title: Pre-discharge B-type natriuretic peptide predicts early recurrence of decompensated heart failure in patients admitted to a general medical unit.
abstract: BACKGROUND
  B-type natriuretic peptide (BNP) represents a promising predictor of early (30 days) re-admission in patients with heart failure (HF) admitted to cardiology units. Whether BNP retains its predictive value in unselected patients admitted to general medical wards is unknown.
  
  
  METHODS
  We determined BNP levels on admission and pre-discharge in 100 consecutive patients (71 male, mean age 78+/-10 years) admitted to a general medical unit due to decompensated HF. Follow-up after discharge was 30 days.
  
  
  RESULTS
  Of the 100 patients, 86 had >/=1 comorbid conditions. Median BNP was 739 pg/ml on admission (25th-75th percentile 355-1333 pg/ml, respectively), and 414 pg/ml pre-discharge (25th-75th percentile 220-696 pg/ml). Seventeen patients were re-admitted or died within 30 days. Patients with pre-discharge BNP values >75th percentile (696 pg/ml) had greater risk of re-hospitalisation, as compared to values </=696 pg/ml (56% vs. 4%, respectively; p<0.001). Negative predictive value for this cut-off was 96%. BNP values >75th percentile were associated with a 15.0 independent relative hazard (RH) of early re-admission or death (95% CI 4.2-53.8; p<0.0001). The other independent predictor was a NYHA class >/=III at discharge (RH 2.9; 95% CI 1.1-9.3; p<0.05).
  
  
  CONCLUSIONS
  In a general medical unit, pre-discharge BNP levels were a strong independent predictor of early re-admission or death due to HF, irrespective of substantial comorbidity and advanced age.
authors.affiliation: II Unit of Internal Medicine, Azienda Ospedaliera Universitaria Careggi, Florence, Italy. valerioverdiani@virgilio.it
authors.forename: Valerio
authors.initials: V
authors.lastname: Verdiani
authors.forename: Carlo
authors.initials: C
authors.lastname: Nozzoli
authors.forename: Francesca
authors.initials: F
authors.lastname: Bacci
authors.forename: Adriana
authors.initials: A
authors.lastname: Cecchin
authors.forename: Maria Serena
authors.initials: MS
authors.lastname: Rutili
authors.forename: Sergio
authors.initials: S
authors.lastname: Paladini
authors.forename: Iacopo
authors.initials: I
authors.lastname: Olivotto
mesh_terms: D000368:Aged; D015897:Comorbidity; D004562:Electrocardiography; D005260:Female; D006333:Heart Failure / Q000097:blood* / Q000188:drug therapy / Q000453:epidemiology; D006760:Hospitalization; D006801:Humans; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D012372:ROC Curve; D012008:Recurrence; D016019:Survival Analysis
chemical_list: D020097:Natriuretic Peptide, Brain