目的 鉴定具有独立预后价值的生物标志物，并探讨多种生物标志物联合应用对心力衰竭住院患者的预后价值。 连续纳入 2015 年至 2017 年因心力衰竭住院的 884 例患者。入院时测量了 12 种生物标志物，并评估了生物标志物与结果之间的关系。在 913 天的中位随访期间，291 名患者 (32.9%) 遭受主要终点事件。可溶性抑制致瘤性-2 (sST2)（每对数[单位]增加，调整后 HR [95% CI]：1.39 [1.13,1.72]，P = 0.002）和大内皮素-1（大 ET-1）（每对数[单位] 增加，调整后 HR [95% CI]：1.56 [1.23,1.97]，P < 0.001）在调整其他预测因子（包括 N 端 B 型利尿钠肽原）（NT- proBNP) 和高敏心肌肌钙蛋白 T (hs-cTnT)。 sST2（C 统计量：0.810 vs 0.801，P = 0.005 和 0.832 vs 0.826，P = 0.024）和大 ET-1（C 统计量：0.829 vs 0.801，P = 0.001，和 0.843 vs 0.826，P < 0.001，分别）显着提高了 1 年和 3 年主要终点事件的预测值。然而，当添加到临床预测因子和已知生物标志物中时，只有大 ET-1（C 统计量：0.852 vs 0.846，P = 0.014）显着提高了 3 个月时的预测值。根据升高的生物标志物（包括NT-proBNP、hs-cTnT、sST2和大ET-1）的数量，与具有两个或更多生物标志物升高的患者相比，具有三个或更多生物标志物升高的患者发生主要终点事件的风险更高（P = 0.001），以及与具有一种升高的生物标志物的患者相比，具有两种升高的生物标志物的患者（P = 0.004）。然而，一种生物标志物升高的患者与生物标志物不升高的患者之间的主要终点事件风险相当（P = 0.582）。多种生物标志物的组合可以提供比单一生物标志物更好的预后价值。 sST2 和大 ET-1 可以作为多生物标志物策略的替代方案，用于心力衰竭住院患者的预后评估，超越 NT-proBNP 和 hs-cTnT。© 2023 Chen 等人。

To identify biomarkers with independent prognostic value and investigate the prognostic value of multiple biomarkers in combination in patients hospitalized with heart failure.A total of 884 consecutive patients hospitalized with heart failure from 2015 to 2017 were enrolled. Twelve biomarkers were measured on admission, and the relationships between biomarkers and outcomes were assessed.During the median follow-up of 913 days, 291 patients (32.9%) suffered from primary endpoint events. Soluble suppression of tumorigenicity-2 (sST2) (per log [unit] increase, adjusted HR [95% CI]: 1.39 [1.13,1.72], P = 0.002) and big endothelin-1 (big ET-1) (per log [unit] increase, adjusted HR [95% CI]: 1.56 [1.23,1.97], P < 0.001) remained independent predictors of primary endpoint event after adjusting for other predictors including N-terminal pro-B-type natriuretic peptide (NT-proBNP) and high-sensitivity cardiac troponin T (hs-cTnT). Both sST2 (C-statistic: 0.810 vs 0.801, P = 0.005, and 0.832 vs 0.826, P = 0.024, respectively) and big ET-1 (C-statistic: 0.829 vs 0.801, P = 0.001, and 0.843 vs 0.826, P < 0.001, respectively) significantly improved the predictive value for primary endpoint event at 1 year and 3 years. However, only big ET-1 (C-statistic: 0.852 vs 0.846, P = 0.014) significantly improved the predictive value at 3 months when added to clinical predictors and known biomarkers. According to the number of elevated biomarkers (including NT-proBNP, hs-cTnT, sST2, and big ET-1), patients with three or more elevated biomarkers had a higher risk of primary endpoint event compared to those with two elevated biomarkers (P = 0.001), as well as in patients with two elevated biomarkers compared to those with one elevated biomarker (P = 0.004). However, the risk of primary endpoint event was comparable between patients with one elevated biomarker and those with no elevated biomarker (P = 0.582).Multiple biomarkers in combination could provide a better prognostic value than a single biomarker. sST2 and big ET-1 could act as alternatives of multi-biomarkers strategies for prognosis evaluation beyond NT-proBNP and hs-cTnT in patients hospitalized with heart failure.© 2023 Chen et al.