The impact of worsening renal function with elevated B-type natriuretic peptide at discharge on 1-year prognosis in heart failure patients

Toshitaka Okabe,Yuji Oyama,Masahiko Ochiai,Kennosuke Yamashita,Takehiko Kido,Tadayuki Yakushiji,Kisaki Amemiya,Wataru Igawa,Taro Kimura,Yu Asukai,Jumpei Saito,Naoei Isomura,Morio Ono,Myong Hwa Yamamoto,Seitaro Ebara,Suguru Shimazu

doi:10.1038/s41598-020-61404-5

Toshitaka Okabe, Yuji Oyama + Show 14 more

Open Access

https://doi.org/10.1038/s41598-020-61404-5

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Journal: Scientific Reports	Publication Date: Mar 10, 2020
Citations: 4	License type: open-access

Affiliation: Showa University Northern Yokohama Hospital

Abstract

There are a few studies about the clinical impacts of plasma B-type natriuretic peptide (BNP) at discharge with the occurrence of worsening renal function (WRF) on mortality in patients with heart failure (HF). We divided total 301 patients with acute decompensated HF into four groups by the median value (278.7 pg/mL) of BNP level at discharge and by the occurrence of WRF. WRF developed in 100 patients (33.2%). Cardiovascular mortality was significantly different between the four groups (P = 0.0002). Patients with WRF and elevated BNP had a higher cardiovascular mortality than patients without WRF and elevated BNP in Cox proportional hazard models (hazard ratio [HR], 10.48; 95% confident interval [95% CI], 1.27–225.53; P = 0.03). Patients with either WRF or elevated BNP did not have an increased risk of cardiovascular mortality compared to patients without WRF and elevated BNP. Regarding HF readmission and cardiovascular mortality, patients with WRF and elevated BNP had the highest risk (HR, 5.17; 95% CI, 2.07–14.30, P = 0.0003) and patients with either WRF or elevated BNP had a higher risk than patients without WRF and elevated BNP. The occurrence of WRF combined with elevated BNP at discharge was associated with increased 1-year cardiovascular mortality and HF readmission.

Highlights

There are a few studies about the clinical impacts of plasma B-type natriuretic peptide (BNP) at discharge with the occurrence of worsening renal function (WRF) on mortality in patients with heart failure (HF)
We used plasma BNP level at discharge as an indicator of residual congestion in patients with HF because plasma BNP level has a good correlation with high left ventricular end-diastolic pressure that reflects on the hemodynamic congestion, and can be measured compared to invasive procedures such as right heart catheter[9]
Several reports have demonstrated that the combination of WRF and persistence of clinical congestion was associated with death and HF readmission[8,12,13]

Summary

Introduction

There are a few studies about the clinical impacts of plasma B-type natriuretic peptide (BNP) at discharge with the occurrence of worsening renal function (WRF) on mortality in patients with heart failure (HF). Patients with either WRF or elevated BNP did not have an increased risk of cardiovascular mortality compared to patients without WRF and elevated BNP. The occurrence of WRF combined with elevated BNP at discharge was associated with increased 1-year cardiovascular mortality and HF readmission. We used plasma BNP level at discharge as an indicator of residual congestion in patients with HF because plasma BNP level has a good correlation with high left ventricular end-diastolic pressure that reflects on the hemodynamic congestion, and can be measured compared to invasive procedures such as right heart catheter[9]. Our purpose was to evaluate the association between plasma BNP level at discharge or WRF during hospitalization for HF, and cardiovascular mortality in patients with HF

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Results

Conclusion