[Admission and predischarge levels of NT pre brain natriuretic peptide in patients hospitalized because of worsening heart failure. relation to risk of death in the next 6-12 months].
Inhospital treatment of patients with heart failure (HF) can cause changes of N-terminal pro-brain natriuretic peptide (NT proBNP) levels. It has not been established yet which NT proBNP value (before or at height of treatment activation) is closer related to prognosis of unfavorable outcome after discharge.


OBJECTIVE
To compare relation to risk of post discharge unfavorable outcome of patients with HF of NT proBNP levels measured close to hospital admission and discharge.


METHODS
We studied 69 patients (64% men) aged 66.6 +/- 11.0 years with coronary heart disease or hypertension hospitalized because of worsening HF. Median left ventricular ejection fraction was 28%. NT-proBNP was measured during first 3 days of hospitalization (admission level) and in 2 weeks after first measurement (predischarge level). Duration of follow-up was 6-12 (mean 11.6 +/- 1.3) months.


RESULTS
Admission NT-proBNP level (median 13.23, interquartile range 5.95-25.89 ng/ml) exceeded upper limit of normal (ULN) in 67 patients (97.1%). Predischarge NT-proBNP became significantly lower (median 6.02 ng/ml, interquartile range 2.52-12.23 ng/ml; p=0.012), but remained above ULN in 62 patients (89.8%). During follow-up 27 patients (39.1%) died. Median NT-proBNP in the group of patients who later died compared with those who survived was insignificantly higher at admission (15.03 vs. 9.9 ng/ml, respectively, p=0.09) and significantly higher at predischarge (8.65 vs. 3.60 ng/ml, respectively, p=0.012). Analysis of receiver operating characteristic curves identified predischarge NT-proBNP level 3.5 ng/ml as cut - off value for increased risk of death. Multivariate regression analysis selected predischarge NT-proBNP more or equal 3.5 ng/ml as independent predictor of death during follow-up.


CONCLUSIONS
In this group of patients hospitalized because of worsening HF predischarge but not admission NT-proBNP level was independently related to risk of death during next 6-12 months.
Mazovets
O L
OL
Trifonov
I R
IR
Katrukha
A G
AG
Gratsianskiĭ
N A
NA
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death / Q000639:trends; D003955:Diagnostic Tests, Routine / Q000379:methods*; D018450:Disease Progression; D004562:Electrocardiography; D005260:Female; D015590:Fluorophotometry; D005500:Follow-Up Studies; D006333:Heart Failure / Q000097:blood* / Q000175:diagnosis / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010343:Patient Admission; D010351:Patient Discharge; D010446:Peptide Fragments / Q000097:blood*; D011498:Protein Precursors; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D012426:Russia / Q000453:epidemiology; D012720:Severity of Illness Index; D013997:Time Factors
D010446:Peptide Fragments; D011498:Protein Precursors; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain