Direct comparison of serial B-type natriuretic peptide and NT-proBNP levels for prediction of short- and long-term outcome in acute decompensated heart failure
Direct comparison of serial B-type natriuretic peptide and NT-proBNP levels for prediction of short- and long-term outcome in acute decompensated heart failure
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DOI：
10.1186/cc9398
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发表时间：
2011-01-01
期刊：
影响因子：
15.1
通讯作者：
Mueller, Christian
中科院分区：
文献类型：
--
作者：
Noveanu, Markus;Breidthardt, Tobias;Mueller, Christian
简介：监测治疗效果和评估结果的一系列测量利钠肽在急性失代偿性心力衰竭（ADHF）patients可能有助于改善outcome.Methods：这是一个前瞻性的多中心研究171例连续患者（平均年龄80 - 73-85岁）急诊科与ADHF。在就诊时、24小时、48小时和出院时测量BNP和NT-proBNP。主要终点为1年全因死亡率;次要终点为30天全因死亡率和1年心力衰竭（HF）再入院率。在所有时间点，非存活者的BNP和NT-proBNP水平均较高（均P < 0.001）。在存活者中，治疗使BNP和NT-proBNP水平降低了50%以上（P < 0.001），而在非存活者中，治疗没有降低BNP和NT-proBNP水平。BNP（AUC表示：0.67; AUC 24 h：0.77; AUC 48 h：0.78; AUC排出：0.78）和NT-proBNP（AUC表示：0.67; AUC 24 h：0.73; AUC 48 h：0.75; AUC排出：0.77）住院期间预测1年死亡率的ROC曲线下面积（AUC）增加。在多变量分析中，24 h BNP（1.02 [1.01-1.04]，P = 0.003），48 h（1.04 [1.02-1.06]，P < 0.001）和出院（1.02 [1.01-1.03]，P < 0.001）独立预测1年死亡率，而只有出院前NT-proBNP是预测因素（1.07 [1.01-1.13]，P = 0.016）。次要终点30天死亡率可获得可比结果，但一年HF再入院率则无可比结果。结论：BNP和NT-proBNP可可靠预测ADHF患者一年死亡率。两种生物标志物的预后准确性在住院期间增加。在存活者中，BNP水平比NT-proBNP水平下降得更快，因此似乎可以更早地评估治疗疗效。BNP和NT-proBNP预测1年HF再入院的能力较差。试验注册：ClinicalTrials.gov标识符：NCT 00514384。
Introduction: Monitoring treatment efficacy and assessing outcome by serial measurements of natriuretic peptides in acute decompensated heart failure (ADHF) patients may help to improve outcome.Methods: This was a prospective multi-center study of 171 consecutive patients (mean age 80 73-85 years) presenting to the emergency department with ADHF. Measurement of BNP and NT-proBNP was performed at presentation, 24 hours, 48 hours and at discharge. The primary endpoint was one-year all-cause mortality; secondary endpoints were 30-days all-cause mortality and one-year heart failure (HF) readmission.Results: During one-year follow-up, a total of 60 (35%) patients died. BNP and NT-proBNP levels were higher in non-survivors at all time points (all P < 0.001). In survivors, treatment reduced BNP and NT-proBNP levels by more than 50% (P < 0.001), while in non-survivors treatment did not lower BNP and NT-proBNP levels. The area under the ROC curve (AUC) for the prediction of one-year mortality increased during the course of hospitalization for BNP (AUC presentation: 0.67; AUC 24 h: 0.77; AUC 48 h: 0.78; AUC discharge: 0.78) and NT-proBNP (AUC presentation: 0.67; AUC 24 h: 0.73; AUC 48 h: 0.75; AUC discharge: 0.77). In multivariate analysis, BNP at 24 h (1.02 [1.01-1.04], P = 0.003), 48 h (1.04 [1.02-1.06], P < 0.001) and discharge (1.02 [1.01-1.03], P < 0.001) independently predicted one-year mortality, while only pre-discharge NT-proBNP was predictive (1.07 [1.01-1.13], P = 0.016). Comparable results could be obtained for the secondary endpoint 30-days mortality but not for one-year HF readmissions.Conclusions: BNP and NT-proBNP reliably predict one-year mortality in patients with ADHF. Prognostic accuracy of both biomarker increases during the course of hospitalization. In survivors BNP levels decline more rapidly than NT-proBNP levels and thus seem to allow earlier assessment of treatment efficacy. Ability to predict one-year HF readmission was poor for BNP and NT-proBNP.Trial registration: ClinicalTrials.gov identifier: NCT00514384.