Abstract: Objective To evaluate the application of serum soluble suppression of tumorigenicity-2 (sST2), glomerular filtration rate (GFR), and serum iron (SI) combined test for predicting prognosis of acute decompensated heart failure (ADHF) patients. Methods A total of 575 ADHF patients were included in this study. Serum sST2, GFR, SI levels and other biomarkers were measured and followed up. Patients were divided into poor prognosis and good prognosis groups based on the occurrence of major adverse cardiovascular events (MACEs). Kaplan-Meier survival analysis and Cox regression analysis were used to evaluate the prognostic value of these indicators, and receiver operating characteristic (ROC) curves were employed to compare the prediction outcome of single and combined indicators. Results In the poor prognosis group, heart rate, systolic blood pressure, diastolic blood pressure and fasting blood glucose level were all significantly higher than in those in the control group (P＜0.05). Additionally, the poor prognosis group had higher level of sST2 and total iron-binding capacity, while GFR, SI and transferring saturation were lower as compared to control group(P＜0.05). Cox multivariate survival analysis showed that sST2, GFR, and SI were independent predictors of poor prognosis in ADHF patients (P＜0.05). Kaplan-Meier survival analysis revealed that higher level of sST2 was associated with poor survival prognosis. ROC curve analysis showed that when the biomarkers like sST2, GFR and SI were used together, the area under the curve (AUC) increased to 0.834, with a sensitivity of 80.2% and a specificity of 75.6%. Conclusions Combination test of serum sST2, GFR and SI significantly supports the predictive function for ADHF patients'prognosis. The highest AUC value from the combined biomarker prediction may contribute to a more accurate assessment of patient risk. This combined test of indicators provides a more reliable tool for clinicians in terms of early identification of high-risk patients, guiding treatment decisions and improving the prognosis management of patients.

Key words: acute decompensate heart failure, soluble suppression of tumorigenicity-2, glomerular filtration rate, serum iron, prognostic prediction