Poor prognosis of heart failure patients with in-hospital worsening renal function and elevated BNP at discharge.
Poor prognosis of heart failure patients with in-hospital worsening renal function and elevated BNP at discharge.
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DOI：
10.1002/ehf2.12901
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发表时间：
2020-10
影响因子：
3.8
通讯作者：
Ochiai M
中科院分区：
文献类型：
--
作者：
Okabe T;Yakushiji T;Kido T;Kimura T;Asukai Y;Shimazu S;Saito J;Oyama Y;Igawa W;Ono M;Ebara S;Yamashita K;Yamamoto MH;Amemiya K;Isomura N;Ochiai M
Our purpose was to investigate the association between the B‐type natriuretic peptide (BNP) level at discharge, the occurrence of worsening renal function (WRF), and long‐term outcomes in patients with heart failure (HF). We enrolled hospitalized acute HF patients. We divided patients into four groups on the basis of BNP <250 pg/mL (BNP−) or BNP ≥250 pg/mL (BNP+) at discharge and the occurrence of WRF during admission: BNP−/WRF−, BNP−/WRF+, BNP+/WRF−, and BNP+/WRF+. We evaluated the association between BNP at discharge, WRF, and cardiovascular/all‐cause mortality/hospitalization due to HF. Clinical follow‐up was completed in 301 patients. At discharge, percentages of the patients with clinical signs of HF were low and similar among four groups. The median follow‐up period was 1206 days (interquartile range, 733–1825 days). The composite endpoint of cardiovascular mortality and HF hospitalization was significantly different between the four groups [12.9% (BNP−/WRF−), 22.7% (BNP−/WRF+), 35.8% (BNP+/WRF−), and 55.4% (BNP+/WRF+), P < 0.0001]. All‐cause mortality was also different etween the four groups (15.1%, 38.6%, 28.7%, and 39.3%, respectively, P = 0.003). In the multivariate Cox proportional hazards model, the combination of BNP ≥250 pg/mL and WRF showed the highest hazard ratio (HR) for composite endpoint (HR, 5.201; 95% confidence interval, 2.582–11.11; P < 0.0001), and BNP−/WRF+ was associated with increased all‐cause mortality (HR, 2.286; 95% confidence interval, 1.089–4.875; P = 0.03). Patients in BNP+/WRF+ had a higher cardiovascular mortality (28.6%), and those in BNP−/WRF+ had a high non‐cardiovascular mortality (29.5%). Heart failure patients with BNP ≥250 pg/mL at discharge and in‐hospital occurrence of WRF had the highest risk for the composite endpoint (cardiovascular mortality and HF hospitalization) among groups.
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影响因子：
24
作者：
Iwanaga, Y;Nishi, I;Nonogi, H
通讯作者：
Nonogi, H
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Androne, AS;Hryniewicz, K;Katz, SD
通讯作者：
Katz, SD
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Metra, Marco;Davison, Beth;Cas, Livio Dei
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Cas, Livio Dei
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通讯作者：
Mueller, Christian
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Ruocco, Gaetano;Palazzuoli, Alberto;ter Maaten, Jozine M.
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ter Maaten, Jozine M.