Serum beta2-microglobulin concentration as a novel marker to distinguish levels of risk in acute heart failure patients

SummaryBackgroundRecently, serum beta2-microglobulin, an endogenous marker for renal function, has been shown to be an independent predictor of mortality in older adults. However, the prognostic role of beta2-microglobulin in heart failure has not been elucidated.MethodsWe prospectively evaluated serum beta2-microglobulin and creatinine concentrations, creatinine-based renal parameters (estimated glomerular filtration rate and creatinine clearance), and echocardiographic data in 131 patients with acute heart failure and creatinine concentrations ≤3.0mg/dL admitted to our hospitals.ResultsDuring 2.3±1.3 years, 42 patients died of cardiovascular causes and 12 died of noncardiac causes. Cardiovascular events were observed in 63 patients: 53 were readmitted due to worsening heart failure, 5 readmitted for cerebral embolism, and 5 died from sudden cardiac death. According to multivariate stepwise Cox proportional hazard analysis, higher baseline serum beta2-microglobulin concentrations (X2=16, p<0.0001), previous congestive heart failure (X2=11, p<0.001), presence of chronic obstructive pulmonary disease (X2=8, p<0.01), and lower diastolic blood pressure (X2=6, p<0.05) were independent predictors of increased cardiovascular events. Also, higher baseline serum beta2-microglobulin (X2=20, p<0.0001), lower systolic blood pressure (X2=11, p<0.001), higher relative left ventricular wall thickness (X2=6, p<0.05), and lower body mass index (X2=5, p<0.05) were independent predictors of increased cardiac mortality. The adjusted hazard ratio for cardiovascular events increased with baseline serum beta2-microglobulin above 2.1mg/L: 2.9 with beta2-microglobulin of 2.2–2.6mg/L (95%CI 1.2–6.9, p<0.05), 2.9 with beta2-microglobulin of 2.7–3.9mg/L (95%CI 1.2–7.2, p<0.05), and 4.7 with beta2-microglobulin of ≥4.0mg/L (95%CI 2.0–11, p<0.001).ConclusionsHigher baseline serum beta2-microglobulin concentration could be a promising risk marker in acute heart failure patients with creatinine ≤3.0mg/dL