Prediction of in-hospital mortality by brain natriuretic peptide levels and other independent variables in acutely ill patients with suspected heart disease.
BACKGROUND
Brain natriuretic peptide (BNP) measurement can detect and assess heart failure. However, compared with traditional clinical parameters, its value for predicting the in-hospital mortality of patients with suspected heart disease has not been reported.


METHODS
Examination of the ability of 11 continuous and 22 categorical variables, including BNP levels measured at the time of admission, was conducted to predict in-hospital mortality.


METHODS
A small, rural Irish hospital.


METHODS
Six hundred forty-two consecutive patients with suspected heart disease admitted as acute medical emergencies.


RESULTS
Thirty-eight (5.9%) patients died while in hospital. They had significantly higher BNP levels on admission than did patients subsequently discharged alive (763+/-473 pg/mL versus 368+/-412 pg/mL, P<0.0001). Patients who died in hospital were older; had significantly higher white blood cell counts, blood urea, respiratory rates and modified early warning scores; and had significantly lower blood pressure and hemoglobin levels. Five variables were found to be independent predictors of mortality: a systolic blood pressure of 90 mmHg or less; a hemoglobin level of 100 g/L or less; a white blood cell count greater than 13.0 x 10(9)/L being unwell before the current illness; and a BNP level of 700 pg/mL or greater. The presence of three or more of these variables was associated with an in-hospital mortality rate of 39%.


CONCLUSIONS
Five independent variables (hypotension, anemia, leukocytosis, prior illness and elevated BNP levels) are comparable predictors of in-hospital mortality in patients with suspected heart disease.
Kellett
John
J
Department of Medicine, Nenagh Hospital, Nenagh, County Tipperary, Ireland. kellett@iol.ie
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D001794:Blood Pressure / Q000502:physiology; D002648:Child; D002675:Child, Preschool; D005260:Female; D006331:Heart Diseases / Q000378:metabolism* / Q000401:mortality* / Q000503:physiopathology; D006454:Hemoglobins / Q000378:metabolism; D017052:Hospital Mortality; D006801:Humans; D007223:Infant; D007494:Ireland; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000378:metabolism*; D011237:Predictive Value of Tests; D012372:ROC Curve; D013223:Statistics as Topic
D015415:Biomarkers; D006454:Hemoglobins; D020097:Natriuretic Peptide, Brain