Prognostic Value of N-Terminal Pro-B-Type Natriuretic Peptide and Glomerular Filtration Rate in Patients With Acute Heart Failure
Prognostic Value of N-Terminal Pro-B-Type Natriuretic Peptide and Glomerular Filtration Rate in Patients With Acute Heart Failure
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N 端 B 型利钠肽原和肾小球滤过率对急性心力衰竭患者的预后价值
DOI：
10.3389/fcvm.2020.00123
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发表时间：
2020-07-21
影响因子：
3.6
通讯作者：
Li，Xinli
中科院分区：
文献类型：
--
作者：
Wang，Kai;Ni，Gehui;Li，Xinli
目的：探讨 N 末端 B 型利钠肽原 (NT-proBNP)、肾小球滤过率 (GFR) 与急性心力衰竭 (AHF) 住院患者预后之间的关系。方法：试验在http://www.chictr.org/cn/注册。 （ChiCTR – ONC – 12001944）。纳入2012年3月至2016年10月南京医科大学第一附属医院心内科住院的AHF患者493例。最终事件是在 18 个月的随访中发生全因死亡。入院时收集的数据用于通过慢性肾脏病流行病学协作方程（CKD-EPI）计算GFR并进行相应的统计分析。结果：18 个月的随访期间，有 74 名参与者（13.8%）退出，91 名参与者（21.7%）去世。比较存活组和死亡组的临床指标，分析AHF患者的长期预后。单因素分析中，NT-proBNP和GFR均具有统计学意义（P < 0.001）。联合 NT-proBNP 和 GFR 在多因素 COX 回归分析中显示出显着的预测价值 (P < 0.001)。在受试者操作特征 (ROC) 分析中，NT-proBNP 的曲线下面积 (AUC) 为 0.648 [95%CI: 0.598–0.695, P < 0.001]，GFR 为 0.677 [95%CI: 0.627–0.723, P < 0.001]。根据Youden指数，NT-proBNP的最佳预测点为2,137 pg/ml，GFR为61.7 ml/(min·1.73 m2)。使用二元Logistic回归组合两个指标后，AUC为0.711，与任一单因素的AUC相比显着。组合指标的敏感性为0.535，特异性为0.853。根据截点，将这两项指标分为四组，通过Kaplan-Meier生存曲线比较（对数秩检验）进一步分析，结果显示NT-proBNP较高且GFR较低的组患者预后最差。结论：NT-proBNP > 2,137 pg/ml且GFR < 61.7 ml/(min·1.73 m2)的患者死亡风险显着较高。 GFR和NT-proBNP联合应用提高了AHF患者长期预后的预测价值。
Aims: To investigate the relationship between N-terminal pro-B-type natriuretic peptide (NT-proBNP), Glomerular Filtration Rate (GFR), and outcomes in patients hospitalized with acute heart failure (AHF). Methods: The trial was registered at http://www.chictr.org/cn/. (ChiCTR – ONC - 12001944). A total of 493 patients hospitalized for AHF in cardiology department of the First Affiliated Hospital of Nanjing Medical University from March 2012 to October 2016 were enrolled into registry. The end event was the occurrence of all-cause death within an 18-month follow-up. The data collected from the participants in admission were used to calculate the GFR by chronic kidney disease epidemiology collaboration equation (CKD-EPI) and performed the according statistical analysis. Results: There were 74 participants (13.8%) dropped out and 91 (21.7%) passed away within the 18-month follow up. Comparison of clinical indicators between survival and death group were analyzed for the long-term prognosis of patients with AHF. In the single factor analysis, both NT-proBNP and GFR were statistically significant (P < 0.001). Combined NT-proBNP and GFR in multi-factor COX regression analysis showed significant predictive value (P < 0.001). In receiver operator characteristics (ROC) analyses, the area under the curves (AUC) for NT-proBNP was 0.648 [95%CI: 0.598–0.695, P < 0.001] and for GFR was 0.677 [95%CI: 0.627–0.723, P < 0.001]. According to the Youden index, the best prediction point of NT-proBNP was 2,137 pg/ml and GFR was 61.7 ml/(min·1.73 m2). After using the Binary Logistic Regression to combine the two indicators, the AUC was 0.711, which was significantly compared to the AUC of either single factor. The sensitivity of the combined indicators were 0.535, the specificity were 0.853. According to the cut-off point, these two indexes were separated into four groups for further analysis by Kaplan-Meier survival curve comparison (log-rank test), which showed that patients in the group with higher NT-proBNP and lower GFR had the worst prognosis. Conclusions: In patients with NT-proBNP > 2,137 pg/ml and GFR < 61.7 ml/(min·1.73 m2), the risk of death was significantly higher. The combination of GFR and NT-proBNP improved the predictive value for the long-term prognosis of AHF patients.