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Blood was obtained up to seven times during 1-year follow-up after HF hospitalization. Associations between serial KB measurements and the endpoint of death and HF rehospitalization were investigated by joint modeling. Similar analyses were conducted in the Bio-SHiFT study, including 397 chronic HF patients with up to 10 repeated blood samples during a median follow-up of 2.1\u00a0years. The endpoint in Bio-SHiFT was a composite of cardiovascular death, HF hospitalization, left ventricular device implantation and heart transplantation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>In TRIUMPH, median age was 74\u00a0years, 37% of patients were female and 82% were in NYHA class III\/IV. Estimated KBs were continuously higher in the 185 (40%) patients reaching the combined endpoint. Hazard ratios (HR) (95% confidence interval [CI]) for the endpoint per doubling of total KBs (TKBs), acetone, and \u03b2-hydroxybutyrate were 2.10 (1.27\u20133.71), 1.62 (1.08\u20132.44) and 1.62 (1.22\u20132.23), respectively, at any time during follow-up after adjustment for clinical characteristics and NT-proBNP at baseline. In Bio-SHiFT, median age was 64\u00a0years, 28.5% of patients were female, and 124 (31.2%) patients reached the primary endpoint. KBs were higher in patients reaching the endpoint. The HR per doubling of TKB was 5.36 (95% CI 2.18\u201314.0) and 4.24 (31.4\u20135.95) for acetone.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Serially measured KB levels were associated with adverse events in two independent HF cohorts. Patients with adverse events displayed consistently higher KBs, potentially reflecting ongoing metabolic stress.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00392-026-02992-6","type":"journal-article","created":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T07:31:53Z","timestamp":1788161513000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Continuously elevated plasma ketone bodies are linked to adverse outcomes in patients with heart failure"],"prefix":"10.1007","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-6044-1299","authenticated-orcid":false,"given":"Constantin L.","family":"Palm","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Niels T. 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