Abstract 9421: The Role of B-type Natriuretic Peptide as a Prognostic Factor for Endocarditis at the Emergency Room

Abstract

Background: Some prognostic factors for infective endocarditis (IE) are well established, but the role of B-type natriuretic peptide (BNP) at admission has not been well studied. Objective: The purpose of this study was to access the admission BNP value as a prognostic factor in patients with IE. Methods: Between July 2009 and January 2011, consecutive patients with IE admitted to the emergency room were prospectively enrolled. Patients were included if they met possible or definite Duke’s criteria for IE. The association between elevated BNP and in-hospital death was determined. Results: From 104 patients analyzed, 67 were male (48%), the mean age was 52.6±19.1 years. During follow-up, 32 (30.8%) patients died. In univariate analysis, staphylococcal infection (P<0.001, HR 3.94; CI, 1.94-8.0), dyspnea at presentation (P=0.015, HR 2.41; CI, 1.20-4.86), sepsis at presentation (P=0.017, HR 2.34; CI, 1.16-4.72), left ventricular ejection fraction ≤ 55% (P<0.001, HR 3.97; CI, 1.86-8.43), C-reactive protein (CRP) > 120 mg/L, (P<0.001, HR 4.04; CI, 1.91-8.55), creatinine > 1 mg/dL (P=0.006, HR 2.92; CI, 1.26-6.76), and BNP > 200 pg/mL (P<0.001, HR 12.51; CI, 2.98-52.48) were associated with in-hospital mortality. In multivariate analysis, BNP values > 200 pg/ml (P<0.001, HR 2.41; CI, 1.20-4.86), staphylococcal infection (P=0.006, HR 2.89; CI, 1.39-6.02), dyspnea at presentation (P=0.003, HR 3.17; CI, 1.49-6.76), and CRP > 120 mg/L, (P<0.001, HR 3.86; CI, 1.76-8.46) were independent predictors of in-hospital mortality. Conclusion: As important as the classic prognostic factors, elevated BNP levels on admission were related to fatal outcomes in IE patients.