Comparison of prognostic significance of amino-terminal pro-brain natriuretic Peptide versus blood urea nitrogen for predicting events in patients hospitalized for heart failure.
N-terminal pro-brain natriuretic peptide (NT-pro-BNP) and blood urea nitrogen (BUN) predict outcomes in patients with heart failure (HF). However, it is unknown whether NT-pro-BNP is a better prognostic marker than BUN in patients hospitalized with HF. Chart reviews were performed on 257 consecutively hospitalized patients with HF whose NT-pro-BNP levels were drawn at the time of admission. The ability of NT-pro-BNP and BUN to predict the primary end point (death or readmission <30 days after discharge) was determined. Seventy-three patients (28%) reached the primary end point. Patients who reached the primary end point had significantly higher NT-pro-BNP and BUN levels. On multivariate regression analysis, the predictive values of BUN and NT-pro-BNP were very similar: the hazard ratio for NT-pro-BNP greater than the median was 1.81 (p = 0.044), and the hazard ratio for BUN greater than the median was 1.83 (p = 0.039). Analysis of the associations between NT-pro-BNP, BUN, and 30-day death or readmission as end points showed that BUN is a better predictor of outcomes (hazard ratio 3.15, p = 0.012) than NT-pro-BNP (hazard ratio 1.44, p = 0.399). In conclusion, in patients admitted to hospitals with HF, BUN is at least an equal prognosticator of HF rehospitalization or death as NT-pro-BNP. BUN outperforms NT-pro-BNP in predicting mortality in patients with advanced HF. If admitting physicians are confident that the diagnosis of HF is correct, then admission NT-pro-BNP adds little to clinical management.
Shenkman
Heather J
HJ
Cardiology Division, Department of Medicine, University of Rochester Medical Center, Rochester, New York, USA.
Zareba
Wojciech
W
Bisognano
John D
JD
D000368:Aged; D015415:Biomarkers / Q000097:blood; D001794:Blood Pressure / Q000502:physiology; D001806:Blood Urea Nitrogen; D002303:Cardiac Output, Low / Q000097:blood* / Q000209:etiology; D003404:Creatinine / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D006760:Hospitalization; D006801:Humans; D007902:Length of Stay; D008297:Male; D017202:Myocardial Ischemia / Q000150:complications; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010343:Patient Admission; D010359:Patient Readmission; D010446:Peptide Fragments / Q000097:blood*; D011379:Prognosis; D011498:Protein Precursors / Q000097:blood*; D012189:Retrospective Studies; D013318:Stroke Volume / Q000502:physiology; D015996:Survival Rate; D013997:Time Factors
D015415:Biomarkers; D010446:Peptide Fragments; D011498:Protein Precursors; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain; D003404:Creatinine