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Cardiovasc. Med."],"abstract":"<jats:p>Background:Patients with heart failure (HF) are at high risk of mortality and readmission during the 90-day \u201cvulnerable phase\u201d post-discharge, often because of persistent congestion. However, tools effective for assessing risk are lacking. Thus, this study aimed to develop a steroid-based congestion score from the plasma steroid profile and determine the associated prognostic value during the vulnerable phase in patients with acute HF.Methods:Plasma levels of 18 steroids were measured by liquid chromatography\u2013tandem mass spectrometry in patients from the Registry Study of Biomarkers in Heart Failure. Patients were divided into a discovery cohort for biomarker screening and model development (n = 691), a cohort for validation of prognostic value (validation cohort 1, n = 267), and a cohort with paired discharge and 90-day plasma samples available for assessment of dynamic changes in biomarkers (validation cohort 2, n = 46). Steroids independently associated with the clinical congestion score (CCS) were identified by correlation analysis and multivariable logistic regression and were used to construct the \u201csteroid-based\u201d congestion score (SCS). The 90-day prognostic value of the SCS was assessed using Cox regression, and the incremental predictive ability of the SCS was quantified using integrated discrimination improvement.Results:The SCS included cortisol, dehydroepiandrosterone sulfate, and pregnenolone. In the discovery cohort, an SCS \u2265\u20130.563 was associated with a 2.02-fold increase in the risk of the 90-day composite endpoint of all-cause death and HF readmission (95% confidence interval, 1.42\u20132.88). Adding the SCS to clinical, B-type natriuretic peptide, and clinical congestion score model increased the integrated discrimination improvement by 1.2%, 0.8%, and 1.0%, respectively (all p &lt; 0.05). The prognostic value of the SCS for 90-day and long-term outcomes was confirmed in validation cohort 1. In validation cohort 2, a higher baseline SCS was associated with higher 90-day congestion rates, and SCS dynamics paralleled congestion progression.Conclusions:The SCS independently predicts adverse outcomes during the vulnerable phase in patients with HF, offering incremental prognostic value beyond traditional indicators and potentially supporting dynamic monitoring for individualized management.<\/jats:p>","DOI":"10.31083\/rcm53378","type":"journal-article","created":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T10:31:43Z","timestamp":1785407503000},"source":"Crossref","is-referenced-by-count":0,"title":["Plasma Steroids as Biomarkers of Congestion and Predictors of Prognosis in Acute Heart Failure During the Vulnerable Phase"],"prefix":"10.31083","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-0881-8434","authenticated-orcid":true,"given":"Yangkai","family":"Fan","sequence":"first","affiliation":[{"name":"Beijing Collaborative Innovation Centre for Cardiovascular Disorders, The Key Laboratory of Remodeling-Related Cardiovascular Disease, Ministry of Education, Beijing Anzhen Hospital, Capital Medical University, 100029 Beijing, China"},{"name":"Beijing Institute of Heart, Lung, and Blood Vessel Diseases, 100029 Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2086-4899","authenticated-orcid":true,"given":"Jing","family":"Cui","sequence":"additional","affiliation":[{"name":"Beijing Collaborative Innovation Centre for Cardiovascular Disorders, The Key Laboratory of Remodeling-Related Cardiovascular Disease, Ministry of Education, Beijing Anzhen Hospital, Capital Medical University, 100029 Beijing, China"},{"name":"Beijing Institute of Heart, Lung, and Blood Vessel Diseases, 100029 Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7614-9790","authenticated-orcid":true,"given":"Lu","family":"Ren","sequence":"additional","affiliation":[{"name":"Beijing Collaborative Innovation Centre for Cardiovascular Disorders, The Key Laboratory of Remodeling-Related Cardiovascular Disease, Ministry of Education, Beijing Anzhen Hospital, Capital Medical University, 100029 Beijing, China"},{"name":"Beijing Institute of Heart, Lung, and Blood Vessel Diseases, 100029 Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0737-0525","authenticated-orcid":true,"given":"Xin","family":"Tan","sequence":"additional","affiliation":[{"name":"Beijing Collaborative Innovation Centre for Cardiovascular Disorders, The Key Laboratory of Remodeling-Related Cardiovascular Disease, Ministry of Education, Beijing Anzhen Hospital, Capital Medical University, 100029 Beijing, China"},{"name":"Beijing Institute of Heart, Lung, and Blood Vessel Diseases, 100029 Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-0582-0712","authenticated-orcid":true,"given":"Weiyao","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Nutrition, The First Affiliated Hospital of Sun Yat-sen University, 510080 Guangzhou, Guangdong, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9189-3630","authenticated-orcid":true,"given":"Yuan","family":"Wang","sequence":"additional","affiliation":[{"name":"Beijing Collaborative Innovation Centre for Cardiovascular Disorders, The Key Laboratory of Remodeling-Related Cardiovascular Disease, Ministry of Education, Beijing Anzhen Hospital, Capital Medical University, 100029 Beijing, China"},{"name":"Beijing Institute of Heart, Lung, and Blood Vessel Diseases, 100029 Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"16242","published-online":{"date-parts":[[2026,7,21]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","unstructured":"Virani SS, Alonso A, Aparicio HJ, Benjamin EJ, Bittencourt MS, Callaway CW, et al. 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