| Background:Heart Failure(HF)is a complex group of clinical syndromes and is a serious stage in cardiovascular disease caused by various causes.High prevalence,high mortality,and high medical costs make HF to an important public health problem in the society,and it also poses severe challenges to HF care management.Early identification of high-risk HF populations with poor prognosis are conducive to guiding the implementation of clinical decision-making.It is also helpful for nurses to implement effective nursing management.It can enable nurses to intervene in early nursing interventions.It is aimed at improving the prognosis and reducing the rate of re-hospitalization.It is aimed at implementing a nursing plan for patients and consciously improving the self-care ability of patients and delays the heart failure progression.In recent years,the importance of biomarkers has been emphasized in numerous guidelines for the diagnosis and treatment of heart failure,showing its important value in the diagnosis of HF,prognosis prediction,and risk stratification.BNP and N-terminal B-type natriuretic peptide are the most widely used biomarkers in the diagnosis and diagnosis of heart failure,the severity of illness,and the assessment of the prognosis of heart failure(Class I,Level A).Copeptin has attracted more and more attention as a hotspot biomarker closely related to HF prognostic evaluation.However,the prognostic value of copeptin over BNP and NT-pro BNP is still controversial.Therefore,this study will use meta-analysis to evaluate the prognostic value of copeptin in HF patients to determine whether the value of copeptin in HF patients is superior to the"gold standard"NT-proBNP.At the same time,the 2014 Chinese version of the guidelines for the diagnosis and treatment of heart failure indicated that some patients with advanced heart failure may have normal levels of BNP,or that there is a pseudo-normal level of obesity and HF-PEF,and a combination of multiple biomarker detection strategies may guide the treatment of heart failure.Helpfully,we will further explore the prognostic value of multiple biomarkers in patients with HF.Methods:PubMed,Embase and Cochrane databases were systematically searched to identify if a 2×2 contingency table could be constructed based on both the copeptin level and the all-cause mortality in patients diagnosed with HF.The characteristics of test performance were summarized using forest plots and summary receiver operating characteristic curves(SROC).Q-test and I~2 index were used to evaluate heterogeneity.Further,we select Department of Cardiology,First Affiliated Hospital of Guangdong University of Pharmacy Patients with Chronic heart failure(CHF)diagnosed from June to September 2017.Blood samples were collected at admission to patients,detection of biomarkers:copeptin,BNP/NT-ProBNP and cystatin c,regular follow-up and combined with the general information of patients,laboratory tests and other imaging data to analysis the impact of CHF prognosis of independent risk factors.Then we evaluated the short-term prognostic value of multiple biomarkers in CHF patients by ROC curve and explored the relationship between short-term prognosis of patients with CHF at 0,1,2,and 3 when the concentration of biomarkers increases to provide a scientific basis for the combination of multiple biomarkers in the prognosis of HF patients.Results:Ten prospective cohort studies comprising 4473 patients were eligible in this meta-analysis.An elevated copeptin level was associated with an increased risk of all-cause mortality in HF patients(Relative risk(RR)was2.64(95%CI,2.09–3.32)).The pooled sensitivity(SEN)and specificity(SPE)of copeptin were 0.57(95%CI,0.50–0.63)and 0.74(95%CI,0.69–0.79),respectively.The positive likelihood ratio was 2.2(95%CI,1.90–2.60)and the negative likelihood ratio was 0.58(95%CI,0.52–0.66).Furthermore,the summary Diagnostic Odds Ratio(DOR)was 4.00(95%CI,3.00–5.00)and the AUC was 0.70(95%CI,0.66–0.74)similar to the AUC of NT-proBNP 0.71(95%CI,0.67–0.75).The study included 56patients eligible for inclusion of the CHF patients,due to lack of clinical data and the other reasons,9 patients stopped the test.Finally,47 patients entered the study.The median follow-up time was 76(48-95)days,of which 18(38.3%)had all-cause death or adverse end-points of hospital admission due to heart failure.The area under the ROC,the AUC of BNP,cystatin c,and copeptin were 0.70(95%CI,0.55-0.86),0.73(95%CI,0.58-0.89),0.68(95%CI,0.50-0.85),respectively.When the number of biomarkers increased by?2,the incidence of adverse endpoint events was significantly higher in both groups than in the group of 0 biomarkers(P=0.003(2),P=0.0001(3)).By multivariate Cox model,we found that BNP(RR=3.865,P=0.047),and Copeptin(RR=1.406,P=0.007).Conclusions:Elevated levels of copeptin are associated with all-cause mortality in HF patients.The predictive value of copeptin is comparable with NT-proBNP for all-cause mortality in HF patients.BNP and Copeptin are predictors of adverse end-point events in all-cause cardiac death or re-admission due to heart failure.When combined with 3 biomarkers(BNP,copeptin,and cystatin c)(AUC=0.79(95%CI,0.66-0.92))predicted the exact value of end-point adverse events of heart failure to be higher than any single biomarker alone. |
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