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.docVIP

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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.doc

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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

Noveanuetal.CriticalCare2011,15:R1 /content/15/1/R1 RESEARCH OpenAccess DirectcomparisonofserialB-typenatriuretic peptideandNT-proBNPlevelsforpredictionof short-andlong-termoutcomeinacute decompensatedheartfailure MarkusNoveanu1,2*,TobiasBreidthardt1,MihaelPotocki2,TobiasReichlin2,RaphaelTwerenbold1,HeikoUthoff1, ThenralSocrates1,NishaArenja1,MiriamReiter1,JuliaMeissner1,CorinnaHeinisch1,SybilleStalder1,ChristianMueller1 Abstract Introduction:Monitoringtreatmentefficacyandassessingoutcomebyserialmeasurementsofnatriureticpeptides inacutedecompensatedheartfailure(ADHF)patientsmayhelptoimproveoutcome. Methods:Thiswasaprospectivemulti-centerstudyof171consecutivepatients(meanage8073-85years) presentingtotheemergencydepartmentwithADHF.MeasurementofBNPandNT-proBNPwasperformedat presentation,24hours,48hoursandatdischarge.Theprimaryendpointwasone-yearall-causemortality; secondaryendpointswere30-daysall-causemortalityandone-yearheartfailure(HF)readmission. Results:Duringone-yearfollow-up,atotalof60(35%)patientsdied.BNPandNT-proBNPlevelswerehigherin non-survivorsatalltimepoints(allP0.001).Insurvivors,treatmentreducedBNPandNT-proBNPlevelsbymore than50%(P0.001),whileinnon-survivorstreatmentdidnotlowerBNPandNT-proBNPlevels.Theareaunder theROCcurve(AUC)forthepredictionofone-yearmortalityincreasedduringthecourseofhospitalizationforBNP (AUCpresentation:0.67;AUC24h:0.77;AUC48h:0.78;AUCdischarge:0.78)andNT-proBNP(AUCpresentation: 0.67;AUC24h:0.73;AUC48h:0.75;AUCdischarge:0.77).Inmultivariateanalysis,BNPat24h(1.02[1.01-1.04],P= 0.003),48h(1.04[1.02-1.06],P0.001)anddischarge(1.02[1.01-1.03],P0.001)independentlypredictedone-year mortality,whileonlypre-dischargeNT-proBNPwaspredictive(1.07[1.01-1.13],P=0.016).Comparableresultscould beobtainedforthesecondaryendpoint30-daysmortalitybutnotforone-yearHFreadmissions. Conclusions:BNPandNT-proBNPreliablypredictone-yearmortalityinpatientswithADHF.Prognosticaccuracyof bothbiomarkerincreasesduringthecourseofhospitalization.InsurvivorsBNPlevelsdecl