The Changes Of Plasma Ghrelin Level And Its Relationship With In-hospital Mortality In Acute Heart Failure Patients

ObjectivesThe aim of this study was to explore the changes of Ghrelin level and to assess the association of Ghrelin level with cardiac function and prognosis in acute heart failure patients.MethodsThe subjects included an prospective cohort of 197 patients with acute heart failure from June 2014 to January 2015 in Fujian Provincial Hospital. The indices including age, gender, etiologies, clinical symptoms and signs, echocardiography test and regimen, the plasma Ghrelin level, were recorded. The study included 49 healthy control subjects. The age and sex of the control subjects were similar to those of the 197 patients with acute heart failure. Multiple regression analysis method were performed to examine the relationship between Ghrelin level and in-hospital mortality in patients with acute heart failure.Results1. A total of 197 Patients with acute heart failure were enrolled. The majority(61.4%) were males and the average age was 69.2±13.4 years old. Of them, the bedside clinical grade Ⅰ ~ Ⅳ accounted for 10.2%, 57.9%, 10.7%, 21.3%, respectively. The median length of stay was 11(5, 18) days. In-hospital mortality was 15.7%. The main medical history were hypertension(64.5%), coronary heart disease(56.9%), diabetes(36.6%) and atrial fibrillation(27.9%).2. The Ghrelin level in the acute heart failure patients and the control subjects were 4.03(2.88, 5.40) ng/ml, 3.03(2.22, 3.91) ng/ml, respectively. The Ghrelin level in acute heart failure patients was higher than that in control subjects(P<0.01). The independent predictive factors of Ghrelin level were diabetes, used of beta blockers,used of aspirin, clinical bedside grade, hematocrit, heart rate, e GFR and NT-pro BNP(all P<0.05).3. The Ghrelin level in heart failure with diabetes was lower than that in heart failure without diabetes(P<0.05). There was no significant difference in ghrelin level between acute new-onset heart failure and acute decompensated chronic heart failure(P>0.05). There was no significant difference in ghrelin level between heart failure with acute myocardial infarction and heart failure without acute myocardial infarction(P>0.05). There was no significant difference in ghrelin level between heart failure with reduced ejection fraction and heart failure with preserved ejection fraction(P>0.05).4. There was a positive correlation between clinical bedside grade and the Ghrelin level(r=0.218, P for Trend<0.01), the positive correlation is more significant in survivors during the period of hospitalization than that in all of the acute heart failure patients(r=0.330, P for Trend < 0.01). there was a positive correlation between Ghrelin and NT-pro BNP in survivors during the period of hospitalization(r=0.236, P<0.01). There was no correlation between echocardiography indexes and Ghrelin level in the acute heart failure Patients(all P>0.05).5. The Ghrelin level was a independent predictor of in-hospital mortality in acute heart failure patients. Each 1ng/ml increase in plasma Ghrelin level was associated with a 38.8% reduced risk of in-hospital mortality(OR=0.612, P<0.01). In-hospital mortality was six times as high in patients with plasma Ghrelin level in the first quartile compared with the fourth quartile(P for Trend<0.01).ConclusionsPlasma Ghrelin level increased significantly in patients with acute heart failure. Ghrelin level was positive correlated with the severity of acute heart failure. The level of Ghrelin may predict in-hospital mortality in patients with acute heart failure.