title: Prognostic value of N-terminal pro-B-type natriuretic peptide in patients with active infective endocarditis.
abstract: Our aim was to determine whether N-terminal pro-B-type natriuretic peptide (NT-pro-BNP) and cardiac troponin I (cTnI) levels are valuable for predicting prognosis in patients with infective endocarditis (IE). We analyzed measured plasma NT-pro-BNP levels at admission in 45 patients with definite IE. The primary end point was early surgery or in-hospital death. The other data recorded were baseline clinical, echocardiographic, and laboratory parameters. Thirty patients underwent early surgery, and 9 died in hospital. Univariate analysis revealed that log NT-pro-BNP, cTnI > or =0.03 ng/ml, New York Heart Association functional class III to IV symptoms, left atrial diameter, left ventricular end-diastolic diameter, left ventricular end-systolic diameter, and severe valvular regurgitation were associated with increased risk of reaching the primary end point. Cox proportional hazard regression analysis identified log NT-pro-BNP (hazard ratio 1.5; 95% confidence interval 1.2 to 1.9, p <0.001) as the only independent predictor of the primary end point. The log NT-pro-BNP cut-off value with the highest sensitivity (97%) and specificity (92%) for predicting primary end point was 7.2 (1,500 pg/ml). Patients with NT-pro-BNP level > or =1,500 pg/ml had significantly lower event-free survival than others. In conclusion, admission NT-pro-BNP is of prognostic value in patients with IE. The combination of admission NT-pro-BNP and cTnI levels appears to have even greater value for risk stratification in this patient group.
authors.affiliation: Department of Cardiology, Kosuyolu Heart and Research Hospital, Istanbul, Turkey.
authors.forename: Gokhan
authors.initials: G
authors.lastname: Kahveci
authors.forename: Fatih
authors.initials: F
authors.lastname: Bayrak
authors.forename: Bulent
authors.initials: B
authors.lastname: Mutlu
authors.forename: Atila
authors.initials: A
authors.lastname: Bitigen
authors.forename: Tansu
authors.initials: T
authors.lastname: Karaahmet
authors.forename: Kenan
authors.initials: K
authors.lastname: Sonmez
authors.forename: Akin
authors.initials: A
authors.lastname: Izgi
authors.forename: Muzaffer
authors.initials: M
authors.lastname: Degertekin
authors.forename: Yelda
authors.initials: Y
authors.lastname: Basaran
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D015415:Biomarkers / Q000097:blood; D006348:Cardiac Surgical Procedures; D002648:Child; D018572:Disease-Free Survival; D004452:Echocardiography; D004697:Endocarditis, Bacterial / Q000097:blood* / Q000000981:diagnostic imaging / Q000382:microbiology / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D016905:Gram-Negative Bacterial Infections / Q000097:blood / Q000382:microbiology; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010343:Patient Admission; D010446:Peptide Fragments / Q000097:blood*; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity; D019210:Troponin I / Q000097:blood
chemical_list: D015415:Biomarkers; D010446:Peptide Fragments; D019210:Troponin I; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain