PENK and hydrops fetalis: Multivariable Cox regression models showed PENK independently predicted 2 year death/HF [hazard ratio (for 1 SD increment of log-transformed biomarker) HR 1.45 [95% CI 1.12–1.88, p = 0.005]], even after adjustment for troponin (HR 1.59 [1.14–2.20, p = 0.006]), and Body Mass Index (HR 1.63 [1.13–2.33, p = 0.009]).