In-hospital percentage BNP reduction is highly predictive for adverse events in patients admitted for acute heart failure: the Italian RED Study

Abstract

IntroductionOur aim was to evaluate the role of B-type natriuretic peptide (BNP) percentage variations at 24 hours and at discharge compared to its value at admission in order to demonstrate its predictive value for outcomes in patients with acute decompensated heart failure (ADHF).MethodsThis was a multicenter Italian (8 centers) observational study (Italian Research Emergency Department: RED). 287 patients with ADHF were studied through physical exams, lab tests, chest X Ray, electrocardiograms (ECGs) and BNP measurements, performed at admission, at 24 hours, and at discharge. Follow up was performed 180 days after hospital discharge. Logistic regression analysis was used to estimate odds ratios (OR) for the various subgroups created. For all comparisons, a P value < 0.05 was considered statistically significant.ResultsBNP median (interquartile range (IQR)) value at admission was 822 (412 - 1390) pg\mL; at 24 hours was 593 (270 - 1953) and at discharge was 325 (160 - 725). A BNP reduction of >46% at discharge had an area under curve (AUC) of 0.70 (P < 0.001) for predicting future adverse events. There were 78 events through follow up and in 58 of these patients the BNP level at discharge was >300 pg/mL. A BNP reduction of 25.9% after 24 hours had an AUC at ROC curve of 0.64 for predicting adverse events (P < 0.001). The odds ratio of the patients whose BNP level at discharge was <300 pg/mL and whose percentage decrease at discharge was <46% compared to the group whose BNP level at discharge was <300 pg/mL and whose percentage decrease at discharge was >46% was 4.775 (95% confidence interval (CI) 1.76 - 12.83, P < 0.002). The odds ratio of the patients whose BNP level at discharge was >300 pg/mL and whose percentage decrease at discharge was <46% compared to the group whose BNP level at discharge was <300 pg/mL and whose percentage decrease at discharge was >46% was 9.614 (CI 4.51 - 20.47, P < 0.001).ConclusionsA reduction of BNP >46% at hospital discharge compared to the admission levels coupled with a BNP absolute value < 300 pg/mL seems to be a very powerful negative prognostic value for future cardiovascular outcomes in patients hospitalized with ADHF.

Opinion paper on utility of point-of-care biomarkers in the emergency department pathways decision making

“…Data from our group showed that a reduction in BNP > 46% compared to the admission levels, coupled with an absolute BNP value < 300 pg/mL was a very powerful NPV for future cardiovascular outcomes in patients hospitalized with acute decompensated heart failure ( Figure 3) [31]. Furthermore, analysis of a large Medicare database has shown that discharge BNP measurements are the most important characteristic for predicting 1-year mortality (HR 1.34, 95% CI 1.28-1.40) and 1-year death or rehospitalization (HR 1.15, 95% CI 1.12-1.18) among older patients hospitalized with heart failure [32].…”

Prognostic prediction in acute heart failure patients with extreme BNP values

“…It is interesting to note that, despite the association of higher discharge BNP with worse prognosis even in extremes of natriuretic peptide activation at discharge; BNP changes during hospitalisation did not, as expected (Di Somma et al 2010), predict outcome; probably, these discharge BNP extremes -low and high -are already a mirror of response and non-response, respectively.…”

Natriureticus peptidek mérése szívelégtelen betegekben: a helyes laboratóriumi és klinikai gyakorlat

“…Az Italian Research Emergency Department (RED) vizsgálat 287 betegében az elbocsátáskori 300 pg/mL feletti vagy <46%-os csökkenést mutató BNP-szint 9,614-es rizikóhányadossal (95% CI: 4,51-20,47) volt prediktív a 180 napos adverz eseményekre (cardiovascularis mortalitás vagy szívelégtelenség miatti hospitalizá-ció) [35]. Az elbocsátás előtti natriureticuspeptid-szint a natriureticuspeptid-szint változásával együtt nemrég egy halálozást és rehospitalizációt előre jelző rizikó-score része lett [36].…”