Abstract
Plasma N-terminal pro-brain natriuretic peptide (NT-proBNP) is an excellent prognostic–predictive tool in heart failure (HF) patients, but its plasma level changes following therapy. The comparison of prognosis–predictivity of a single measurement of plasma NT-pro BNP in different follow-up periods in acute HF patients has been less studied. This study aimed to evaluate whether the association between initial plasma NT-proBNP levels and all-cause mortality would decrease along with an increased follow-up period in patients with acute HF. The retrospective study was carried out, enrolling adult patients with hospitalization-requiring acute HF who fulfilled the predefined criteria from January 1, 2011, to December 31, 2013. We evaluated the independent predictors of 12-month mortality, and subsequently compared the predictivity of NT-proBNP level at initial presentation for 1-, 3-, 6-, 9- and 12-month mortality. In total, 269 patients (mean age, 74.45 ± 13.59 years; female, 53.9%) were enrolled. The independent predictors of 12-month mortality included higher “Charlson Comorbidity Index” (adjusted hazard ratio (aHR) = 1.22; 95% confidence interval (CI), 1.10–1.34), increased “age” (aHR = 1.07; 95% CI, 1.04–1.10), “administration of vasopressor” (aHR = 3.43; 95% CI, 1.76–6.71), “underwent cardiopulmonary resuscitation” (aHR = 4.59; 95% CI, 1.76–6.71), and without “angiotensin-converting enzyme inhibitors/angiotensin receptor blocker” (aHR = 0.41; 95% CI, 1.86–11.31) (all p <0.001). “Plasma NT-pro BNP level ≧11,755 ng/L” was demonstrated as an independent predictor in 1-month (aHR = 2.37; 95% CI, 1.10–5.11; p = 0.028) and 3-month mortality (aHR = 1.98; 95% CI, 1.02–3.86; p = 0.045) but not in more extended follow-up. The outcome predictivity of plasma NT-proBNP levels diminished in a longer follow-up period in hospitalized acute HF patients. In conclusion, these findings remind physicians to act with caution when using a single plasma level of NT-proBNP to predict patient outcomes with a longer follow-up period.
Highlights
Heart failure (HF) is a complex and fatal medical entity with high morbidity and mortality, causing a large burden with respect to health expenditure [1,2]
In total 1276 patients were screened, and 1007 patients were excluded (990 patients due to lack of final diagnosis of HF at discharge, age younger than 18 years, severe chronic pulmonary disease, decompensated hepatic disease with ascites, or renal failure requiring renal replacement therapy, and 17 patients owing to lack of echocardiography examinations)
The non-survivors had a higher proportion of infection (70.8% versus 44.2%), and were more likely to receive mechanical ventilation (29.2% versus 14.2%), noninvasive positive pressure ventilation (NIPPV) (19.4% versus 7.1%), vasopressors (25.0% versus 7.6%), and cardiopulmonary resuscitation (CPR) (12.5% versus 2.0%)
Summary
Heart failure (HF) is a complex and fatal medical entity with high morbidity and mortality, causing a large burden with respect to health expenditure [1,2]. Patients with HF have poor prognoses, with a re-hospitalization rate of >50% and mortality rate of 13–31% within 1 year depending on the severity of HF [1,3,4,5] Natriuretic peptides such as brain natriuretic peptide (BNP) and N-terminal pro-BNP (NT-proBNP) are secreted by the heart in response to hemodynamic change as well as neuro-hormone and immune systems disturbances [6], which play a key role in the regulation of cardiovascular and renal function [7]. The pre-discharge NT-proBNP level could independently predict one-year mortality [17]
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