Impact of brain natriuretic peptide reduction on the worsening renal function in patients with acute heart failure

Yamagata, Kenji; Matsue, Yuya; Okumura, Takahiro; Kida, Kenji; Oishi, Shogo; Akiyama, Eiichi; Suzuki, Satoshi; Yamamoto, Masayoshi; Mizukami, Akira; Kuroda, Shunsuke; Kagiyama, Nobuyuki; Yamaguchi, Tetsuo; Sasano, Tetsuo; Matsumura, Akihiko; Kitai, Takeshi

doi:10.1371/journal.pone.0235493

Cited by 5 publications

(8 citation statements)

References 34 publications

(45 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Previous studies found that WRF with higher BNP levels at discharge had a worse prognosis ( 32 , 33 ). This study further found that regardless of the degree of WRF, 1-year mortality was higher in patients with higher BNP levels at discharge.…”

Section: Discussionmentioning

confidence: 89%

Impact of the degree of worsening renal function and B-type natriuretic peptide on the prognosis of patients with acute heart failure

Zhao

Wang

et al. 2023

Front. Cardiovasc. Med.

View full text Add to dashboard Cite

BackgroundThe impact of the degree of worsening renal function (WRF) and B-type natriuretic peptide (BNP) on the prognosis of patients with acute heart failure (AHF) is still debatable. The present study investigated the influence of different degrees of WRF and BNP levels at discharge on 1-year all-cause mortality in AHF.MethodsHospitalized AHF patients diagnosed with acute new-onset/worsening of chronic heart failure (HF) between January 2015 and December 2019 were included in this study. Patients were assigned into high and low BNP groups based on the median BNP level at discharge (464 pg/ml). According to serum creatinine (Scr) levels, WRF was divided into non-severe WRF (nsWRF) (Scr increased ≥0.3 mg/dl and <0.5 mg/dl) and severe WRF (sWRF) (Scr increased ≥0.5 mg/dl); non-WRF (nWRF) was defined as Scr increased of <0.3 mg/dl). Multivariable cox regression was used to evaluate the association of low BNP value and different degrees of WRF with a all-cause death, as well as testing for an interaction between the two.ResultsAmong 440 patients in the high BNP group, there was a significant difference in WRF on mortality (nWRF vs. nsWRF vs. sWRF: 22% vs. 23.8% vs. 58.8%, P < 0.001). Yet, mortality did not significantly differ across the WRF subgroups in the low BNP group (nWRF vs. nsWRF vs. sWRF: 9.1% vs. 6.1% vs. 15.2%, P = 0.489). In multivariate Cox regression analysis, low BNP group at discharge (HR, 0.265; 95%CI, 0.162–0.434; P < 0.001) and sWRF (HR, 2.838; 95%CI, 1.756–4.589; P < 0.001) were independent predictors of 1-year mortality in AHF.There was a significant interaction between low BNP group and sWRF(HR, 0.225; 95%CI, 0.055–0.918; P < 0.05).ConclusionsnsWRF does not increase the 1-year mortality in AHF patients, whereas sWRF does. A low BNP value at discharge is associated with better long-term outcomes and mitigates the adverse effects of sWRF on prognosis.

show abstract

Section: Discussionmentioning

confidence: 89%

Impact of the degree of worsening renal function and B-type natriuretic peptide on the prognosis of patients with acute heart failure

Zhao

Wang

et al. 2023

Front. Cardiovasc. Med.

View full text Add to dashboard Cite

show abstract

“…[29] The implications of WRF during the early phase of AHF can be better understood by evaluating the decongestion process (measured as the percentage drop in BNP concentration). [30] A percentage decrease of ≥30% in BNP levels when compared to admission values was shown to be associated with favorable outcomes, both during the hospital stay and at 1 year follow-up. [31,32] A combination of BNP ≥ 250 pg/mL, occurrence of in-hospital WRF, and history of hospital admission for heart failure predicted composite outcomes (short-term and long-term cardiovascular mortality).…”

Section: Discussionmentioning

confidence: 99%

Brain natriuretic peptide in acute heart failure and its association with glomerular filtration rate: A systematic review and meta-analysis

Mughal,

Majeed,

Aftab

et al. 2024

Medicine

View full text Add to dashboard Cite

Background: Acute heart failure (AHF) is one of the most common cardiovascular diseases. Early diagnosis and prognosis are essential, as they can eventually lead to a fatal condition. Recently, brain natriuretic peptide (BNP) has been recognized as one of the most popular biomarkers for AHF. Changes in glomerular filtration rate (GFR) are often observed in AHF. Methods: We searched PubMed, Google Scholar, and ScienceDirect between March and June 2023. Original case control studies written in English that assessed levels oh BNP in AHF were included. Systematic reviews, letters to editor, correspondence, comprehensive reviews, and duplicated studies were excluded. Funnel plots were constructed to assess publication bias. Results: A total of 9 studies were selected and we obtained the mean difference (MD) of BNP level to be 2.57 (95% CI: 1.35, 3.78), and GFR to be −15.52, (95% CI: −23.35, −7.70) in AHF patients. Sensitivity analyses supported the robustness of the outcome. Conclusion: Results indicated that BNP was a promising prognostic biomarker of AHF, whereas GFR was found to be negatively correlated with AHF.

show abstract

“…Multivariate Cox regression models were reconstructed to evaluate the prognostic value of FIB‐4 to predict mortality when compared with other variables only in the WRF group. We adjusted the model for BUN, eGFR, and change in per cent BNP, which have been reported as useful markers to identify prognostically relevant WRF (Model 1) 8,19 . Model 2 was adjusted by adding the variables used in Model 1 to those used in the multivariate analysis of the primary endpoint.…”

Section: Methodsmentioning

confidence: 99%

“…We calculated Pearson's correlation coefficient to evaluate the relationship between the log‐transformed FIB‐4 score at discharge and the following indicators of congestion: log‐transformed BNP at discharge; estimated plasma volume status (ePVS) at discharge calculated using the Strauss formula 18 ; changes in total protein, serum albumin, haemoglobin, haematocrit, 10 and ePVS; and log‐transformed change in per cent BNP from admission to discharge. 19 Multivariate Cox regression models were reconstructed to evaluate the prognostic value of FIB‐4 to predict mortality when compared with other variables only in the WRF group. We adjusted the model for BUN, eGFR, and change in per cent BNP, which have been reported as useful markers to identify prognostically relevant WRF (Model 1).…”

Section: Methodsmentioning

confidence: 99%

“…We adjusted the model for BUN, eGFR, and change in per cent BNP, which have been reported as useful markers to identify prognostically relevant WRF (Model 1). 8 , 19 Model 2 was adjusted by adding the variables used in Model 1 to those used in the multivariate analysis of the primary endpoint. All statistical analyses were performed using JMP® 15.1.0 (SAS Institute, Cary, NC, USA).…”

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

Fibrosis‐4 index identifies worsening renal function associated with adverse outcomes in acute heart failure

et al. 2023

View full text Add to dashboard Cite

Aims Worsening renal function (WRF) often develops during heart failure (HF) treatment. However, prognostic implications of WRF in acute HF remain controversial, and risk stratification of WRF is challenging. Although the fibrosis-4 index (FIB-4) was initially established as a liver fibrosis marker, recent studies show that high FIB-4 is associated with venous congestion and poor prognosis in acute HF. This study aimed to evaluate whether FIB-4 could identify prognostically relevant and non-relevant WRF in patients with acute HF. Methods and resultsWe retrospectively analysed data from a single-centre registry on acute HF at our university hospital between January 2015 and June 2021. This study included patients with acute HF aged ≥20 years who were immediately hospitalized and had brain natriuretic peptide levels ≥100 pg/mL at admission. WRF was defined as increases of ≥0.3 mg/dL and >25% in serum creatinine level from admission to discharge. FIB-4 scores were calculated before discharge. The primary endpoint was all-cause mortality within 1 year of discharge. Based on the presence of WRF and whether FIB-4 scores were above the median, patients were stratified into four groups: no WRF and lower FIB-4 scores, no WRF and higher FIB-4 scores, WRF and lower FIB-4 scores, and WRF and higher FIB-4 scores. The patients were followed up via clinical visits or telephone interviews. Clinical outcomes were collected from the electronic medical records. Results Of the 969 patients hospitalized for acute HF (76 ± 11 years, 59% men), 118 patients (12%) had WRF at discharge. The median (interquartile range) FIB-4 score at discharge was 2.36 (1.55-3.25). The primary endpoint occurred in 136 patients (14.0%). The 1 year mortality rates were 10.5% in the no WRF and lower FIB-4 scores (≤2.36) group (n = 428), 16.1% in the no WRF and higher FIB-4 scores (>2.36) group (n = 423), 12.5% in the WRF and lower FIB-4 scores group (n = 56), and 25.8% in the WRF and higher FIB-4 scores group (n = 62) (P = 0.005). Kaplan-Meier analysis demonstrated higher all-cause mortality in the WRF and higher FIB-4 group (log-rank P = 0.003). In the Cox regression analysis, only the WRF and higher FIB-4 scores group was associated with an increased risk of mortality compared with the no WRF and lower FIB-4 scores group (hazard ratio = 2.11, 95% confidence interval: 1.07-4.18, P = 0.032), despite adjusting for other confounding factors. Conclusions FIB-4 is a valuable risk stratification marker for WRF in patients with acute HF. The underlying mechanism and potential clinical importance of these observations require further investigation.

show abstract

Impact of brain natriuretic peptide reduction on the worsening renal function in patients with acute heart failure

Cited by 5 publications

References 34 publications

Impact of the degree of worsening renal function and B-type natriuretic peptide on the prognosis of patients with acute heart failure

Impact of the degree of worsening renal function and B-type natriuretic peptide on the prognosis of patients with acute heart failure

Brain natriuretic peptide in acute heart failure and its association with glomerular filtration rate: A systematic review and meta-analysis

Fibrosis‐4 index identifies worsening renal function associated with adverse outcomes in acute heart failure

Contact Info

Product

Resources

About