Long-term prognostic value of B-type natriuretic peptide in cardiac and non-cardiac causes of acute dyspnoea.
BACKGROUND
B-type natriuretic peptide (BNP) levels significantly predict increased risk of death in heart failure. The predictive role of BNP levels in patients with non-cardiac causes of acute dyspnoea presenting to the emergency department is not well characterized.


METHODS
The B-type natriuretic peptide for Acute Shortness of Breath EvaLuation (BASEL) study enrolled consecutive patients with acute dyspnoea.


RESULTS
Cumulative mortality was 14.8%, 33.1% and 51.9% in 452 patients (age: 19-97 years; 58% male) within low (< 100 pg mL(-1)), intermediate (100-500 pg mL(-1)) and high (> 500 pg mL(-1)) BNP plasma levels at 18 months of follow-up. BNP classes (point estimate: 1.55, 95%CI: 1.19-2.03, P = 0.001) in addition to age, increased heart rate and diuretic use emerged as significant predictors for long-term mortality in multivariable Cox regression analyses. The BNP concentration alone had an area under the receiver operating characteristic curve of 0.71 (95%CI: 0.66-0.76; P < 0.001) for predicting 18 months mortality. BNP plasma levels independently predicted long-term risk of death in patients with non-cardiac (point estimate: 1.72, 95%CI: 1.16-2.56; P = 0.007) and with cardiac causes of acute dyspnoea (point estimate: 2.21, 95%CI: 1.34-3.64; P = 0.002).


CONCLUSIONS
BNP levels are strong and independent predictors for long-term mortality in unselected dyspnoeic patients presenting to the emergency department independent from the cause of dyspnoea.
Christ
M
M
Department of Internal Medicine, University Hospital Basel, Petersgraben 4, Basel, Switzerland. micchrist@uhbs.ch
Thuerlimann
A
A
Laule
K
K
Klima
T
T
Hochholzer
W
W
Perruchoud
A P
AP
Mueller
C
C
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003327:Coronary Disease / Q000097:blood* / Q000175:diagnosis / Q000401:mortality; D004417:Dyspnea / Q000097:blood* / Q000175:diagnosis / Q000401:mortality; D004636:Emergency Service, Hospital; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D011379:Prognosis
D020097:Natriuretic Peptide, Brain