title: NT-pro-BNP measured at discharge predicts outcome in multimorbid diabetic inpatients with a broad spectrum of cardiovascular disease.
abstract: The prognostic value of NT-pro-BNP has not been thoroughly evaluated in diabetic inpatients with manifest cardiovascular disease. NT-pro-BNP was measured in 156 patients with type 2 diabetes mellitus hospitalised due to cardiovascular disease. The association of NT-pro-BNP with mortality and the combined endpoint (CE) of death, heart failure decompensation, stroke and myocardial infarction was analysed during a median follow-up time of 1183 days. Patients who died (1669 IQR 788-5640 vs. 398, IQR 158-990 pg/ml) and patients with CE (1353, IQR 730-4289 vs. 304, IQR 128-784 pg/ml, both p=0.0001) had significantly elevated NT-pro-BNP compared to patients without the corresponding endpoint. Patients with supramedian NT-pro-BNP (>518 pg/ml) had significantly worse outcome regarding mortality (HR 5.5, 95%CI 2.0-14.8) and CE (HR 5.0, 95%CI 2.2-11.2) than patients with inframedian values even after adjustment for age, NYHA class and renal function. At a cut-off of 422 pg/ml, NT-pro-BNP showed a sensitivity of 89.6% and a negative predictive value of 92.8% for detection of patients with future CE. In this sample of diabetic patients with a broad spectrum of cardiovascular disease, NT-pro-BNP was a strong predictor of long-term outcome. NT-pro-BNP measured at discharge identifies high-risk patients independently of the underlying heart disease.
authors.affiliation: Department III of Internal Medicine, University of Cologne, Josef-Stelzmann Str. 9, D-50924, Cologne, Germany. roman.pfister@uk-koeln.de
authors.forename: R
authors.initials: R
authors.lastname: Pfister
authors.forename: D
authors.initials: D
authors.lastname: Tan
authors.forename: J
authors.initials: J
authors.lastname: Thekkanal
authors.forename: M
authors.initials: M
authors.lastname: Hellmich
authors.forename: E
authors.initials: E
authors.lastname: Erdmann
authors.forename: C A
authors.initials: CA
authors.lastname: Schneider
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000097:blood* / Q000401:mortality; D003404:Creatinine / Q000378:metabolism; D003925:Diabetic Angiopathies / Q000097:blood* / Q000401:mortality; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D007297:Inpatients; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010351:Patient Discharge; D010446:Peptide Fragments / Q000097:blood*; D011379:Prognosis; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D003404:Creatinine; D006442:Glycated Hemoglobin; D020097:Natriuretic Peptide, Brain; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76)