NT-ProBNP reduction percentage during hospital stay predicts long-term mortality and readmission in heart failure patients

Abstract

We prospectively evaluated whether the N-terminal brain natriuretic peptide (NT-ProBNP) reduction percentage, during hospitalization for acutely decompensated heart failure (HF), has a prognostic significance in 6-month follow-up. In 120 patients consecutively admitted for acute HF to an internal medicine unit, plasma NT-ProBNP was measured on admission and at discharge. During a 6-month follow-up 52 (43.3%) patients had events: 9 (7.5%) died from cardiovascular causes, and 43 (35.8%) were readmitted for HF. In patients without events, the mean reduction percentage of NT-ProBNP was greater than in patients with events (39.5 +/- 7.4 versus 26.3 +/- 5.9%; P = 0.04). In receiver operating characteristic curve analysis, the mean area under the curve for NT-ProBNP reduction percentage was 0.63 (95% CI, 0.51-0.75; P = 0.04) for the composite end point (death or readmission), and 0.81 (95% CI, 0.65-0.97, P = 0.01) for cardiovascular mortality. NT-ProBNP reduction percentage less than 30% was the best cut-off for the identification of patients at risk of events. We suggest that in clinical practice the evaluation of change of NT-ProBNP levels during admission is probably more helpful than predischarge NT-ProBNP absolute value.

Utility of natriuretic peptide testing in the evaluation and management of acute decompensated heart failure

“…Risk was substantially lower when NT-proBNP levels fell by more than 30% of the baseline value compared to patients with no significant change or increased NT-proBNP levels. This threshold of NT-proB-NP change was confirmed in the recent study by Verdiani et al [79] who also found that patients discharged with NT-proBNP reductions of \30% from admission levels were at increased risk. In this study, these patients had more than twice the risk of cardiovascular death or rehospitalization due to heart failure exacerbation compared to patients with a reduction of C30%.…”

“…Moreover, the higher levels often observed during hospitalization may not vary as much spontaneously, on a percentage basis, as the lower levels frequently observed in the outpatient clinic. Until evidence from randomized clinical trials is available, a reasonable approach would be to administer treatment in order to achieve a 30% reduction in initial NP concentration or to a target level, in the case of NT-proBNP \1,000 pg/ml, and BNP \250 to 350 pg/ml [74][75][76][77][78][79][80][83][84][85].…”

A novel discharge risk model for patients hospitalised for acute decompensated heart failure incorporating N-terminal pro-B-type natriuretic peptide levels: a European coLlaboration on Acute decompeNsated Heart Failure: ÉLAN-HF Score

“…The second cohort consisted of patients screened for the PRIMA study 24. Furthermore, we identified one more published study at the time we were collecting our data on the basis of the bibliographies of expert advisors 11. All cohorts were registries, and patients were admitted for ADHF, in whom NT-proBNP concentrations had been measured at admission and at discharge.…”

“…For the conduction of the current study, we received the approval of the ethical commission. The principal investigators of seven of the eight studies7–9 11 23 24 agreed to perform a collaborative analysis. The flow diagram for selection of articles is shown in figure 1.…”

“…We excluded 51 patients of the Verdiani et al 11 cohort from our analysis, because no follow-up was available. We also removed duplicate reports of the same patients (n=147) in the Bettencourt et al 8 and Pimenta et al 23 cohorts from the analyses.…”