Abstract: SA-OR07
Association of Post-Hospitalization Vascular Biomarker Clusters with Future Heart Failure
Session Information
- AKI Research: Seeking New Paths to Progress
November 04, 2023 | Location: Room 118, Pennsylvania Convention Center
Abstract Time: 05:24 PM - 05:33 PM
Category: Acute Kidney Injury
- 102 AKI: Clinical, Outcomes, and Trials
Authors
- Shi, Audrey, Yale School of Medicine, New Haven, Connecticut, United States
- Andrawis, Anna Simone, Yale School of Medicine, New Haven, Connecticut, United States
- Obeid, Wassim, Johns Hopkins University, Baltimore, Maryland, United States
- Go, Alan S., University of California San Francisco, San Francisco, California, United States
- Liu, Kathleen D., University of California San Francisco, San Francisco, California, United States
- Wurfel, Mark M., University of Washington, Seattle, Washington, United States
- Himmelfarb, Jonathan, University of Washington, Seattle, Washington, United States
- Parikh, Chirag R., Johns Hopkins University, Baltimore, Maryland, United States
- Bhatraju, Pavan K., University of Washington, Seattle, Washington, United States
- Chinchilli, Vernon M., The Pennsylvania State University, University Park, Pennsylvania, United States
- Kimmel, Paul L., National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland, United States
- Kaufman, James S., VA New York Harbor Healthcare System, New York, New York, United States
- Coca, Steven G., Icahn School of Medicine at Mount Sinai, New York, New York, United States
- Reeves, William Brian, The University of Texas Health Science Center at San Antonio, San Antonio, Texas, United States
- Garg, Amit X., Western University, London, Ontario, Canada
- Siew, Edward D., Vanderbilt University, Nashville, Tennessee, United States
- Ikizler, Talat Alp, Vanderbilt University, Nashville, Tennessee, United States
- Thiessen Philbrook, Heather, Johns Hopkins University, Baltimore, Maryland, United States
- Hsu, Chi-yuan, University of California San Francisco, San Francisco, California, United States
- Prince, David K., University of Washington, Seattle, Washington, United States
- Wilson, Francis Perry, Yale School of Medicine, New Haven, Connecticut, United States
- Mansour, Sherry, Yale School of Medicine, New Haven, Connecticut, United States
Background
Individual vascular biomarkers helped elucidate the connections between acute kidney injury (AKI) and future heart failure (HF). The role of combined vascular biomarkers in recently discharged patients with risk of future hospitalizations with HF is unknown.
Methods
Using the ASSESS-AKI cohort, we performed an unsupervised spectral cluster analysis with 9 plasma biomarkers measured at 3 months post-hospitalization [Angiopoietin (angpt)-1, angpt-2, vascular endothelial growth factor (VEGF)-A, VEGF-C, VEGF-d, VEGF receptor 1 (R1), solubleTie-2 (sTie-2), placental growth factor (PlGF), and basic fibroblast growth factor (bFGF)] in 1,497 patients, half of whom had AKI. We used a Cox regression analysis to evaluate the associations between clusters and future hospitalizations with HF. Models were adjusted for demographics, cardiovascular disease risk factors, medications, ICU status, lung disease, sepsis, serum creatinine, proteinuria, and admission center.
Results
3 biomarker-derived clusters were identified: Cluster 1 [n=302, Vascular Injury (VI) phenotype] had higher levels of vessel injury markers, whereas Cluster 2 [n=728, Vascular Repair (VR) phenotype] had higher levels of vessel repair markers. Cluster 3 (n=467) had lower levels of both repair and injury markers (dormant phenotype). The median time to HF was 4.7 years (IQR: 2.93-5.93). Participants with the VI phenotype were twice as likely to have a HF event [aHR 2.23 (1.56, 3.18)] compared to the VR phenotype. The dormant phenotype was also significantly associated with HF [1.98 (1.22, 3.21)] compared to the VR phenotype. AKI was a significant effect modifier for the relationship between clusters and HF with an interaction P-value of <0.01. Among those with AKI, the relationship between the VI phenotype and HF was significant [aHR 2.13 (95%CI: 1.36-3.36)].
Conclusion
Vascular biomarkers can be used to derive clusters to risk-stratify patients for future HF events. Vascular panels may be used to tailor post-AKI follow-up to minimize risk of future HF.
Funding
- NIDDK Support