Predicting Variables of Mortality among Patients with NT-proBNP > 70,000 Pg/Ml

Abstract

Introduction: Elevated NT-pro-BNP levels have been identified as independent predictors of mortality in patients with heart failure, end stage renal disease, as well as the general population. No study to date has evaluated the significance of NT-proBNP > 70,000 pg/ml and mortality. In addition, predicting variables of mortality among this patient population have not been identified. Purpose To determine the mortality rate among patients with NT-proBNP > 70,000 pg/ml and identify mortality predicting variables in this population. Methods We collected retrospective data from 141 patients from January 1, 2012 through January 30, 2016. Predicting mortality variables including ejection fraction, E/e', age, gender, race and BMI were collected to determine their influence in mortality. Living status was determined via chart review or through the social security death index. Our primary endpoint was death from any cause, with secondary endpoints including the association between mortality and predicting variables as above. We defined systolic left ventricular failure as EF < 40%, while diastolic left ventricular failure >40% and E/e' > 12. Further statistical analysis was performed among patients with EF <35% and <25%. The vast majority of our patients had end-stage renal disease. Results All-cause mortality was 45.39%, with a mean survival time of 204.1 days. There was a statistically significant difference in mortality (P = .0089) and survival (P = .0043) among patients with an ejection fraction <25% (Fig. 1). The best-fit logistic regression model predicting mortality contained only age (P = .0203; OR: 1.0301, 95% CI = 1.005, 1.057) and ejection fraction <25% (P-.0306). The odds of death were 2.5 times higher for patients with an ejection fraction <25%. Conclusion Our study demonstrates that among patients with symptomatic heart failure and NT-proBNP > 70,000 pg/ml, mortality rate is nearly 50% over four years. Furthermore, it re-emphasizes the important role of left ventricular systolic function in predicting mortality in this patient population.