Serum malondialdehyde predicts mortality in patients with acute heart failure

Acute heart failure (AHF) is associated with high short- and long-term mortality, and early identification of patients at highest risk remains challenging despite the use of established biomarkers and clinical risk scores. Oxidative stress plays a central role in the pathophysiology of AHF but has been insufficiently investigated as a prognostic target. This study aimed to evaluate the prognostic value of serum oxidative stress biomarkers for predicting short- and long-term mortality in AHF patients and to determine whether they improve risk stratification beyond established tools. Admission serum levels of malondialdehyde (MDA), advanced oxidation protein products (AOPPs), catalase, and superoxide dismutase (SOD) were measured in a cohort of 315 hospitalized AHF patients. Univariable and multivariable logistic regression analyses were performed to assess associations with in-hospital, 6-month, and 12-month mortality. Prognostic performance was compared with N-terminal pro-brain natriuretic peptide (NT-proBNP) and established risk scores (ADHERE, GWTG-HF, OPTIMIZE-HF) using receiver operating characteristics curves, the continuous net reclassification index (cNRI) and decision curve analysis. Serum MDA, catalase, and SOD were significantly elevated in non-survivors at all time points. In the adjusted analyses, MDA was the only oxidative stress marker independently associated with mortality. MDA showed robust prognostic performance, with improvements in AUC and cNRI as well as increased net benefit, when added to NT-proBNP or clinical scores. Survival analysis confirmed lower survival in patients with MDA ≥1.45 nmol/L (the median in our cohort). Other biomarkers (AOPPs, catalase, SOD) showed limited prognostic utility. Serum MDA is a robust, independent predictor of mortality in AHF. Incorporating MDA into routine assessment may enhance early identification of high-risk patients and support personalized management strategies in AHF. • We evaluated the prognostic value of MDA, AOPPs, catalase, and SOD in patients with AHF. • Only MDA independently predicted short- and long-term mortality in AHF. • Adding MDA to NT-proBNP and clinical risk scores improved discrimination for mortality. • High MDA levels were linked to poor survival in patients with AHF.