Serial monitoring of soluble interleukin family member ST2 in patients with acutely decompensated heart failure.

OBJECTIVES: To determine whether serial measures of the interleukin receptor family member soluble ST2 (sST2) provide additional prognostic information to baseline measures for long-term risk stratification of acutely decompensated heart failure (ADHF) patients. METHODS: We prospectively enrolled 72 ADHF patients. Blood samples were collected to measure sST2 concentrations at presentation and on day 4 of hospitalization. All patients were clinically followed, and vital status was registered. RESULTS: Between presentation and day 4, sST2 concentrations decreased from 62 ng/ml (interquartile range 38-105) to 44 ng/ml (interquartile range 26-72; p < 0.001). Both sST2 concentrations at presentation [hazard ratio (HR) 1.011, 95% confidence interval (CI) 1.005-1.016; p < 0.001] and on day 4 (HR 1.015, 95% CI 1.005-1.024; p = 0.003) were independent predictors of mortality. Patients with sST2 ≤ 76 ng/ml at presentation and ≤ 46 ng/ml on day 4 had the lowest mortality rates (3%), whereas those with both sST2 values above these cutoff points had the highest mortality (50%). C index and reclassification analyses demonstrated that the use of serial sST2 measures resulted in an improvement in the accuracy of mortality prediction. CONCLUSIONS: Among ADHF patients, sST2 concentrations tend to decrease following initiation of treatment and are prognostic both at presentation and during hospitalization. Serial sampling of sST2 adds prognostic information and may provide a basis for enhanced clinical decision making.

Effects of an integrated control programme with ivermectin on growth, carcase composition and nematode infection of beef cattle in Argentina's western pampas.

The effect of previous pasture management and ivermectin treatment on gastrointestinal parasitism, weight gain and carcase composition of steers was studied in the semiarid Pampeana region of Argentina from April 1986 to April 1987. Three groups, each of 15 weaned calves, were grazed on separate lucerne pastures. Group 1 control calves, which grazed paddocks previously grazed by nematode-infected weaners and yearlings with a high nematode egg output, were only medicated when heavy parasitism was recorded. Group 2 calves, which grazed paddocks previously infected by steers at least two and a half years old with low nematode egg output, were treated strategically with ivermectin. Group 3 calves, which grazed on 'clean' paddocks, were treated monthly with ivermectin. Group 1 calves showed heavy parasitism and parasitological parameters were higher than in groups 2 and 3. The liveweight gain responses of groups 2 and 3 were significantly greater than those of group 1 (P less than 0.001) during autumn, winter and early spring. At the end of the study when cattle reached market condition, the liveweight gains of groups 2 and 3 were 74.1 and 81.9 kg, respectively, greater than group 1. Carcase analyses showed significantly greater weight and killing-out percentages in groups 2 and 3 than in group 1. Reduced total bone, muscle and fat weights were observed in group 1.