HE4 Concentrations and Risk of Cardiac Complications among Hospitalized Patients with Burns. Lab Med 2022; 53:320-325. [PMID: 35134974 DOI: 10.1093/labmed/lmab110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The decrease in effective blood volume after burns is closely related to abnormal heart function. OBJECTIVE To investigate whether serum human epididymis protein 4 (HE4), an indicator of early renal injury, contributes to increased risk of cardiac complications in patients with burns. METHODS Within 24 hours after hospital admission, clinical condition assessment and biochemical testing in patients with burns were performed. Multivariate analysis was performed by evaluating the relationship between serum HE4 levels and risk of cardiac complications (cardiac insufficiency, arrhythmia, and myocardial infarction) during hospitalization. RESULTS The number (percentage) of cardiac complications in all included patients with burns was 80 (15.6%). The results of sensitivity analysis suggest that elevated serum HE4 levels were related to higher risk of cardiac complications in patients with sepsis (OR = 2.1; 95% CI, 1.19-3.17; P <.001) and in patients without sepsis (OR = 2.29; 95% CI, 1.33-4.71l; P = .005), respectively, after adjustments for clinical confounding factors were made. Sepsis did not have a modification effect on the association between serum and cardiac complications among these patients. Also, the results of ROC curve analysis showed that serum HE4 levels have good predictive value for predicting cardiac complications in patients with burns (AUC = 0.708; 95% CI, 0.61-0.81; P <.001). CONCLUSIONS In the current study, we identified that elevated HE4 levels contributed to increased risk of cardiac complications in the hospital in patients with burns. This novel finding suggests that burn patients with serum HE4 may provide the opportunity to predict cardiac complications before hospital admission.
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Affiliation(s)
- Yangyang Wu
- Department of Burns and Plastic Surgery, Affiliated Hospital of Nantong University, Nantong City, China
| | - Ling Cao
- Department of Burns and Plastic Surgery, Affiliated Hospital of Nantong University, Nantong City, China
| | - Jun Qi
- Department of Burns and Plastic Surgery, Affiliated Hospital of Nantong University, Nantong City, China
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Cardiac fibrosis and atrial fibrillation. POSTEP HIG MED DOSW 2022. [DOI: 10.2478/ahem-2022-0035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Abstract
Cardiac fibrosis is characterized by the imbalance of production and degradation of the extracellular matrix. The result of this process is an accumulation of scar tissue, which is associated with many pathological processes such as excessive mechanical stress on the heart, inflammation, ischemia, oxidative stress, or excessive neurohormonal activation. Fibrotic response results in damaged heart architecture and dysfunction of the heart. Cardiac fibrosis leads to increased stiffness of the left ventricle and arteries, promotes disorders of contraction and relaxation of the heart, disrupts electrophysiology of heart cells, and induces arrhythmias.
Atrial fibrillation is one of the most common arrhythmias. It is associated with a deterioration in the quality of life and more frequent use of medical assistance. It is also an instantaneous risk factor for many diseases, including stroke. The underlying cause of this arrhythmia is electrical and structural remodeling induced by cardiac fibrosis. Therefore, much attention is paid to the search for biochemical markers that would allow non-invasive determination of the degree of this fibrosis.
The promising markers include galectin-3, human epididymis protein 4 (HE4), serum soluble ST2, and adipose triglyceride lipase (ATGL). Studies have shown that plasma concentrations of these substances reflect the degree of myocardial fibrosis and are indirectly associated with AF.
There are high hopes for the use of these markers in patients undergoing arrhythmia ablation. More research is needed to confirm that these markers can be used to estimate the chance of maintaining sinus rhythm in patients after ablation.
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Kilci H, Altınbilek E, Çetinkal G, Sığırcı S, Koçaş BB, Yıldız SS, Kılıçkesmez KO. Relation of a novel fibrosis marker and post-myocardial infarction left ventricular ejection fraction in revascularized patients. Biomark Med 2021; 15:1651-1658. [PMID: 34704823 DOI: 10.2217/bmm-2021-0003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: To investigate the relationship between post-myocardial infarction (MI) left ventricular ejection fraction (LVEF) and fibrosis marker HE-4 in primarily revascularized patients with ST-segment elevation MI (STEMI). Patients & methods: In 94 consecutive STEMI patients (median age 57 [IQR: 50-69] years; 77.7% male), HE-4 values were measured at hospital admission and 4 days after STEMI. Transthoracic echocardiography was performed 4 days after STEMI (median 5 days [interquartile range: 4-6]). Results: HE-4 levels 4 days after STEMI were significantly higher in the low ejection fraction group (30.1 [26.0-46.5] pmol/l vs 48.5 [32.5-85.9] pmol/l, p = 0.004). In the multivariable analysis, HE-4 values (odds ratio: 1.029, 95% CI: 1.012-1.046, p = 0.001), troponin I levels, anterior MI and diabetes mellitus were independent predictors of low LVEF after STEMI. A negative correlation existed between ΔHE-4 levels and LVEF (r: -0.337, p = 0.001). Receiver operating characteristic analysis indicated 34.01 pmol/l HE-4 at 4 days after STEMI identified patients with low LVEF (AUC = 0.707; 95% CI: 0.601-0.813; p = 0.001). Conclusion: In revascularized STEMI patients, high HE-4 levels are associated with decreased LVEF. HE-4 may represent a diagnostic marker and treatment target for patients with heart failure or left ventricular systolic dysfunction after STEMI.
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Affiliation(s)
- Hakan Kilci
- Department of Cardiology, Sisli Hamidiye Etfal Training & Research Hospital, Istanbul, 34371,Turkey
| | - Ertuğrul Altınbilek
- Department of Emergency, Sisli Hamidiye Etfal Training & Research Hospital, Istanbul, 34371, Turkey
| | - Gökhan Çetinkal
- Department of Cardiology, Sisli Hamidiye Etfal Training & Research Hospital, Istanbul, 34371,Turkey
| | - Serhat Sığırcı
- Department of Cardiology, Sisli Hamidiye Etfal Training & Research Hospital, Istanbul, 34371,Turkey
| | - Betül B Koçaş
- Department of Cardiology, Sisli Hamidiye Etfal Training & Research Hospital, Istanbul, 34371,Turkey
| | - Süleyman S Yıldız
- Department of Cardiology, Sisli Hamidiye Etfal Training & Research Hospital, Istanbul, 34371,Turkey
| | - Kadriye Orta Kılıçkesmez
- Department of Cardiology, Sisli Hamidiye Etfal Training & Research Hospital, Istanbul, 34371,Turkey
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17
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Tang Y, Wang Y, Xu X, Tu LY, Huang P, Yang X, Li L, Wu J, Zhang Y, Fu Q, Yu Y, Zheng Z, Song L, Zhang Y. Human epididymis protein 4: a novel predictor of ischemic cardiomyopathy. BMC Cardiovasc Disord 2021; 21:511. [PMID: 34674652 PMCID: PMC8532267 DOI: 10.1186/s12872-021-02319-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 10/06/2021] [Indexed: 11/10/2022] Open
Abstract
Background The prognostic value of human epididymis protein 4 (HE4) in patients with ischemic cardiomyopathy (ICM) is unknown. Methods A total of 103 patients with ICM were prospectively enrolled in this study from Hunan Provincial People’s Hospital between February 2019 and June 2019. All patients were tested for HE4 levels at baseline and follow-up. Endpoints of the study included cardiovascular death and heart failure-related hospitalization. Results A total of 96 patients with ICM were included for analysis. After a mean follow-up period of 263 (153–313) days, cardiovascular events were observed in 45 patients. Serum HE4 levels in patients with events were significantly higher than those in patients without events [188.70 (113.35–326.82) pmol/L versus 92.90 (61.50–123.20) pmol/L, P < 0.001]. Multivariate Cox regression analysis revealed that HE4 [χ2: 9.602, hazard ratio (HR): 1.003, 95% confidence interval (CI): 1.001–1.005, P = 0.002] and age [χ2: 4.55, HR: 1.044, 95% CI: 1.003–1.085, P = 0.033] were independent predictors of events. After adjusting for age and sex, the risk of events in patients with HE4 > 100.2 pmol/L was higher than that in patients with HE4 ≤ 100.2 pmol/L [HR: 3.372, 95% CI: 1.409–8.065, P < 0.001]. Conclusion HE4 is an independent predictor of cardiovascular death and heart failure-related rehospitalization in patients with ICM.
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Affiliation(s)
- Yi Tang
- Department of Cardiology, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Clinical Medicine Research Center of Heart Failure of Hunan Province, Hunan Normal University, Changsha, 410005, China
| | - Yinzhen Wang
- Department of Cardiology, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Clinical Medicine Research Center of Heart Failure of Hunan Province, Hunan Normal University, Changsha, 410005, China
| | - Xiaoping Xu
- Department of Gastroenterology, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Hunan Normal University, Changsha, 410005, China
| | - Laura Yan Tu
- Department of Medicine, Austin Health, Melbourne, VIC, 3084, Australia
| | - Pei Huang
- Department of Gastroenterology, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Hunan Normal University, Changsha, 410005, China
| | - Xiaoyan Yang
- Department of Gastroenterology, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Hunan Normal University, Changsha, 410005, China
| | - Lihua Li
- Department of Cardiology, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Clinical Medicine Research Center of Heart Failure of Hunan Province, Hunan Normal University, Changsha, 410005, China
| | - Juan Wu
- Department of Cardiology, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Clinical Medicine Research Center of Heart Failure of Hunan Province, Hunan Normal University, Changsha, 410005, China
| | - Yan Zhang
- Department of Cardiology, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Clinical Medicine Research Center of Heart Failure of Hunan Province, Hunan Normal University, Changsha, 410005, China
| | - Qinghua Fu
- Department of Cardiology, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Clinical Medicine Research Center of Heart Failure of Hunan Province, Hunan Normal University, Changsha, 410005, China
| | - Yingli Yu
- Institute of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, 300193, China
| | - Zhaofen Zheng
- Department of Cardiology, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Clinical Medicine Research Center of Heart Failure of Hunan Province, Hunan Normal University, Changsha, 410005, China
| | - Lixia Song
- Department of Cardiology, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Clinical Medicine Research Center of Heart Failure of Hunan Province, Hunan Normal University, Changsha, 410005, China.
| | - Yi Zhang
- Department of Cardiology, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Clinical Medicine Research Center of Heart Failure of Hunan Province, Hunan Normal University, Changsha, 410005, China.
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18
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Guo L, Song B, Xiao J, Lin H, Chen J, Su X. The Prognostic Value of Biomarkers on Detecting Non-Small Cell Lung Cancer in a Chinese Elderly Population. Int J Gen Med 2021; 14:5279-5286. [PMID: 34522127 PMCID: PMC8434877 DOI: 10.2147/ijgm.s331311] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 08/23/2021] [Indexed: 12/25/2022] Open
Abstract
Background Survival in non-small cell lung cancer (NSCLC) remains poor. Early detection of NSCLC is of great significance to provide a chance to improve survival. Aim We constructed predictive models to evaluate the predictive value of four tumor biomarkers by including serum human epididymis protein 4 (HE4), carcinoembryonic antigen (CEA), squamous cell carcinoma antigen (SCCA), and cytokeratin 19 fragment (CY21-1) on detecting NSCLC in a Chinese elderly population. Methods A total of 363 patients with NSCLC and 433 subjects without cancer (healthy control group) were admitted to the respiratory department in our hospital. We assessed serum levels of these four tumor biomarkers in the two groups and then the predictive value of predictive models was evaluated. Results Serum median values of HE4 (143.3 pmol/L), CEA (4.60 ng/mL), SCCA (1.52 ng/mL), and CY21-1 (5.36 ng/mL) in patients with NSCLC were significantly higher than the healthy control group, respectively (all P<0.05). A multivariate logistic regression model showed that HE4 (OR=2.10, 95% CI=1.22–4.42, P=0.013), CEA (OR=2.30, 95% CI=1.44–4.53, P=0.004), SCCA (OR=2.20, 95% CI=1.29–4.55, P=0.011), and CY21-1 (OR=2.60, 95% CI=1.56–6.25, P<0.001) were significantly and independently associated with increased risk of NSCLC on admission after confounding factors were corrected. Importantly, the ROC curve suggested HE4 had a good value on predicting NSCLC in the Chinese elderly population. Additionally, the predictive model (CEA+SCCA+CY21-1+HE4) had better idea capability to detecting the existence of NSCLC (AUC=0.954, 95% CI=0.927–0.999, P<0.001). Conclusion Our study showed that several lung cancer-related biomarkers were used to build prediction models, which has good value for early prediction of NSCLC.
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Affiliation(s)
- Lianghua Guo
- Department of Respiratory Medicine, Mindong Hospital of Fujian Medical University, Fuan City, 355000, People's Republic of China
| | - Bin Song
- Department of Respiratory Medicine, Mindong Hospital of Fujian Medical University, Fuan City, 355000, People's Republic of China
| | - Jianhong Xiao
- Department of Respiratory Medicine, Mindong Hospital of Fujian Medical University, Fuan City, 355000, People's Republic of China
| | - Hui Lin
- Department of Respiratory Medicine, Mindong Hospital of Fujian Medical University, Fuan City, 355000, People's Republic of China
| | - Junhua Chen
- Department of Respiratory Medicine, Mindong Hospital of Fujian Medical University, Fuan City, 355000, People's Republic of China
| | - Xianghua Su
- Department of Neurosurgery, Mindong Hospital of Fujian Medical University, Fuan City, 355000, People's Republic of China
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19
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Meijers WC, Bayes-Genis A, Mebazaa A, Bauersachs J, Cleland JGF, Coats AJS, Januzzi JL, Maisel AS, McDonald K, Mueller T, Richards AM, Seferovic P, Mueller C, de Boer RA. Circulating heart failure biomarkers beyond natriuretic peptides: review from the Biomarker Study Group of the Heart Failure Association (HFA), European Society of Cardiology (ESC). Eur J Heart Fail 2021; 23:1610-1632. [PMID: 34498368 PMCID: PMC9292239 DOI: 10.1002/ejhf.2346] [Citation(s) in RCA: 59] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 08/13/2021] [Accepted: 09/07/2021] [Indexed: 12/18/2022] Open
Abstract
New biomarkers are being evaluated for their ability to advance the management of patients with heart failure. Despite a large pool of interesting candidate biomarkers, besides natriuretic peptides virtually none have succeeded in being applied into the clinical setting. In this review, we examine the most promising emerging candidates for clinical assessment and management of patients with heart failure. We discuss high-sensitivity cardiac troponins (Tn), procalcitonin, novel kidney markers, soluble suppression of tumorigenicity 2 (sST2), galectin-3, growth differentiation factor-15 (GDF-15), cluster of differentiation 146 (CD146), neprilysin, adrenomedullin (ADM), and also discuss proteomics and genetic-based risk scores. We focused on guidance and assistance with daily clinical care decision-making. For each biomarker, analytical considerations are discussed, as well as performance regarding diagnosis and prognosis. Furthermore, we discuss potential implementation in clinical algorithms and in ongoing clinical trials.
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Affiliation(s)
- Wouter C Meijers
- Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands
| | - Antoni Bayes-Genis
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, CIBERCV, Barcelona, Spain
| | - Alexandre Mebazaa
- Inserm U942-MASCOT; Université de Paris; Department of Anesthesia and Critical Care, Hôpitaux Saint Louis & Lariboisière; FHU PROMICE, Paris, France.,Université de Paris, Paris, France.,Department of Anesthesia and Critical Care, Hôpitaux Saint Louis & Lariboisière, Paris, France.,FHU PROMICE, Paris, France
| | - Johann Bauersachs
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - John G F Cleland
- Robertson Centre for Biostatistics and Clinical Trials, University of Glasgow; National Heart & Lung Institute, Imperial College London, London, UK
| | - Andrew J S Coats
- Monash University, Melbourne, Australia.,University of Warwick, Coventry, UK
| | | | | | | | - Thomas Mueller
- Department of Clinical Pathology, Hospital of Bolzano, Bolzano, Italy
| | - A Mark Richards
- Christchurch Heart Institute, Christchurch, New Zealand.,Cardiovascular Research Institute, National University of Singapore, Singapore
| | - Petar Seferovic
- Faculty of Medicine, Belgrade University, Belgrade, Serbia.,Serbian Academy of Sciences and Arts, Belgarde, Serbia
| | | | - Rudolf A de Boer
- Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands
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20
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Grams ME, Surapaneni A, Chen J, Zhou L, Yu Z, Dutta D, Welling PA, Chatterjee N, Zhang J, Arking DE, Chen TK, Rebholz CM, Yu B, Schlosser P, Rhee EP, Ballantyne CM, Boerwinkle E, Lutsey PL, Mosley T, Feldman HI, Dubin RF, Ganz P, Lee H, Zheng Z, Coresh J. Proteins Associated with Risk of Kidney Function Decline in the General Population. J Am Soc Nephrol 2021; 32:2291-2302. [PMID: 34465608 PMCID: PMC8729856 DOI: 10.1681/asn.2020111607] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 04/22/2021] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Proteomic profiling may allow identification of plasma proteins that associate with subsequent changesin kidney function, elucidating biologic processes underlying the development and progression of CKD. METHODS We quantified the association between 4877 plasma proteins and a composite outcome of ESKD or decline in eGFR by ≥50% among 9406 participants in the Atherosclerosis Risk in Communities (ARIC) Study (visit 3; mean age, 60 years) who were followed for a median of 14.4 years. We performed separate analyses for these proteins in a subset of 4378 participants (visit 5), who were followed at a later time point, for a median of 4.4 years. For validation, we evaluated proteins with significant associations (false discovery rate <5%) in both time periods in 3249 participants in the Chronic Renal Insufficiency Cohort (CRIC) and 703 participants in the African American Study of Kidney Disease and Hypertension (AASK). We also compared the genetic determinants of protein levels with those from a meta-analysis genome-wide association study of eGFR. RESULTS In models adjusted for multiple covariates, including baseline eGFR and albuminuria, we identified 13 distinct proteins that were significantly associated with the composite end point in both time periods, including TNF receptor superfamily members 1A and 1B, trefoil factor 3, and β-trace protein. Of these proteins, 12 were also significantly associated in CRIC, and nine were significantly associated in AASK. Higher levels of each protein associated with higher risk of 50% eGFR decline or ESKD. We found genetic evidence for a causal role for one protein, lectin mannose-binding 2 protein (LMAN2). CONCLUSIONS Large-scale proteomic analysis identified both known and novel proteomic risk factors for eGFR decline.
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Affiliation(s)
- Morgan E. Grams
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland,Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Aditya Surapaneni
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Jingsha Chen
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Linda Zhou
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Zhi Yu
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Diptavo Dutta
- Department of Biostatistics, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Paul A. Welling
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Nilanjan Chatterjee
- Department of Biostatistics, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Jingning Zhang
- Department of Biostatistics, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Dan E. Arking
- McKusick-Nathans Institute, Department of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Teresa K. Chen
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Casey M. Rebholz
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Bing Yu
- Department of Epidemiology, Human Genetics and Environmental Sciences, University of Texas Health Sciences Center at Houston School of Public Health, Houston, Texas
| | - Pascal Schlosser
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland,Institute of Genetic Epidemiology, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Eugene P. Rhee
- Nephrology Division and Endocrine Unit, Massachusetts General Hospital, Boston, Massachusetts
| | | | - Eric Boerwinkle
- Department of Epidemiology, Human Genetics and Environmental Sciences, University of Texas Health Sciences Center at Houston School of Public Health, Houston, Texas,Human Genome Sequencing Center, Baylor College of Medicine, Houston, Texas
| | - Pamela L. Lutsey
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota
| | - Thomas Mosley
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi
| | - Harold I. Feldman
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ruth F. Dubin
- Department of Medicine, University of California San Francisco, San Francisco, California
| | - Peter Ganz
- Department of Medicine, University of California San Francisco, San Francisco, California
| | - Hongzhe Lee
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Zihe Zheng
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Josef Coresh
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland,Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland,Department of Biostatistics, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
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21
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Park H, Lee DW, Kim MJ, Shin JE, Lee HN. Low serum T3 levels are associated with false-positive results when using the risk of ovarian malignancy algorithm (ROMA) in women with benign ovarian disease. Taiwan J Obstet Gynecol 2021; 60:36-40. [PMID: 33495005 DOI: 10.1016/j.tjog.2020.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2020] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE We investigated factors that could cause false-positive results when using the risk of ovarian malignancy algorithm (ROMA) for assessing ovarian cancer risk. MATERIALS AND METHODS ROMA scores were calculated from patients followed surgery to remove a pelvic mass. We compared a false-positive group with a true-negative group of ROMA scores. RESULTS We analyzed 324 patients using medical records. There were 22 with an epithelial ovarian cancer (EOC), 15 with a borderline ovarian tumor, and 287 with benign disease. Twenty-nine (10.1%) of the patients with benign disease showed high-risk ROMA score (false positive) and 13/37 (35%) patients with EOC, or borderline ovarian tumor showed low ROMA scores (false negatives). The median serum triiodothyronine (T3) level of the false-positive ROMA group in patients with benign disease was lower than in the true-negative ROMA group (p < 0.001) and the estimated glomerular filtration rate (eGFR) was also lower (p = 0.001) in the false-positive ROMA group. Median serum T3 levels in the true-positive ROMA group among patients with EOC, or borderline ovarian tumor were lower than in the false-negative ROMA group (p = 0.043). CONCLUSION Median serum T3 level and eGFR in the false-positive ROMA group in patients with benign ovarian disease were lower than in the true-negative group.
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Affiliation(s)
- Haeil Park
- Departments of Laboratory Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Dae Woo Lee
- Department of Obstetrics and Gynecology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Min Jeong Kim
- Department of Obstetrics and Gynecology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jae Eun Shin
- Department of Obstetrics and Gynecology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hae Nam Lee
- Department of Obstetrics and Gynecology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
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22
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Yamamoto M, Hanatani S, Araki S, Izumiya Y, Yamada T, Nakanishi N, Ishida T, Yamamura S, Kimura Y, Arima Y, Nakamura T, Takashio S, Yamamoto E, Sakamoto K, Kaikita K, Matsushita K, Morimoto S, Ito T, Tsujita K. HE4 Predicts Progressive Fibrosis and Cardiovascular Events in Patients With Dilated Cardiomyopathy. J Am Heart Assoc 2021; 10:e021069. [PMID: 34320813 PMCID: PMC8475713 DOI: 10.1161/jaha.120.021069] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Cardiac fibrosis plays a crucial role in the pathogenesis of dilated cardiomyopathy (DCM). HE4 (human epididymis protein 4) is a secretory protein expressed in activated fibroblasts that exacerbates tissue fibrosis. In the present study, we investigated the clinical utility of HE4 measurement in patients with DCM and its pathophysiological role in preclinical experiments in vivo and in vitro. Methods and Results We measured serum HE4 levels of 87 patients with DCM. Endomyocardial biopsy expressed severe fibrosis only in the high HE4 group (P<0.0001). Echocardiography showed that left ventricular end‐diastolic diameter tends to decrease over time (58±7.3 to 51±6.6 mm; P<0.0001) in the low HE4 group (<59.65 pmol/L [median value]). HE4 was significantly associated with risk reduction of mortality and cardiovascular hospitalization in multivariate Cox model. In vivo, HE4 was highly expressed in kidney and lung tissue of mouse, and scarcely expressed in heart. In genetically induced DCM mouse model, HE4 expression increased in kidney but not in heart and lung. In vitro, supernatant from HE4‐transfected human embryonic kidney 293T cells enhanced transdifferentiation of rat neonatal fibroblasts and increased expression of fibrosis‐related genes, and this was accompanied by the activation of extracellular signal‐regulated kinase signaling in cardiac fibroblasts. Treatment with an inhibitor of upstream signal of extracellular signal‐regulated kinase or a neutralizing HE4 antibody canceled the profibrotic properties of HE4. Conclusions HE4 functions as a secretory factor, activating cardiac fibroblasts, thereby inducing cardiac interstitial fibrosis. HE4 could be a promising biomarker for assessing ongoing fibrosis and a novel therapeutic target in DCM. Registration URL: https://upload.umin.ac.jp/cgi‐open‐bin/ctr; Unique identifier: UMIN000043062.
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Affiliation(s)
- Masahiro Yamamoto
- Department of Cardiovascular Medicine Faculty of Life Sciences Kumamoto University Kumamoto Japan
| | - Shinsuke Hanatani
- Department of Cardiovascular Medicine Faculty of Life Sciences Kumamoto University Kumamoto Japan
| | - Satoshi Araki
- Department of Cardiovascular Medicine Faculty of Life Sciences Kumamoto University Kumamoto Japan
| | - Yasuhiro Izumiya
- Department of Cardiovascular Medicine Faculty of Life Sciences Kumamoto University Kumamoto Japan.,Department of Cardiovascular Medicine Osaka City University Graduate School of Medicine Osaka Japan
| | - Toshihiro Yamada
- Department of Cardiovascular Medicine Faculty of Life Sciences Kumamoto University Kumamoto Japan
| | - Nobuhiro Nakanishi
- Department of Cardiovascular Medicine Faculty of Life Sciences Kumamoto University Kumamoto Japan
| | - Toshifumi Ishida
- Department of Cardiovascular Medicine Faculty of Life Sciences Kumamoto University Kumamoto Japan
| | - Satoru Yamamura
- Department of Cardiovascular Medicine Faculty of Life Sciences Kumamoto University Kumamoto Japan
| | - Yuichi Kimura
- Department of Cardiovascular Medicine Faculty of Life Sciences Kumamoto University Kumamoto Japan
| | - Yuichiro Arima
- Department of Cardiovascular Medicine Faculty of Life Sciences Kumamoto University Kumamoto Japan.,International Research Center for Medical Sciences Kumamoto University Kumamoto Japan
| | - Taishi Nakamura
- Department of Cardiovascular Medicine Faculty of Life Sciences Kumamoto University Kumamoto Japan
| | - Seiji Takashio
- Department of Cardiovascular Medicine Faculty of Life Sciences Kumamoto University Kumamoto Japan
| | - Eiichiro Yamamoto
- Department of Cardiovascular Medicine Faculty of Life Sciences Kumamoto University Kumamoto Japan
| | - Kenji Sakamoto
- Department of Cardiovascular Medicine Faculty of Life Sciences Kumamoto University Kumamoto Japan
| | - Koichi Kaikita
- Department of Cardiovascular Medicine Faculty of Life Sciences Kumamoto University Kumamoto Japan
| | - Kenichi Matsushita
- Department of Cardiovascular Medicine Faculty of Life Sciences Kumamoto University Kumamoto Japan
| | - Sachio Morimoto
- Department of Health Sciences Fukuoka International University of Health and Welfare Fukuoka Japan
| | - Takaaki Ito
- Department of Pathology and Experimental Medicine Faculty of Life Sciences Kumamoto University Kumamoto Japan
| | - Kenichi Tsujita
- Department of Cardiovascular Medicine Faculty of Life Sciences Kumamoto University Kumamoto Japan.,Center for Metabolic Regulation of Healthy Aging Kumamoto University Kumamoto Japan
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23
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Schirinzi A, Cazzolla AP, Mascolo E, Palmieri G, Pesce F, Gesualdo L, Santacroce L, Ballini A, Lovero R, Di Serio F. Determination of the Upper Reference Limit of Human Epididymis Secretory Protein 4 (HE4) in Healthy Male Individuals and Correlation with Renal and Fertility Markers. Endocr Metab Immune Disord Drug Targets 2021; 21:912-918. [PMID: 32767951 DOI: 10.2174/1871530320666200807121050] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 06/05/2020] [Accepted: 06/08/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Elevated human epididymis secretory protein 4 (HE4) serum levels have been widely investigated in patients with ovarian cancer. However, high levels of HE4 can be also found in other tumors and in renal fibrosis. To date, the HE4 assay manufacturer features the reference value only for the female pre- and post-menopausal population. The aim of this study was to determine the upper reference limit (URL) of HE4 in a well-defined and large cohort of healthy male individuals and investigate potential factors influencing HE4 levels in healthy subjects. METHODS The study included 307 Italian healthy male individuals. HE4 was measured using a chemiluminescent assay (Abbott Laboratories, Wiesbaden, Germany). The URL was calculated using the non-parametric percentile method. Differences in HE4 concentrations according to age, estimated glomerular filtration rate (eGFR), free and bioavailable testosterone were also evaluated. RESULTS The 97.5th percentile URL of serum HE4 in our study population was 57 pmol/L (90% CI). After stratifying subjects according to age, we found that the URL of HE4 was higher in older (> 50 years) than in younger subjects (18-30 years old), and overlapping with the URL in males from 31 to 50 years old (P=4.769e-16, r=0.44). A strong negative correlation between HE4 and eGFR was observed (P=8.412e-12, r=-0.38). Moreover, a statistically significant negative correlation was also found between HE4 and free and bioavailable testosterone. CONCLUSION This study determined the URL of HE4 in a large cohort of healthy male subjects. Our findings indicate that the HE4 age-dependent differences in males need to be taken into account. The definition of the HE4 URL in males and the correlation observed with eGFR and testosterone should foster the clinical use of HE4 beyond gynecologic cancer.
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Affiliation(s)
| | - Angela Pia Cazzolla
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Elisa Mascolo
- Clinic Pathology Unit, Polyclinic University Hospital, Bari, Italy
| | | | - Francesco Pesce
- Nephrology, Dialysis and Transplantation Unit, DETO, University "Aldo Moro", Bari, Italy
| | - Loreto Gesualdo
- Nephrology, Dialysis and Transplantation Unit, DETO, University "Aldo Moro", Bari, Italy
| | - Luigi Santacroce
- Ionian Department (DJSGEM), Microbiology and Virology Laboratory, University of Bari "Aldo Moro", Bari, Italy
| | - Andrea Ballini
- Department of Biosciences, Biotechnologies and Biopharmaceutics, Campus Universitario "Ernesto Quagliariello", University of Bari "Aldo Moro", Bari, Italy
| | - Roberto Lovero
- Clinic Pathology Unit, Polyclinic University Hospital, Bari, Italy
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24
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Tan S, Zeng Y, Kuang S, Li J. Serum Human Epididymis Protein 4 is a Potential Biomarker for Early Chronic Kidney Disease in an Obese Population. Diabetes Metab Syndr Obes 2021; 14:1601-1608. [PMID: 33889001 PMCID: PMC8057804 DOI: 10.2147/dmso.s300940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 03/10/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND At present, it is difficult to clinically diagnose early chronic kidney disease (CKD). As a novel biomarker of malignancies in the female reproductive tract, the human epididymis protein 4 (HE4) has been reported to be significantly expressed in CKD patients. AIM We sought to assess whether HE4 can be used as a potential biomarker of early-stage CKD. METHODS The association between serum HE4 levels and CKD was analyzed in a retrospective study. A cohort of 506 patients with diabetic nephropathy who were hospitalized at Weihai Central Hospital, China, from January 2016 to November 2019 were included. RESULTS Serum HE4 levels were increased with increasing stage of CKD and significantly elevated in patients with CKD3-5 than CKD1-2 (P<0.001). In multivariate linear regression analyses, HE4 levels were strongly correlated with the estimated glomerular filtration rate (eGFR) in CKD patients (Model 2, P<0.001). HE4 (area under the curve; AUC=0.934) had better diagnostic value than serum creatinine (SCr; AUC=0.770) and blood urea nitrogen (BUN; AUC=0.647) for patients with early-stage CKD (CKD1-2). Additionally, HE4 levels increased with increasing glomerular lesion (GL) and renal interstitial fibrosis (IF)/tubular atrophy (TA) scores in 51 CKD patients (P<0.001). CONCLUSION Serum HE4 levels can be positively associated with the severity of CKD and are a very valuable clinical biomarker for predicting early-stage CKD.
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Affiliation(s)
- Shubo Tan
- Department of Urology, Second Affiliated Hospital of the University of South China, Hengyang City, 421000, People’s Republic of China
| | - Yongmao Zeng
- Department of Urology, Second Affiliated Hospital of the University of South China, Hengyang City, 421000, People’s Republic of China
| | - Shiliang Kuang
- Department of Urology, Second Affiliated Hospital of the University of South China, Hengyang City, 421000, People’s Republic of China
| | - Jianjun Li
- Department of Urology, Second Affiliated Hospital of the University of South China, Hengyang City, 421000, People’s Republic of China
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25
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Drake I, Hindy G, Almgren P, Engström G, Nilsson J, Melander O, Orho-Melander M. Methodological considerations for identifying multiple plasma proteins associated with all-cause mortality in a population-based prospective cohort. Sci Rep 2021; 11:6734. [PMID: 33762603 PMCID: PMC7990913 DOI: 10.1038/s41598-021-85991-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 03/08/2021] [Indexed: 11/09/2022] Open
Abstract
Novel methods to characterize the plasma proteome has made it possible to examine a wide range of proteins in large longitudinal cohort studies, but the complexity of the human proteome makes it difficult to identify robust protein-disease associations. Nevertheless, identification of individuals at high risk of early mortality is a central issue in clinical decision making and novel biomarkers may be useful to improve risk stratification. With adjustment for established risk factors, we examined the associations between 138 plasma proteins measured using two proximity extension assays and long-term risk of all-cause mortality in 3,918 participants of the population-based Malmö Diet and Cancer Study. To examine the reproducibility of protein-mortality associations we used a two-step random-split approach to simulate a discovery and replication cohort and conducted analyses using four different methods: Cox regression, stepwise Cox regression, Lasso-Cox regression, and random survival forest (RSF). In the total study population, we identified eight proteins that associated with all-cause mortality after adjustment for established risk factors and with Bonferroni correction for multiple testing. In the two-step analyses, the number of proteins selected for model inclusion in both random samples ranged from 6 to 21 depending on the method used. However, only three proteins were consistently included in both samples across all four methods (growth/differentiation factor-15 (GDF-15), N-terminal pro-B-type natriuretic peptide, and epididymal secretory protein E4). Using the total study population, the C-statistic for a model including established risk factors was 0.7222 and increased to 0.7284 with inclusion of the most predictive protein (GDF-15; P < 0.0001). All multiple protein models showed additional improvement in the C-statistic compared to the single protein model (all P < 0.0001). We identified several plasma proteins associated with increased risk of all-cause mortality independently of established risk factors. Further investigation into the putatively causal role of these proteins for longevity is needed. In addition, the examined methods for identifying multiple proteins showed tendencies for overfitting by including several putatively false positive findings. Thus, the reproducibility of findings using such approaches may be limited.
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Affiliation(s)
- Isabel Drake
- Diabetes and Cardiovascular Disease-Genetic Epidemiology, Department of Clinical Sciences in Malmö, Lund University, Clinical Research Centre House 60 Floor 13, Jan Waldenströms gata 35, 205 02, Malmö, Sweden.
| | - George Hindy
- Diabetes and Cardiovascular Disease-Genetic Epidemiology, Department of Clinical Sciences in Malmö, Lund University, Clinical Research Centre House 60 Floor 13, Jan Waldenströms gata 35, 205 02, Malmö, Sweden.,Department of Population Medicine, College of Medicine Qatar University, Doha, Qatar
| | - Peter Almgren
- Diabetes and Cardiovascular Disease-Genetic Epidemiology, Department of Clinical Sciences in Malmö, Lund University, Clinical Research Centre House 60 Floor 13, Jan Waldenströms gata 35, 205 02, Malmö, Sweden.,Hypertension and Cardiovascular Disease, Department of Clinical Sciences in Malmö, Lund University, Malmö, Sweden
| | - Gunnar Engström
- Cardiovascular Epidemiology, Department of Clinical Sciences in Malmö, Lund University, Malmö, Sweden
| | - Jan Nilsson
- Experimental Cardiovascular Research, Department of Clinical Sciences in Malmö, Lund University, Malmö, Sweden
| | - Olle Melander
- Hypertension and Cardiovascular Disease, Department of Clinical Sciences in Malmö, Lund University, Malmö, Sweden
| | - Marju Orho-Melander
- Diabetes and Cardiovascular Disease-Genetic Epidemiology, Department of Clinical Sciences in Malmö, Lund University, Clinical Research Centre House 60 Floor 13, Jan Waldenströms gata 35, 205 02, Malmö, Sweden
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26
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Mao ZJ, Lin Y, Hu XK, Chen YH, Huang WJ, Huang ZQ. Serum human epididymis protein 4 levels in the prediction of the recurrence of atrial fibrillation after catheter ablation. Heart Vessels 2021; 36:686-692. [PMID: 33394104 DOI: 10.1007/s00380-020-01744-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 11/27/2020] [Indexed: 11/25/2022]
Abstract
The aim of this study is to assess serum human epididymis protein 4 (HE-4) levels as a biomarker for predicting the recurrence of atrial fibrillation (AF) after catheter ablation. This was a prospective observational study that enrolled one hundred eighty-four consecutive nonvalvular AF patients (65 persistent, 119 paroxysmal) who were eligible for their first ablation. Multiple Cox proportional hazards models and Kaplan-Meier curve analyses were used to test the association between serum HE-4 levels and AF recurrence after catheter ablation. During the 12-month follow-up, we observed that 47 patients (25.5%) experienced AF recurrence. Patients were divided into tertiles of HE-4 level (T1: < 50 pmol/L; T2: ≥ 50 pmol/L). The AF recurrence rate of higher serum HE-4 level patients was significantly increased (34.6% vs 13.8%, P < 0.001). Generalized additive models were used to visually assess functional relationships between the serum HE-4 levels and the risk of AF recurrence. When stratified with serum levels as the cut-off value, Kaplan-Meier analysis showed that patients with serum HE-4 levels (> 50 pmol/L) had a significantly increased risk of AF recurrence. In addition, multivariate Cox proportional hazard modelling revealed that HE-4 (≥ 50 pmol/L) (HR 2.65; 95% CI 1.34, 5.27, P = 0.005) was independent predictors of AF recurrence. Serum HE-4 levels in patients with AF are associated with postoperative recurrence of AF, and high HE-4 levels are an independent predictor of AF recurrence after ablation.
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Affiliation(s)
- Zhi-Jie Mao
- The Key Laboratory of Cardiovascular Disease of Wenzhou, Department of Cardiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Ya Lin
- The Key Laboratory of Cardiovascular Disease of Wenzhou, Department of Cardiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Xiao-Kang Hu
- The Key Laboratory of Cardiovascular Disease of Wenzhou, Department of Cardiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Yi-He Chen
- The Key Laboratory of Cardiovascular Disease of Wenzhou, Department of Cardiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Wei-Jian Huang
- The Key Laboratory of Cardiovascular Disease of Wenzhou, Department of Cardiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China.
| | - Zhou-Qing Huang
- The Key Laboratory of Cardiovascular Disease of Wenzhou, Department of Cardiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China.
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27
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Lin H, Xiao J, Su X, Song B. The Association Between Serum Human Epididymis Protein 4 Level and Cardiovascular Events in Patients with Chronic Obstructive Pulmonary Disease. Lab Med 2020; 52:260-266. [PMID: 33009814 DOI: 10.1093/labmed/lmaa076] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Serum human epididymis protein 4 (HE4) is associated with immune and inflammatory responses. This study aimed to assess the performance of serum HE4 in the early detection of cardiovascular (CV) events in patients with chronic obstructive pulmonary disease (COPD). METHODS Serum HE4 levels were measured in 199 patients with COPD, all of whom were prospectively followed up for a median period of 36 months (range = 3 months-38 months). Logistic regression analysis was performed to assess the association between cardiovascular disease (CVD) history and HE4 in patients with COPD. Cox proportional hazard analysis was performed to assess the prognostic value of serum HE4 for predicting CV events. RESULTS Serum HE4 levels were higher in patients with COPD with CV events than in those without CV events (252.6 pmol/L [186.4-366.8] vs 111.0 pmol/L [84.8-157.1]; P <.001). The multivariate logistic regression model revealed that serum HE4 (odds ratio = 1.639; 95% confidence interval [CI], 1.213-2.317; Ptrend =.009) was independently associated with CVD history after adjusting for age, sex, body mass index, current smoking status, current alcohol consumption status, admission systolic blood pressure and diastolic blood pressure, hyperlipidemia, left ventricular ejection fraction, primary diseases, and laboratory measurements in patients with COPD at baseline. The multivariate Cox proportional hazard analysis revealed that serum HE4 (hazard ratio = 2.012; 95% CI, 1.773-4.469; P <.001) was an independent prognostic factor for CV events in these patients. The Kaplan-Meier analysis showed that the rate of CV events was higher in patients with COPD with HE4 levels above the median (187.5 pmol/L) than in those with HE4 levels below the median. CONCLUSION Our results showed that serum HE4 was significantly and independently associated with CVD history and had independent predictive value for CV events in patients with COPD. Serum HE4 may enable early recognition of CV complication development among patients with COPD.
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Affiliation(s)
- Hui Lin
- Department of Respiratory Medicine, Mindong Hospital of Fujian Medical University, Fuan, Fujian, China
| | - Jianhong Xiao
- Department of Respiratory Medicine, Mindong Hospital of Fujian Medical University, Fuan, Fujian, China
| | - Xianghua Su
- Neurosurgery Department, Mindong Hospital of Fujian Medical University, Fuan, Fujian, China
| | - Bin Song
- Department of Respiratory Medicine, Mindong Hospital of Fujian Medical University, Fuan, Fujian, China
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28
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Shi C, van der Wal HH, Silljé HHW, Dokter MM, van den Berg F, Huizinga L, Vriesema M, Post J, Anker SD, Cleland JG, Ng LL, Samani NJ, Dickstein K, Zannad F, Lang CC, van Haelst PL, Gietema JA, Metra M, Ameri P, Canepa M, van Veldhuisen DJ, Voors AA, de Boer RA. Tumour biomarkers: association with heart failure outcomes. J Intern Med 2020; 288:207-218. [PMID: 32372544 PMCID: PMC7496322 DOI: 10.1111/joim.13053] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 02/18/2020] [Accepted: 02/25/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND There is increasing recognition that heart failure (HF) and cancer are conditions with a number of shared characteristics. OBJECTIVES To explore the association between tumour biomarkers and HF outcomes. METHODS In 2,079 patients of BIOSTAT-CHF cohort, we measured six established tumour biomarkers: CA125, CA15-3, CA19-9, CEA, CYFRA 21-1 and AFP. RESULTS During a median follow-up of 21 months, 555 (27%) patients reached the primary end-point of all-cause mortality. CA125, CYFRA 21-1, CEA and CA19-9 levels were positively correlated with NT-proBNP quartiles (all P < 0.001, P for trend < 0.001) and were, respectively, associated with a hazard ratio of 1.17 (95% CI 1.12-1.23; P < 0.0001), 1.45 (95% CI 1.30-1.61; P < 0.0001), 1.19 (95% CI 1.09-1.30; P = 0.006) and 1.10 (95% CI 1.05-1.16; P < 0.001) for all-cause mortality after correction for BIOSTAT risk model (age, BUN, NT-proBNP, haemoglobin and beta blocker). All tumour biomarkers (except AFP) had significant associations with secondary end-points (composite of all-cause mortality and HF hospitalization, HF hospitalization, cardiovascular (CV) mortality and non-CV mortality). ROC curves showed the AUC of CYFRA 21-1 (0.64) had a noninferior AUC compared with NT-proBNP (0.68) for all-cause mortality (P = 0.08). A combination of CYFRA 21-1 and NT-proBNP (AUC = 0.71) improved the predictive value of the model for all-cause mortality (P = 0.0002 compared with NT-proBNP). CONCLUSIONS Several established tumour biomarkers showed independent associations with indices of severity of HF and independent prognostic value for HF outcomes. This demonstrates that pathophysiological pathways sensed by these tumour biomarkers are also dysregulated in HF.
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Affiliation(s)
- C Shi
- From the, Department of Cardiology, Uni, University Medical Center Groningen, Groningen, the Netherlands.,University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - H H van der Wal
- From the, Department of Cardiology, Uni, University Medical Center Groningen, Groningen, the Netherlands.,University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - H H W Silljé
- From the, Department of Cardiology, Uni, University Medical Center Groningen, Groningen, the Netherlands.,University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - M M Dokter
- From the, Department of Cardiology, Uni, University Medical Center Groningen, Groningen, the Netherlands.,University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - F van den Berg
- From the, Department of Cardiology, Uni, University Medical Center Groningen, Groningen, the Netherlands.,University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - L Huizinga
- From the, Department of Cardiology, Uni, University Medical Center Groningen, Groningen, the Netherlands.,University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - M Vriesema
- From the, Department of Cardiology, Uni, University Medical Center Groningen, Groningen, the Netherlands.,University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - J Post
- From the, Department of Cardiology, Uni, University Medical Center Groningen, Groningen, the Netherlands.,University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - S D Anker
- Department of Cardiology, Berlin-Brandenburg Center for Regenerative Therapies, German Centre for Cardiovascular Research (DZHK) Partner site Berlin, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - J G Cleland
- National Heart & Lung Institute, Royal Brompton & Harefield Hospitals, Imperial College, London, UK.,Robertson Institute of Biostatistics and Clinical Trials Unit, University of Glasgow, Glasgow, UK
| | - L L Ng
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK.,NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - N J Samani
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK.,NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - K Dickstein
- University of Bergen, Stavanger University Hospital, Stavanger, Norway
| | - F Zannad
- Clinical Investigation Center 1433, French Clinical Research Infrastructure Network, Investigation Network Initiative-Cardiovascular and Renal Clinical Trialists, Centre Hospitalier Regional et Universitaire de Nancy, Vandoeuvre les Nancy, France
| | - C C Lang
- Division of Molecular and Clinical Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee, UK
| | - P L van Haelst
- F. Hoffmann-La Roche Ltd. Diagnostics Division, Basel, Switzerland
| | - J A Gietema
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - M Metra
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Institute of Cardiology, University of Brescia, Brescia, Italy
| | - P Ameri
- Cardiovascular Disease Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy.,IRCCS Italian Cardiovascular Network, Department of Internal Medicine, University of Genova, Genova, Italy
| | - M Canepa
- Cardiovascular Disease Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy.,IRCCS Italian Cardiovascular Network, Department of Internal Medicine, University of Genova, Genova, Italy
| | - D J van Veldhuisen
- From the, Department of Cardiology, Uni, University Medical Center Groningen, Groningen, the Netherlands.,University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - A A Voors
- From the, Department of Cardiology, Uni, University Medical Center Groningen, Groningen, the Netherlands.,University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - R A de Boer
- From the, Department of Cardiology, Uni, University Medical Center Groningen, Groningen, the Netherlands.,University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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29
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Huang Y, Jiang H, Zhu L. Human Epididymis Protein 4 as an Indicator of Acute Heart Failure in Patients with Chronic Kidney Disease. Lab Med 2020; 51:169-175. [PMID: 31245814 DOI: 10.1093/labmed/lmz041] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Cardiovascular disease (CVD) is the leading cause of death in patients with chronic kidney disease (CKD). OBJECTIVE To assess whether human epididymis protein 4 (HE4) can be useful in diagnosing acute heart failure (AHF) in patients with CKD. METHODS A cohort of 139 Han nationality female patients with CKD who were hospitalized at Renmin Hospital of Wuhan University, Wuhan, China from January 2015 through November 2017 were included. RESULTS Multivariable linear regression analysis showed that HE4 levels were significantly associated with N-terminal pro b-type natriuretic peptide (NT-proBNP) after adjustment of kidney function and other confounding factors. In the multivariate logistic regression analysis, HE4 was independently associated with AHF in patients with CKD (odds ratio, 2.120; 95% confidence interval, 1.034-4.344; P = .04). Moreover, according to the optimal cutoff value of 639.6 pmol per L, the area under the curve, sensitivity, and specificity of HE4 were 0.729, 74.2%, and 76.8%, respectively. CONCLUSIONS During hospitalization, HE4 maybe an useful indicator for diagnosing AHF in patients with CKD.
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Affiliation(s)
- Ying Huang
- Department of Cardiology, Renmin Hospital, Wuhan, China.,Cardiovascular Research Institute of Wuhan University, Wuhan, China
| | - Hong Jiang
- Department of Cardiology, Renmin Hospital, Wuhan, China.,Cardiovascular Research Institute of Wuhan University, Wuhan, China
| | - Lihua Zhu
- Department of Cardiology, Renmin Hospital, Wuhan, China.,Cardiovascular Research Institute of Wuhan University, Wuhan, China
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30
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Jin Q, Tang Y, Liu Z, Xie W, Luo Q, Zhao Z, Zhao Q, Huang Z, Yu X, Yan L, Xiong C, Ni X, Yan Y. Serum human epididymis protein 4 level as a predictor of clinical worsening in idiopathic pulmonary arterial hypertension: a pilot study. BMC Cardiovasc Disord 2020; 20:175. [PMID: 32295533 PMCID: PMC7160929 DOI: 10.1186/s12872-020-01461-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 04/01/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Human epididymis protein 4 (HE4) was proved to be a novel biomarker for left heart failure. The purpose of this exploratory study was to evaluate the role of HE4 in patients with idiopathic pulmonary arterial hypertension (IPAH) who usually have concurrent right heart failure. METHODS 55 patients with newly diagnosed IPAH were continuously enrolled and serum HE4 levels were assessed at baseline. All patients were followed up from the date of blood sampling, and a composite endpoint of clinical worsening was detailedly recorded. RESULTS Serum levels of HE4 were significantly higher in IPAH patients than healthy controls (6.9 ± 2.2 vs 4.4 ± 0.9 ng/ml, p < 0.05) and increased as cardiac function deteriorated. HE4 levels correlated with endothelin-1 (r = 0.331, p < 0.01) and right atrial pressure (r = 0.30, p < 0.03). After a mean follow-up of 20 ± 10 months, 13 patients experienced clinical worsening. Receiver operating characteristic analysis showed that HE4 levels > 6.5 ng/ml discriminated clinical worsening with a sensitivity of 92.31% and a specificity of 59.52% (area under the curve [AUC] = 0.81). Multivariate Cox regression analysis demonstrated that HE4 (χ2: 5.10; hazard ratio [HR] = 1.26; 95% confidence interval: 1.03 to 1.55, p < 0.02) and pulmonary vascular resistance (χ 2: 4.19; HR = 1.14; 95% confidence interval: 1.00-1.29, p < 0.04) were independently predictive of clinical worsening. Patients with HE4 > 6.5 ng/ml had a worse 2-year survival rate than those with HE4 ≤ 6.5 ng/ml (58.9% vs 96.2%, p < 0.001). CONCLUSIONS Serum levels of HE4 were elevated in IPAH patients and correlated with disease severity. HE4 was an independent predictor of clinical worsening in IPAH patients.
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Affiliation(s)
- Qi Jin
- State Key Laboratory of Cardiovascular Disease, Center for Pulmonary Vascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Xicheng District, Beijing, 100037, China
| | - Yi Tang
- State Key Laboratory of Cardiovascular Disease, Center for Pulmonary Vascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Xicheng District, Beijing, 100037, China.,Department of Cardiology, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, The College of Clinical Medicine of Hunan Normal University, Changsha, China
| | - Zhihong Liu
- State Key Laboratory of Cardiovascular Disease, Center for Pulmonary Vascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Xicheng District, Beijing, 100037, China.
| | - Wenlin Xie
- Department of Pathology, The Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
| | - Qin Luo
- State Key Laboratory of Cardiovascular Disease, Center for Pulmonary Vascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Xicheng District, Beijing, 100037, China
| | - Zhihui Zhao
- State Key Laboratory of Cardiovascular Disease, Center for Pulmonary Vascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Xicheng District, Beijing, 100037, China
| | - Qing Zhao
- State Key Laboratory of Cardiovascular Disease, Center for Pulmonary Vascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Xicheng District, Beijing, 100037, China
| | - Zhiwei Huang
- State Key Laboratory of Cardiovascular Disease, Center for Pulmonary Vascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Xicheng District, Beijing, 100037, China
| | - Xue Yu
- State Key Laboratory of Cardiovascular Disease, Center for Pulmonary Vascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Xicheng District, Beijing, 100037, China
| | - Lu Yan
- State Key Laboratory of Cardiovascular Disease, Center for Pulmonary Vascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Xicheng District, Beijing, 100037, China
| | - Changming Xiong
- State Key Laboratory of Cardiovascular Disease, Center for Pulmonary Vascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Xicheng District, Beijing, 100037, China
| | - Xinhai Ni
- State Key Laboratory of Cardiovascular Disease, Center for Pulmonary Vascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Xicheng District, Beijing, 100037, China
| | - Yinkun Yan
- Department of Epidemiology, Capital institute of Pediatrics, Beijing, China
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31
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Human Epididymis Protein 4 Levels in Neonates with Respiratory Disorder. BIOMED RESEARCH INTERNATIONAL 2020; 2020:1509379. [PMID: 32337222 PMCID: PMC7154981 DOI: 10.1155/2020/1509379] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Accepted: 03/16/2020] [Indexed: 11/17/2022]
Abstract
Results There were no differences found in the HE4 levels determined for the mothers' blood samples and umbilical cord blood samples in all investigated groups. In comparison with healthy children, the elevated HE4 levels were observed in neonates with TTN. Significant positive correlation between HE4 and CRP as well as PCT levels was observed in all investigated neonates. The receiver operating characteristic (ROC) curve analysis demonstrated the cut-off value for the serum HE4 in the researched neonates at the level of 318.5 pmol/L, yielding the sensitivity of 73.9% and specificity of 66.7% for the early diagnosis of TTN. Conclusions Serum HE4 could be considered as a candidate biomarker for the early diagnosis of pulmonary dysfunction in the newborns.
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32
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Bai F, Li T, Li B, Li X, Zhu L. Serum Human Epididymis Protein 4 Level is Associated with Cognitive Function in Patients with Diabetes Mellitus. Diabetes Metab Syndr Obes 2020; 13:3919-3924. [PMID: 33122928 PMCID: PMC7591157 DOI: 10.2147/dmso.s274413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 09/03/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Previous studies have reported that patients with diabetes mellitus (DM) have a higher incidence of cognitive decline and an increased risk of developing all types of dementia. The aim was to elucidate the association between serum human epididymal protein 4 and cognitive function in patients with DM. METHODS Serum levels of HE4 were measured in 205 patients with DM. All DM patients were followed up for a median period of 48 months (range=5-49) prospectively. Cox proportional hazard analysis was used to evaluate the predictive value of serum HE4 for predicting cognitive decline (end point). RESULTS Multivariate linear regression analysis revealed that serum HE4 was independently associated with MOCA score after adjusting for age, gender, BMI, current smoker, current drinker, admission systolic and diastolic BP, CVD history and laboratory measurements in patients with DM at baseline (Sβ= -0.120; 95% CI, -0.151- -0.069; P<0.001). The multivariate Cox proportional hazard analysis revealed that serum HE4 (HR=2.408, 95% CI 1.669-5.238, P<0.001) was an independent prognostic factor for cognitive decline in these DM patients. CONCLUSION Our results showed that serum HE4 was significantly and independently associated with cognitive decline and had independent predictive value for cognitive decline in patients with DM. Serum HE4 might enable early recognition of senile dementia among DM patients.
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Affiliation(s)
- Fengfeng Bai
- Department of Psychiatry, Anding Hospital, Tianjin300222, People’s Republic of China
| | - Tao Li
- Department of Psychiatry, Anding Hospital, Tianjin300222, People’s Republic of China
| | - Baozhu Li
- Department of Psychiatry, Anding Hospital, Tianjin300222, People’s Republic of China
| | - Xiaozheng Li
- Department of Psychiatry, Anding Hospital, Tianjin300222, People’s Republic of China
| | - Lifeng Zhu
- Nursing Department, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong250033, People’s Republic of China
- Correspondence: Lifeng Zhu Nursing Department, The Second Hospital, Cheeloo College of Medicine, Shandong University, 247 Beiyuan Street, Jinan, Shandong250033, People’s Republic of ChinaTel +86 17660087098 Email
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Li L, Yao Y, Liang J, Zhan X, Wang F, Yue C, Wu BQ, Hu S, Liu M, Wan J, Luo J. Serum human epididymis protein 4 concentrations are associated with severity of patients with pulmonary tuberculosis. Clin Chim Acta 2019; 502:255-260. [PMID: 31730821 DOI: 10.1016/j.cca.2019.11.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Revised: 10/02/2019] [Accepted: 11/05/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Human epididymis protein 4 (HE4) has been recognized as a biomarker which elevated in various diseases. The aim of this study was to evaluate the value of serum HE4 in pulmonary tuberculosis (PTB). METHODS Serum HE4 concentrations were determined in 127 PTB, 88 chronic bronchitis (CHB), and 105 healthy control subjects by chemiluminescent microparticle immunoassay. Receiver operating characteristic (ROC) curves and Spearman's correlation analysis were performed for investigating value of HE4. RESULTS Serum HE4 concentrations were significantly increased in PTB (62.8 pmol/L, IQR 45.8-90.7), compared with that of CHB (50.2 pmol/L, IQR 42.3-64.3, P = 0.0002) and normal control (35.4 pmol/L, IQR 31.1-42.9, P < 0.0001). ROC curve suggested that the AUC of HE4 used to discriminate PTB from CHB was 0.647 (95% CI, 0.574-0.719), with the cutoff value, sensitivity, specificity, PPV, and NPV at 71.9 pmol/L, 0.417, 0.852, 0.672 and 0.543, respectively. Meanwhile, compared with mild to moderated PTB, the levels of HE4 in advanced PTB were significantly elevated (75.8 vs. 57.7 pmol/L, P = 0.0052). What's more, the levels of HE4 in PTB were found to be significantly associated with the albumin, CRP, and cavity (r = -0.2996, P = 0.0006, r = 0.265, P = 0.0026, r = 0.4699, P < 0.0001, respectively). CONCLUSIONS Elevated serum HE4 concentration could be used as a biomarker for the diagnosis and assessment of disease severity in PTB.
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Affiliation(s)
- Laisheng Li
- Department of Laboratory Medicine, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, People's Republic of China
| | - Yingsheng Yao
- Department of Laboratory Medicine, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, People's Republic of China; Department of Laboratory Medicine, Shantou Central Hospital, Affiliated Shantou Hospital of Sun Yat-sen University, Shantou, Guangdong 515041, People's Republic of China
| | - Jianbo Liang
- Department of Laboratory Medicine, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, People's Republic of China
| | - Xiaoxia Zhan
- Department of Laboratory Medicine, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, People's Republic of China
| | - Fen Wang
- Department of Pathology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, People's Republic of China
| | - Caifeng Yue
- Department of Laboratory Medicine, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, People's Republic of China
| | - Ben-Quan Wu
- Department of Internal Medicine, Medical Intensive Care Unit and Division of Respiratory Diseases, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, People's Republic of China
| | - Shengfeng Hu
- Institute of Molecular Immunology, School of Laboratory Medicine and Biotechnology, Southern Medical University, Guangzhou 510515, People's Republic of China
| | - Min Liu
- Department of Laboratory Medicine, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, People's Republic of China
| | - Jianxin Wan
- Department of Laboratory Medicine, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, People's Republic of China.
| | - Jinmei Luo
- Department of Internal Medicine, Medical Intensive Care Unit and Division of Respiratory Diseases, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, People's Republic of China.
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Serum Human Epididymis Protein 4 is Associated with Renal Function and Diabetic Kidney Disease in Patients with Type 2 Diabetes Mellitus. BIOMED RESEARCH INTERNATIONAL 2019; 2019:4831459. [PMID: 31815140 PMCID: PMC6878769 DOI: 10.1155/2019/4831459] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 10/01/2019] [Indexed: 11/23/2022]
Abstract
Human epididymis protein 4 (HE4) is an available tumor biomarker mainly for detecting ovarian cancer. However, it is unknown whether it can be a novel indicator for diagnosis of diabetic kidney disease (DKD). The aim of this study was to investigate the possibility of serum HE4 as a novel biomarker for DKD in patients with type 2 diabetes mellitus (T2DM). We enrolled 236 patients with T2DM and 82 healthy individuals. Serum HE4 was detected by ARCHITECT i2000 and compared between T2DM patients and healthy controls. The relationships between various variables and HE4 were analyzed by univariate or multivariate linear regression analyses. The receiver operating characteristic (ROC) curve was constructed to assess the diagnostic performance of HE4 for DKD. The association between HE4 and DKD was analyzed by logistic regression analysis. The serum HE4 level was significantly increased in T2DM patients (median, interquartile range (IQR), 69.7, 46.5–153.9, pM) compared with healthy control (median, IQR, 40.3 33.2–46.3, pM) (P < 0.001). Furthermore, it was higher in those with DKD (median, IQR, 211.1, 141.6–367.4, pM) than those without DKD (median, IQR, 55.5, 42.7–79.6, pM) (P < 0.001). The multivariable analysis showed that age, eGFR, HDL, CRP, and urea significantly independently correlated with HE4 level, while other variables did not. The ROC curve showed that the diagnostic performance of serum HE4 for DKD with 82.9 pM as the optimal cutoff value was good (AUC = 0.917, 95% CI: 0.872–0.961, P < 0.001, with a sensitivity and specificity of 92.1% and 76.9%, respectively) in T2DM patients. Multivariable logistic regression analysis showed that increased HE4 level was a significant, independent risk factor for DKD (OR, 95% CI, 57.7, 3.0–1112.9, P < 0.001) after adjusting for factors associated with HE4. Increased serum HE4 level is associated with decreased renal function and increased risks of DKD in patients with DM. It displays a good diagnostic value for DKD.
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Human Epididymis Protein 4 (HE4) Reference Limits in Polish Population of Healthy Women, Pregnant Women, and Women with Benign Ovarian Tumors. DISEASE MARKERS 2019; 2019:3890906. [PMID: 31583027 PMCID: PMC6754914 DOI: 10.1155/2019/3890906] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Revised: 05/14/2019] [Accepted: 07/16/2019] [Indexed: 12/18/2022]
Abstract
Objectives Defining precisely the normal range of HE4 protein is crucial for the proper interpretation of tumor marker results and for a more efficient diagnosis of ovarian malignancy. The aim of our study was to evaluate a reference limit of HE4 protein in a population to promote and facilitate the common use of HE4 protein assays. We also tried to identify potential association of HE4 levels with other conditions such as smoking, age, BMI, and creatinine levels. Methods Blood samples were collected from 617 patients divided into three groups: healthy, pregnant, and with benign ovarian tumors. Serum HE4 concentrations were measured following a standard procedure. HE4 reference ranges for each group and association of HE4 levels with BMI, creatinine, and smoking were investigated. Results HE4 reference limit for healthy patients equals 85 pmol/l, which becomes 73 pmol/l and 93 pmol/l for pre and postmenopausal subgroups, respectively. There is a statistically significant correlation between HE4 serum level and smoking (p = 0.000001) and there is no correlation with creatinine. But if we take into account age and smoking, in multivariate analysis, there is a correlation. For pregnant, the upper limit values of normal HE4 levels are 55 pmol/l (median = 40 pmol/l), 80 pmol/l (median = 43 pmol/l), and 106 pmol/l (median = 53 pmol/l) for the first, second, and third trimesters, respectively. Conclusions HE4 protein value strongly depends on the patient's age and smoking. The serum concentration of HE4 marker increases with the duration of pregnancy. Understanding the normal range of HE4 protein enables the correct interpretation of marker measurements. This may result in an earlier and more effective diagnosis of ovarian cancer.
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Usefulness of HE4 protein in differentiation of pelvic masses in woman. MENOPAUSE REVIEW 2019; 18:27-32. [PMID: 31114455 PMCID: PMC6528042 DOI: 10.5114/pm.2019.84154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 01/28/2019] [Indexed: 01/08/2023]
Abstract
Introduction HE4 protein (human epididymis protein-4), which is the fourth subfraction of human epithelial protein, is a glycoprotein widely used as a tumor marker in ovarian cancer. If was first discovered in the epididymal epithelium and recognized as a protease inhibitor contributing to sperm maturation. The plasma HE4 concentration may also be increased in gynecological pathologies other than ovarian cancer. Material and methods The study was conducted between 2016 and 2017 among patients hospitalized in the Academic Department of Gynaecology. A total of 191 women were examined. Depending on the type of pathology which was the reason for hospitalization, 4 groups of patients were identified in the study. The first of these included 30 patients with ovarian cancer, the second 33 patients with benign ovarian lesion, the third 50 patients with endometrial cancer, and the fourth 28 patients with leiomyomas. Results The highest concentration of HE4 protein was found in women with ovarian cancer, and it was statistically significantly higher compared to all other groups. Lower HE4 protein concentration than in women with ovarian cancer was reported in women with endometrial cancer, but it was statistically significantly higher compared to patients with uterine fibroids. Conclusions This marker may have significant clinical value in the differentiation of benign ovarian pathology from ovarian cancer. The study confirms the validity of using HE4 results in the assessment of potential malignancy of ovarian and endometrial lesions.
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The diagnostic value of human epididymis protein 4 as a novel biomarker in patients with renal dysfunction. Int Urol Nephrol 2018; 50:2043-2048. [PMID: 30006786 DOI: 10.1007/s11255-018-1930-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 06/20/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE In this study, we investigated the diagnostic value of human epididymis protein 4 (HE4) in acute and chronic renal dysfunction and analyzed the correlation between HE4 levels and the results of routine renal function tests. We aimed to provide evidence to establish HE4 as a novel biomarker of renal injury and its appropriate application as a marker of ovarian cancer. METHODS We collected 259 serum samples from hospitalized patients with different causes of renal damage. HE4 serum levels were detected by chemiluminescence and the levels of serum creatinine, urea, and cystatin C were tested by conventional clinical chemical methods. RESULTS The levels of HE4 were highest in the acute kidney injury groups and chronic kidney disease groups, although other groups were also significantly higher than the control group. HE4 and creatinine, urea, and cystatin C had a positive linear correlation. In contrast, HE4 and estimated glomerular filtration rate (eGFR) had a negative linear correlation, with a correlation coefficient of - 0.674 (P < 0.01). Area under the receiver-operating characteristic curve analysis showed that HE4 has higher diagnostic value compared with creatinine, urea, and cystatin C in both acute and chronic renal injury patients; however, HE4 and creatinine have a similar diagnostic value. Notably, HE4 concentration gradually increased with a decline of glomerular filtration rate, with significant differences evident between different eGFR stages. CONCLUSION HE4 is a potential biomarker of kidney injury in acute and chronic renal dysfunction. Importantly, clinicians should be aware of this when using HE4 to diagnose ovarian cancer.
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Zhang M, Yuan L, Yao F, Cao P, Rong J, Zhang B, Su J. Human epididymis protein 4 concentration is not associated with liver fibrosis and cirrhosis in a case control study. Clin Chim Acta 2018; 484:213-217. [PMID: 29864404 DOI: 10.1016/j.cca.2018.05.051] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 05/17/2018] [Accepted: 05/25/2018] [Indexed: 01/27/2023]
Abstract
BACKGROUND Human epididymis protein 4 (HE4) is an emerging fibrotic biomarker which has been studied in chronic kidney disease cohorts. However, it is unclear if the serum level of HE4 may be altered in patients with liver fibrosis and cirrhosis. METHODS we assessed serum HE4 concentrations in patients (n = 366) with chronic liver diseases (CLD) and compared to matched healthy controls (n = 366). Liver stiffness measurement (LSM) by transient elastography (TE, FibroScan) was also performed on all patients. Liver biopsy was performed on 34 of 366 subjects. Moreover, we analysed a subgroup of patients with confirmed cirrhosis to validate the correlation between HE4 and the severity of cirrhosis. Child-Pugh (CP) score was evaluated in this subgroup. RESULTS No statistically significant differences were observed in the median HE4 level between patients with fibrosis and cirrhosis and controls (median: 56.2 vs. 55 pmol/L, p = .562). Neither were any significant differences found among different groups with Child-Pugh Classes A, B and C (median: 56.9, 58.3 and 52.1 pmol/L, respectively; p = .842). Correlation analysis did not show a significant correlation between HE4 and degree of liver fibrosis according to LSM values or histological assessment (r = 0.159, p = .239; r = 0.045, p = .788). CONCLUSIONS Serum HE4 level does not appear to be associated with fibrotic and cirrhotic liver, suggesting that HE4 may not serve as a valuable clinical biomarker for liver fibrosis and cirrhosis.
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Affiliation(s)
- Mingxia Zhang
- Department of Clinical Laboratory Medicine, Shanxi Academy of Medical Sciences & Shanxi DAYI Hospital, Shanxi Province, China.
| | - Lili Yuan
- Department of Gastroenterology, Shanxi Academy of Medical Sciences & Shanxi DAYI Hospital, Shanxi Province, China
| | - Fucheng Yao
- Department of Ultrasound, Shanxi Academy of Medical Sciences & Shanxi DAYI Hospital, Shanxi Province, China
| | - Ping Cao
- Department of Gastroenterology, Shanxi Academy of Medical Sciences & Shanxi DAYI Hospital, Shanxi Province, China
| | - Jianrong Rong
- Department of Clinical Laboratory Medicine, Shanxi Academy of Medical Sciences & Shanxi DAYI Hospital, Shanxi Province, China
| | - Bin Zhang
- Department of Clinical Laboratory Medicine, Shanxi Academy of Medical Sciences & Shanxi DAYI Hospital, Shanxi Province, China
| | - Jie Su
- Department of Clinical Laboratory Medicine, Shanxi Academy of Medical Sciences & Shanxi DAYI Hospital, Shanxi Province, China
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Ren Y, Xie J, Lin F, Luo W, Zhang Z, Mao P, Zhong R, Liang Y, Yang Z. Serum human epididymis protein 4 is a predictor for developing nephritis in patients with systemic lupus erythematosus: A prospective cohort study. Int Immunopharmacol 2018; 60:189-193. [PMID: 29747124 DOI: 10.1016/j.intimp.2018.04.048] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 04/16/2018] [Accepted: 04/30/2018] [Indexed: 01/09/2023]
Abstract
BACKGROUND It has been demonstrated that serum human epididymis protein 4 (HE4) is a useful biomarker for differentiating lupus nephritis (LN) from systemic lupus erythematosus (SLE). However, it remains unclear whether HE4 can be used to predict the development of LN. METHODS A total of 74 SLE patients without LN were recruited between August 2008 and September 2013. Serum HE4 concentrations were measured by enzyme-linked immunosorbent assay. These patients were followed up from the date of SLE diagnosis to LN development or the end of the study. The receiver operating characteristics (ROC) curve was drawn to assess the predictive value of HE4 for the incidence of LN. In addition, Kaplan-Meier and Cox regression analyses were used to determine the prognostic factors for the incidence of LN. RESULTS Serum HE4 levels significantly increased in patients who are positive for anti-dsDNA antibody, low C3 and the incidence LN (P < 0.05), and these were closely correlated with age, erythrocyte sedimentation rate (ESR) and the SLE disease activity index (SLEDAI) (P < 0.05). During the follow-up, 44 patients developed LN. The ROC curve revealed that for HE4 levels, the predictive performance for LN with 64.8 pM as an optimal cutoff yielded an AUC of 0.714, with a 95% confidence interval of 0.597-0.831, and a sensitivity and specificity of 81.8% and 53.3%, respectively. The Kaplan-Meier analysis revealed that LN occurred in 72% of high-HE4 patients and 33.3% of low-HE4 patients (P = 0.036). The univariate analysis revealed that anti-dsDNA antibody, low C3, SLEDAI and HE4 were significantly associated with the incidence of LN (P < 0.05). Multivariate Cox regression revealed that only SLEDAI and HE4 were independently associated with the incidence of LN. CONCLUSION Elevated serum HE4 is significantly associated with a higher risk of incidence for LN, and may be a useful predictor for developing LN.
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Affiliation(s)
- Yingpeng Ren
- Department of Laboratory Medicine, Huangyan Hospital of Wenzhou Medical University, Taizhou First People's Hospital, Taizhou, Zhejiang, China
| | - Jing Xie
- Department of Laboratory Medicine, Huangyan Hospital of Wenzhou Medical University, Taizhou First People's Hospital, Taizhou, Zhejiang, China
| | - Feng Lin
- Department of general surgery, Huangyan Hospital of Wenzhou Medical University, Taizhou First People's Hospital, Taizhou, Zhejiang, China
| | - Wanwan Luo
- Department of Laboratory Medicine, Huangyan Hospital of Wenzhou Medical University, Taizhou First People's Hospital, Taizhou, Zhejiang, China
| | - Zhencheng Zhang
- Department of Laboratory Medicine, Huangyan Hospital of Wenzhou Medical University, Taizhou First People's Hospital, Taizhou, Zhejiang, China
| | - Panying Mao
- Department of Laboratory Medicine, Huangyan Hospital of Wenzhou Medical University, Taizhou First People's Hospital, Taizhou, Zhejiang, China
| | - Renqian Zhong
- Department of Laboratory Diagnostics, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Yan Liang
- Department of Laboratory Diagnostics, Changzheng Hospital, Second Military Medical University, Shanghai, China.
| | - Zaixing Yang
- Department of Laboratory Medicine, Huangyan Hospital of Wenzhou Medical University, Taizhou First People's Hospital, Taizhou, Zhejiang, China.
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Piek A, Du W, de Boer RA, Silljé HHW. Novel heart failure biomarkers: why do we fail to exploit their potential? Crit Rev Clin Lab Sci 2018; 55:246-263. [PMID: 29663841 DOI: 10.1080/10408363.2018.1460576] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Plasma biomarkers are useful tools in the diagnosis and prognosis of heart failure (HF). In the last decade, numerous studies have aimed to identify novel HF biomarkers that would provide superior and/or additional diagnostic, prognostic, or stratification utility. Although numerous biomarkers have been identified, their implementation in clinical practice has so far remained largely unsuccessful. Whereas cardiac-specific biomarkers, including natriuretic peptides (ANP and BNP) and high sensitivity troponins (hsTn), are widely used in clinical practice, other biomarkers have not yet proven their utility. Galectin-3 (Gal-3) and soluble suppression of tumorigenicity 2 (sST2) are the only novel HF biomarkers that are included in the ACC/AHA HF guidelines, but their clinical utility still needs to be demonstrated. In this review, we will describe natriuretic peptides, hsTn, and novel HF biomarkers, including Gal-3, sST2, human epididymis protein 4 (HE4), insulin-like growth factor-binding protein 7 (IGFBP-7), heart fatty acid-binding protein (H-FABP), soluble CD146 (sCD146), interleukin-6 (IL-6), growth differentiation factor 15 (GDF-15), procalcitonin (PCT), adrenomedullin (ADM), microRNAs (miRNAs), and metabolites like 5-oxoproline. We will discuss the biology of these HF biomarkers and conclude that most of them are markers of general pathological processes like fibrosis, cell death, and inflammation, and are not cardiac- or HF-specific. These characteristics explain to a large degree why it has been difficult to relate these biomarkers to a single disease. We propose that, in addition to clinical investigations, it will be pivotal to perform comprehensive preclinical biomarker investigations in animal models of HF in order to fully reveal the potential of these novel HF biomarkers.
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Affiliation(s)
- Arnold Piek
- a Department of Cardiology , University Medical Center Groningen, University of Groningen , Groningen , The Netherlands
| | - Weijie Du
- a Department of Cardiology , University Medical Center Groningen, University of Groningen , Groningen , The Netherlands.,b Department of Pharmacology, College of Pharmacy , Harbin Medical University , Harbin , China
| | - Rudolf A de Boer
- a Department of Cardiology , University Medical Center Groningen, University of Groningen , Groningen , The Netherlands
| | - Herman H W Silljé
- a Department of Cardiology , University Medical Center Groningen, University of Groningen , Groningen , The Netherlands
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Wan J, Wang Y, Cai G, Liang J, Yue C, Wang F, Song J, Wang J, Liu M, Luo J, Li L. Elevated serum concentrations of HE4 as a novel biomarker of disease severity and renal fibrosis in kidney disease. Oncotarget 2018; 7:67748-67759. [PMID: 27589683 PMCID: PMC5356516 DOI: 10.18632/oncotarget.11682] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 08/26/2016] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Human epididymis protein 4 (HE4), has recently been reported as a mediator of renal fibrosis. However, serum HE4 levels appear in a large number of patient samples with chronic kidney disease (CKD), and the relationship of these levels to disease severity and renal fibrosis is unknown. METHODS In 427 patients at different stages of CKD excluding gynecologic cancer and 173 healthy subjects, serum HE4 concentrations were tested by chemiluminescent microparticle immunoassay. Renal biopsy was performed on 259 of 427 subjects. Histological findings were evaluated using standard immunohistochemistry. RESULTS The levels of serum HE4 were higher in CKD patients than in healthy subjects, and higher levels were associated with more severe CKD stages. Patients with more severe renal fibrosis tended to have higher HE4 levels, and correlation analysis showed a significant correlation between HE4 and degree of renal fibrosis (r = 0.938, P < 0.0001). HE4 can be a predictor of renal fibrosis in CKD patients; the area under the receiver-operating characteristic curve (AUC-ROC) was 0.99, higher than the AUC-ROC of serum creatinine (0.89). CONCLUSION Elevated levels of serum HE4 are associated with decreased kidney function, and also with an advanced stage of renal fibrosis, suggesting that HE4 may serve as a valuable clinical biomarker for renal fibrosis of CKD.
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Affiliation(s)
- Jianxin Wan
- Department of Laboratory Medicine, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Yanhong Wang
- Department of Internal Medicine, Medical Intensive Care Unit and Division of Respiratory Diseases, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Gaorong Cai
- Department of Laboratory Medicine, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Jianbo Liang
- Department of Laboratory Medicine, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Caifeng Yue
- Department of Laboratory Medicine, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Fen Wang
- Department of Pathology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Junli Song
- Reproductive Medicine Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Jianfeng Wang
- Institute of Laboratory Medicine, Guangdong Medical College, Dongguan, People's Republic of China
| | - Min Liu
- Department of Laboratory Medicine, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Jinmei Luo
- Department of Internal Medicine, Medical Intensive Care Unit and Division of Respiratory Diseases, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Laisheng Li
- Department of Laboratory Medicine, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China
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Fan Q, Luo G, Yi T, Wang Q, Wang D, Zhang G, Jiang X, Guo X. Diagnostic value of urinary-to-serum human epididymis protein 4 ratio in ovarian cancer. Biomed Rep 2017; 7:67-72. [PMID: 28685063 PMCID: PMC5492654 DOI: 10.3892/br.2017.913] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 04/27/2017] [Indexed: 12/27/2022] Open
Abstract
Human epididymis protein 4 (HE4) is one of the best-known tumor markers for ovarian cancer (OC). Emerging evidence indicates that the evaluation of serum HE4 (S-HE4) levels may be problematic when patients have chronic kidney disease (CKD). Assaying urine for HE4 levels is non-invasive alternative for the diagnosis of OC. However, whether the combined detection of S- and urinary HE4 (U-HE4) levels distinguishes OC from CKD remains unknown. To investigate this issue, the present study recruited 31 female patients with OC, 38 female patients with CKD, and 36 healthy control (HC) females. Serum and urine samples were preoperatively collected for HE4 level detection. Receiver operating characteristic (ROC) curves were constructed to assess the diagnostic performance of S-HE4 level, U-HE4 level and the ratio of urinary-to-serum HE4 level (R-HE4). Data from the current study indicated that serum HE4 levels in the OC and CKD groups were significantly higher than that in the HC group. The U-HE4 level in the OC group was significantly higher than that in the CKD and HC groups. The highest R-HE4 was observed in the HC group, followed by the OC group, and the lowest R-HE4 was observed in the CKD group. ROC analysis demonstrated that the R-HE4 was useful in differentiating OC from CKD and HC. Based on the diagnostic interval of optimal cut-off values from 36.85 to 96.15, the sensitivity and specificity of R-HE4 in differentiating OC patients from non-OC patients were 82.6 and 85.4%, respectively. Thus, the combined detection of S- and U-HE4 levels facilitates the diagnosis of OC, and R-HE4 is an effective marker for differentiating OC from CKD.
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Affiliation(s)
- Quming Fan
- Department of Clinical Laboratory, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan 637000, P.R. China
| | - Guangcheng Luo
- Department of Clinical Laboratory, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan 637000, P.R. China
| | - Tingting Yi
- Department of Clinical Laboratory, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan 637000, P.R. China
| | - Qiang Wang
- Department of Clinical Laboratory, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan 637000, P.R. China
| | - Dongsheng Wang
- Department of Clinical Laboratory, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan 637000, P.R. China
| | - Guoyuan Zhang
- Department of Clinical Laboratory, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan 637000, P.R. China
| | - Xingliang Jiang
- Department of Clinical Laboratory, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan 637000, P.R. China
| | - Xiaolan Guo
- Department of Clinical Laboratory, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan 637000, P.R. China
- Translational Medicine Research Center, North Sichuan Medical College, Nanchong, Sichuan 637000, P.R. China
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