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.
Crit Care. 2011 Jan 5;15(1):R1
Authors: Noveanu M, Breidthardt T, Potocki M, Reichlin T, Twerenbold R, Uthoff H, Socrates T, Arenja N, Reiter M, Meissner J, Heinisch C, Stalder S, Mueller C
ABSTRACT: 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 24h: 0.77; AUC 48h: 0.78; AUC discharge: 0.78) and NT-proBNP (AUC presentation: 0.67; AUC 24h: 0.73; AUC 48h: 0.75; AUC discharge: 0.77). In multivariate analysis, BNP at 24h (1.02 [1.01-1.04], p=0.003), 48h (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 HFreadmissions. 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.
PMID: 21208408 [PubMed - as supplied by publisher]