title: Prognosis of decompensated heart failure: role of NT-proBNP.
abstract: BACKGROUND
  The prognostic value of natriuretic peptides in heart failure (HF) is well established. The objective of this study was to evaluate the role of NT-proBNP in predicting outcome in decompensated HF.
  
  
  METHODS
  Patients admitted with decompensated HF to our Internal Medicine Department between November 2002 and April 2004 with at least two measurements of NT-proBNP (within 24 hours of admission and on discharge) were analyzed. Patients discharged alive were followed for up to 6 months. The primary endpoint was death or readmission.
  
  
  RESULTS
  We included 304 patients (72.7+/-11.6 years of age, 53.9% female, 49.3% ischemic etiology). Echocardiography was performed in 73.7%. Left ventricular systolic function (LVSF) was preserved in 20.7%, mildly to moderately depressed in 32.2% and severely depressed in 20.7%. There was a significant decrease in median NT-proBNP levels during hospitalization (from 7006 to 3796 pg/ml, p<0.001). The patients were classified in three groups according to NT-proBNP variation: 1 decreasing by at least 30% (n=162); 2 - no significant variation (n=95); and 3 - increasing by at least 30% (n=47). The primary endpoint was observed in 43% of the patients. In univariate analysis, variables predictive of outcome were: NT-proBNP at discharge (> median: HR=2.72; 95% CI=1.89-3.92): variation in NT-proBNP levels during hospitalization (group 2 vs. group 1 - HR=2.28; 95% CI=1.52-3.42; group 3 vs. group 1 - HR=4.82; 95% CI=3.11-7.49); renal failure (creatinine >2 mg/dL - HR=1.65; 95% CI=1.07-2.53); and treatment with ACE-Is (HR=0.59; 95% CI=0.39-0.89). After adjustment for NYHA class at discharge, pulse pressure, LVSF, renal function and hemoglobin, only NT-proBNP at discharge and NT-proBNP variation remained independent predictors of prognosis (NT-proBNP at discharge > median: HR=2.02; 95% CI=1.28-3.2; NT-proBNP variation: group 2 vs. group 1 - HR=2.24; 95% CI=1.37-3.66; group 3 vs. group 1 - HR=3.85; 95% CI=2.24-6.63).
  
  
  CONCLUSIONS
  Our results extend previous reports on the value of NT-proBNP in predicting outcome after discharge in patients hospitalized due to decompensated HF, and demonstrate its potential usefulness and applicability in clinical practice.
authors: Departamento de Medicina, Hospital São João, Semiótica Clínica, Porto, Portugal. susanaferreira14@hotmail.com
authors: Susana
authors: S
authors: Ferreira
authors: Rui
authors: R
authors: Almeida
authors: Hector
authors: H
authors: Guerrero
authors: Susana
authors: S
authors: Lourenço-Ferreira
authors: Luísa
authors: L
authors: Fonseca
authors: Ruben
authors: R
authors: Rocha
authors: Francisco
authors: F
authors: Rocha-Gonçalves
authors: Antonio
authors: A
authors: Ferreira
authors: Paulo
authors: P
authors: Bettencourt
mesh_terms: D000368:Aged; D005260:Female; D006333:Heart Failure / Q000097:blood* / Q000401:mortality*; D006801:Humans; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010359:Patient Readmission / Q000706:statistics & numerical data*; D010446:Peptide Fragments / Q000097:blood*; D011379:Prognosis
chemical_list: D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain