Vascular Biomarkers Stratify Heart Failure Risk Post-Hospitalization in AKI Patients

Article Impact Level: HIGH
Data Quality: STRONG
Summary of BMC Nephrology. https://doi.org/10.1186/s12882-025-04169- 
Dr. Audrey A. Shi  et al.

Points

Patients experiencing acute kidney injury have a higher incidence of heart failure, prompting the need for improved risk stratification methods.
This research hypothesized that a panel of nine specific vascular biomarkers could effectively predict future heart failure events following hospitalization.
The study identified three distinct biomarker-derived phenotypes in 1,497 hospitalized patients, categorizing them as vascular injury, repair, or dormant.
The vascular injury phenotype was significantly associated with a two-fold increased risk of future heart failure events across the entire cohort.
Integrating these vascular biomarkers with routine clinical variables substantially enhanced the prediction and reclassification of heart failure events.

Summary

This research investigated the utility of nine vascular biomarkers in predicting future heart failure (HF) events in hospitalized patients, with a specific focus on those with acute kidney injury (AKI). The study utilized the ASSESS-AKI cohort, comprising 1,497 patients, half of whom had experienced AKI. Plasma biomarker levels, including Angiopoietin (angpt)-1, angpt-2, various Vascular Endothelial Growth Factors (VEGF-A, VEGF-C, VEGF-D), VEGF receptor 1 (R1), solubleTie-2 (sTie-2), placental growth factor (PlGF), and basic fibroblast growth factor (bFGF), were measured at 3 months post-hospitalization. An unsupervised spectral cluster analysis was employed to group patients based on these biomarker profiles.

The analysis identified three distinct biomarker-derived clusters: Cluster 1, labeled the “Vascular Injury (Injury) Phenotype” (n = 302), exhibited elevated levels of injury markers. Cluster 2, the “Vascular Repair (Repair) Phenotype” (n = 728), showed higher levels of repair markers. Cluster 3 (n = 467), designated the “Dormant Phenotype,” presented with lower levels across all measured markers. Cox regression analysis, adjusted for a comprehensive set of confounding variables, evaluated the association between these clusters and HF events.

Across the entire cohort, patients classified with the Injury Phenotype demonstrated a twofold higher risk of a HF event compared to the Repair Phenotype, with an adjusted Hazard Ratio (aHR) of 2.24 (95% CI: 1.57–3.19). This elevated risk was consistently observed in both participants with AKI [aHR 2.12 (95% CI: 1.35–3.34)] and those without AKI [aHR 2.94 (95% CI: 1.57–5.50)]. The Dormant Phenotype was associated with an increased risk of HF events only in the subgroup of patients without AKI. The area under the curve (AUC) for predicting HF event or death at 3 years was 0.76 (95% CI: 0.73–0.80) for the biomarkers alone, 0.77 (95% CI: 0.73–0.80) for a clinical model, and significantly improved to 0.80 (95% CI: 0.77–0.83) when the biomarkers were added to the clinical model. The addition of biomarkers also substantially improved the net reclassification index for HF event or death.

Link to the article: https://medicalxpress.com/news/2025-09-heart-failure-patients-acute-kidney.html

References

Shi, A. A., Andrawis, A. S., Biswas, A., Wilson, F. P., Obeid, W., Philbrook, H. T., Go, A. S., Ikizler, T. A., Siew, E. D., Chinchilli, V. M., Hsu, C.-Y., Garg, A. X., Reeves, W. B., Prince, D. K., Bhatraju, P., Coca, S. G., Liu, K. D., Kimmel, P. L., Kaufman, J. S., … for the ASSESS-AKI Consortium*. (2025). Using vascular biomarkers to assess heart failure event risk in hospitalized patients with and without AKI. BMC Nephrology, 26(1), 271. https://doi.org/10.1186/s12882-025-04169-