Li XZ, Zhang KZ, Yan JJ, et al. - Researchers evaluated the prognostic value of serum retinol-binding protein 4 (RBP4), an adipokine with adverse effects on the cardiovascular system, in elderly patients with chronic heart failure (CHF). In this prospective cohort study, 934 consecutive elderly patients (aged 60 years and older) with CHF and 138 age-matched and gender-matched control individuals were included. CHF patients vs controls exhibited elevated serum RBP4 levels. N terminal pro brain natriuretic peptide (NT-proBNP) levels were higher but left ventricular eject fraction (LVEF) and estimated glomerular filtration rate were lower among patients with the highest RBP4 concentrations. Increase in serum RBP4 levels was observed when there was an increase in the New York Heart Association functional class and decrease in LVEF; these levels were negatively associated with LVEF but positively correlated with NT-proBNP levels. As per multivariate Cox regression analysis, there is an independent predictive value of log RBP4 for major adverse cardiac event(s), together with age, male, LVEF, log NT-proBNP, and estimated glomerular filtration rate. Furthermore, there was an independent predictive value of log RBP4 for cardiovascular mortality and CHF rehospitalization even after adjustment for the established adverse prognostic factors for CHF. This study, for the first time, establishes the correlation of elevated serum RBP4 with worse outcomes in elderly patients with CHF.