Prognostic Utility of Soluble Suppression of Tumorigenicity 2 level as a Predictor of Clinical Outcomes in Incident Hemodialysis Patients

Background: The suppression of tumorigenicity 2 (ST2) is associated with cardiac remodeling and tissue fibrosis. It is well known as a novel biomarker on predictor of cardiovascular events in patients with heart failure. In patients needed to start dialysis treatment, most of them had congestive heart failure. However, the prognostic implications of serum ST2 level are unknown in incident hemodialysis patients. Methods: A total 182 patients undergoing incident hemodialysis were consecutively enrolled from November 2011 to December 2014. These patients were classified into two groups according to their median ST2 levels. The two groups were subsequently compared with respect to their major adverse cerebro-cardiovascular events (MACCE) including all-cause mortality, heart failure admission, acute coronary syndrome, and nonfatal stroke. Results: The median duration of follow up was 628 days (interquartile range 382 to 1,052 days). ST2 was significant correlated with variable echocardiographic parameters. The parameters of diastolic function, deceleration time of the early filing velocity and maximal tricuspid regurgitation velocity were independently associated with the ST2 levels. High ST2 group had significantly higher incidence of all-cause mortality, and MACCE. High ST2 was a significant independent predictor of MACCE (adjusted hazard ratio 2.33, 95% confidence interval 1.12 to 4.87, p=0.024). Conclusion: The ST2 is associated with diastolic function and may be a predictor of clinical outcomes in incident hemodialysis patients.