Predischarge B-type natriuretic peptide assay for identifying patients at high risk of re-admission after decompensated heart failure
Predischarge B-type natriuretic peptide assay for identifying patients at high risk of re-admission after decompensated heart failure
复制标题
DOI：
10.1016/j.jacc.2003.09.044
复制
发表时间：
2004-02-18
影响因子：
24
通讯作者：
Solal, AC
中科院分区：
文献类型：
--
作者：
Logeart, D;Thabut, G;Solal, AC
目的：本研究的目的是确定系列b型利钠肽（BNP）测定在预测失代偿性充血性心力衰竭（CHF）患者出院后预后方面的价值。背景：因失代偿性CHF住院的患者经常再次入院。因此，在高危患者出院前对其进行识别仍然是一个具有挑战性的主要问题。b型利钠肽测定可能有用。方法对连续两例患者从入院到出院期间进行连续BNP检测。对幸存者进行为期6个月的监测，主要终点是合并死亡或首次因CHF再次入院。结果在衍生研究的105名幸存者中，所有序列BNP值、BNP水平百分比变化和出院前多普勒二尖瓣模式与预后相关。相比之下，临床变量和左心室射血分数的预测能力较差。出院前BNP检测具有最佳判别能力（受试者工作特征曲线下面积= 0.80），是多因素分析中唯一的显著变量（风险比[HR] = 1.14[95%可信区间{CI}， 1.02 ~ 1.28], p = 0.027）。在验证研究的97名幸存者中，出院前BNP检测也是最具预测性的参数（ROC曲线下面积= 0.83）。随着出院前BNP范围的增加，死亡或再入院的风险逐步增加（p < 0.0001）。调整基线协变量后，与BNP水平相比，BNP水平在350至700 ng/l之间的hr为5.1 [95% Cl 2.8至9.1]，BNP水平在100至700 ng/l之间的hr为15.2 [95% Cl 8.5至27]
OBJECTIVES The aim of this study was to determine the value of serial B-type natriuretic peptide (BNP) assay for predicting post-discharge outcome of patients admitted for decompensated congestive heart failure (CHF).BACKGROUND Patients hospitalized for decompensated CHF are frequently re-admitted. Thus, identification of high-risk patients before their discharge is a major issue that remains challenging. B-type natriuretic peptide measurement could be useful.METHODS Serial BNP measurements were performed from admission to discharge in two samples of consecutive patients. Survivors were monitored for six months, the main end point combined death or first re-admission for CHF.RESULTS Among the 105 survivors of the derivation study, all serial BNP values, percentage change in BNP levels, and predischarge Doppler mitral pattern correlated with the outcome. In contrast, clinical variables and left ventricular ejection fraction were poorly predictive. The predischarge BNP assay had the best discriminative power (area under the receiver operating characteristic [ROC] curve = 0.80) and remained the lone significant variable in multivariate analysis (hazard ratio [HR] = 1.14 [95% confidence interval {CI}, 1.02 to 1.28], p = 0.027). Among the 97 survivors of the validation study, the predischarge BNP assay was also the most predictive parameter (area under the ROC curve = 0.83). The risk of death or re-admission increased in stepwise fashion across increasing predischarge BNP ranges (p < 0.0001). After adjustment for baseline covariables, the HRs were 5.1 [95% Cl 2.8 to 9.1] for BNP levels between 350 and 700 ng/l and 15.2 [95% Cl 8.5 to 27] for BNP levels >700 ng/l, compared with BNP