Jónsdóttir B, et al. - Researchers assessed the protein ST2, a verified biomarker for cardiac stress, as well as its role as a predictor of death in patients with Acute Hypercapnic Respiratory Failure (AHRF) treated with Noninvasive Positive Pressure Ventilation (NPPV), to ultimately aid the selection of treatment in patients with AHRF. Whether the treatment outcome could be predicted by ST2 baseline levels and alterations during the first 12 hrs of treatment, was also determined. Participants were 46 patients treated with NPPV for AHRF. During the follow-up period, ST2 was identified as an independent predictor of both short-term and long-term mortality. Per 1-SD increase of ST2, a Hazard Ratio of 11.00 for 28-day mortality and 2.11 for 18-month mortality was estimated. The largest subgroup of patients, with Acute Exacerbation of COPD, and deaths within the first 28 days appeared to be the drivers of the outcomes. The treatment outcome was not predicted by alterations in ST2 values during the first 12 hrs of treatment. Findings support further exploration of ST2 as a predictor of short-term death in patients with AHRF managed with NPPV.