Introduction:
Acute heart failure (AHF) is a heterogeneous and etiologically complex syndrome with bad prognosis. sαKlotho (sαKL) is an antiaging protein with pleiotropic actions. The aim of the study was to assess the level and kinetics of sαKl during an episode of AHF and its long-term prognostic utility in population of AHF patients.

Material and methods:
It was a prospective multicenter study, which enrolled 133 participants. 112 consecutive patients were admitted to the intensive cardiac care unit with diagnosis of AHF (age 68[IQR,60-75] years, ejection fraction 30%[IQR,20-38], new-onset AHF 46% of the population). 21 individuals consisted the control group. sαKl, N-terminal pro-B-type natriuretic peptide (NT-proBNP) were determined in serum at admission and at discharge. The main clinical outcomes assessed in the study were 3 year all-cause mortality or HF rehospitalization.

Results:
sαKl concentration significantly increased during episode of AHF. A weak negative correlation was observed between sαKl and NT-proBNP at admission and discharge. Only patients with ischemic etiology of AHF did not have considerably elevated sαKl values at admission. Both, women and men had similar values of biomarker. Smoking did not affect sαKl in our study. Patients who developed the combined endpoint during 3 year follow-up presented poor increase in sαKl values on admission compared to control group (p=0.169) and weak biomarker kinetics during hospitalization as compared with group free of outcomes (p=0.01).

Conclusions:
sαKl level is upregulated during an acute episode of HF and may acts as a useful biomarker. Weak reduction in sαKl levels during treatment indicate patients with poor long-term prognosis.