N-terminal-pro-brain natriuretic peptide predicts outcome after hospital discharge in heart failure patients
N-terminal-pro-brain natriuretic peptide predicts outcome after hospital discharge in heart failure patients
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DOI：
10.1161/01.cir.0000144310.04433.be
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发表时间：
2004-10-12
期刊：
影响因子：
37.8
通讯作者：
Ferreira, A
中科院分区：
文献类型：
--
作者：
Bettencourt, P;Azevedo, A;Ferreira, A
背景-心力衰竭（HF）是医院护理的巨大负担。我们的目标是评估N-末端脑钠肽前体（NT-proBNP）在预测死亡或出院后再入院的HF patients.Methods和Results-We纳入了182例连续入院，因为失代偿性HF患者的价值。患者随访6个月。主要终点是死亡或再入院。26名患者在医院死亡。入院时NT-proBNP水平中位数为6778.5 pg/mL，出院时中位数为4137.0 pg/mL（P < 0.001）。患者分为3组：（1）NT-proBNP水平降低至少30%（n = 82），（2）NT-proBNP水平无显著变化（n = 49），（3）NT-proBNP水平升高至少30%（n = 25）。42.9%的患者观察到主要终点。在单变量分析中，与死亡和/或再入院风险增加相关的变量为住院时间、心率、容量超负荷体征、未使用ACE抑制剂、出院时NYHA分级升高、入院和出院时NT-proBNP以及NT-proBNP水平变化。NT-proBNP的变化是不良结局的最强预测因子。与再入院或死亡风险增加相关的独立变量是容量超负荷的迹象和NT-proBNP水平的变化。结论NT-proBNP水平的变化与6个月内的再入院和死亡有关。NT-proBNP水平在评估治疗效果方面可能有用，并可能有助于临床医生计划HF患者的出院。以降低NT-proBNP水平为目的的治疗策略是否会改变预后值得进一步研究。
Background-Heart failure (HF) is responsible for a huge burden in hospital care. Our goal was to evaluate the value of N-terminal-pro-brain natriuretic peptide (NT-proBNP) in predicting death or hospital readmission after discharge of HF patients.Methods and Results-We included 182 patients consecutively admitted to hospital because of decompensated HF. Patients were followed up for 6 months. The primary end point was death or readmission. Twenty-six patients died in hospital. The median admission NT-proBNP level was 6778.5 pg/mL, and the median level at discharge was 4137.0 pg/mL (P < 0.001). Patients were classified into 3 groups: (1) decreasing NT-proBNP levels by at least 30% (n = 82), (2) no significant modifications on NT-proBNP levels (n = 49), and (3) increasing NT-proBNP levels by at least 30% (n = 25). The primary end point was observed in 42.9% patients. Variables associated with an increased hazard of death and/or hospital readmission in univariate analysis were length of hospitalization, heart rate, signs of volume overload, no use of ACE inhibitors, higher NYHA class at discharge, admission and discharge NT-proBNP, and the change in NT-proBNP levels. The variation in NT-proBNP was the strongest predictor of an adverse outcome. Independent variables associated with an increased risk of readmission or death were signs of volume overload and the change in NT-proBNP levels.Conclusions-Variations in NT-proBNP levels are related to hospital readmission and death within 6 months. NT-proBNP levels are potentially useful in the evaluation of treatment efficacy and might help clinicians in planning discharge of HF patients. Whether therapeutic strategies aimed to lower NT-proBNP levels modify prognosis warrants future investigation.