Pre-discharge B-type natriuretic peptide predicts early recurrence of decompensated heart failure in patients admitted to a general medical unit.
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.
Verdiani
Valerio
V
II Unit of Internal Medicine, Azienda Ospedaliera Universitaria Careggi, Florence, Italy. valerioverdiani@virgilio.it
Nozzoli
Carlo
C
Bacci
Francesca
F
Cecchin
Adriana
A
Rutili
Maria Serena
MS
Paladini
Sergio
S
Olivotto
Iacopo
I
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
D020097:Natriuretic Peptide, Brain