Combination of the Modified Models for End-Stage Liver Disease and sST2/LVMI Ratio Predicts Mortality in the Patients with Advanced Heart Failure

Biomarkers in heart failure (HF) management are critical for enhancing diagnostic accuracy, monitoring therapeutic response and assessing the risk of death. The aim of the study was to assess risk factors for one-year mortality in patients with advanced HF, with particular emphasis on the soluble suppression of tumorigenicity 2/left ventricular mass index (sST2/LVMI) ratio, modified Model for End-stage Liver Disease (modMELD) and Model for End-stage Liver Disease excluding INR (MELD-XI). We propectively analyzed 429 adult patients with advanced HF hospitalized between 2018 and 2023. The end-point of the study was defined as all-cause mortality during a one-year follow-up. The median age was 56.0 (50.0–60.0) years; 89.2% were male. During one-year follow-up, 134 (31.2%) patients died. The area under the receiver operating characteristics (ROC) curves indicated an excellent prognostic powers of sST2/LVMI-MELDXI (AUC: 0.90 [CI: 0.87-0.93]; sensitivity 80%, and specificity 85%) and sST2/LVMI-modMELD (AUC: 0.92 [95% CI: 0.90-0.95]; sensitivity 81%, and specificity 92%) for assessment of one-year mortality. The multivariable Cox regression model showed that: sST2/LVMI-MELD-XI [HR 2.501 (2.168-2.886) p<0.001], sodium [HR 1.065(1.004-1.130) p=0.036], NT-proBNP [HR 1.004 (1.004-1.007) p=0.008],fibrinogen [HR 1.002 (1.000-1.004) p<0.001], and uric acid [1.001 (1.000-1.002), 0.0426] in first model, and sST2/LVMI-modMELD [HR 2.552 (2.224-2.928) p<0.0001], NT-proBNP [HR 1.005 (1.002-1.008) p=0.002],fibrinogen [HR 1.002 (1.000-1.003) p=0.0099], and uric acid [1.001 (1.000-1.002), 0.0489] in second model were independent risk factors for one- year mortality. The sST2/LVMI-modMELD and sST2/LVMI- MELD-XI ratios are strongly associated with one-year mortality in the patients with advanced HF. Both models have a excellent prognostic powers for an effective separation of one-year survivors from non-survivors. Another independent risk factors for one-year mortality in the analyzed population were higher levels of fibrinogen, uric acid and NT-proBNP, as well as lower sodium levels.