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: ELAN-HF Score
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: ELAN-HF Score
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DOI：
10.1136/heartjnl-2013-303632
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发表时间：
2014-01-15
期刊：
影响因子：
5.7
通讯作者：
Pinto, Yigal M.
中科院分区：
文献类型：
--
作者：
Salah, Khibar;Kok, Wouter E.;Pinto, Yigal M.
急性失代偿性心力衰竭（ADHF）住院患者的风险分层模型不包括N末端B型利钠肽前体的变化目的我们研究的目的是为这个臭名昭著的高风险人群开发一个简单而强大的出院诊断评分，包括NT-proBNP。前瞻性队列研究的分析设置七个前瞻性队列，总共1301名患者。患者我们的研究人群是通过选择那些因临床证实的ADHF而入院，活着出院，主要结果测量研究的终点是全因死亡率和全因死亡率和/或NT-proBNP的复合终点。结果该模型结合了出院时的NT-proBNP水平以及住院期间NT-proBNP的变化以及年龄= 75岁，外周水肿、收缩压= 115 mm Hg、入院时低钠血症、血清尿素= 15 mmol/L和出院时纽约心脏协会（NYHA）分级产生了最佳C统计量（曲线下面积，0.78，95% CI 0.74 - 0.82）。将NT-proBNP添加到参考模型中显著改善了死亡率的预测，如净重新分类改善所示（62%，p
Background Models to stratify risk for patients hospitalised for acute decompensated heart failure (ADHF) do not include the change in N-terminal pro-Btype natriuretic peptide (NT-proBNP) levels during hospitalisation.Objective The aim of our study was to develop a simple yet robust discharge prognostication score including NT-proBNP for this notorious high-risk population.Design Individual patient data meta-analyses of prospective cohort studies.Setting Seven prospective cohorts with in total 1301 patients.Patients Our study population was assembled from the seven studies by selecting those patients admitted because of clinically validated ADHF, discharged alive, and NT-proBNP measurements available at admission and at discharge.Main outcome measures The endpoints studied were all-cause mortality and a composite of all-cause mortality and/or first readmission for cardiovascular reason within 180 days after discharge.Results The model that incorporated NT-proBNP levels at discharge as well as the changes in NT-proBNP during hospitalisation in addition to age = 75 years, peripheral oedema, systolic blood pressure = 115 mm Hg, hyponatremia at admission, serum urea of = 15 mmol/L and New York Heart Association (NYHA) class at discharge, yielded the best C-statistic (area under the curve, 0.78, 95% CI 0.74 to 0.82). The addition of NT-proBNP to a reference model significantly improved prediction of mortality as shown by the net reclassification improvement (62%, p