title: In-hospital percentage BNP reduction is highly predictive for adverse events in patients admitted for acute heart failure: the Italian RED Study.
abstract: BACKGROUND
  Our aim was to evaluate the role of B-type natriuretic peptide (BNP) percentage variations at 24 hours and at discharge compared to its value at admission in order to demonstrate its predictive value for outcomes in patients with acute decompensated heart failure (ADHF).
  
  
  METHODS
  This was a multicenter Italian (8 centers) observational study (Italian Research Emergency Department: RED). 287 patients with ADHF were studied through physical exams, lab tests, chest X Ray, electrocardiograms (ECGs) and BNP measurements, performed at admission, at 24 hours, and at discharge. Follow up was performed 180 days after hospital discharge. Logistic regression analysis was used to estimate odds ratios (OR) for the various subgroups created. For all comparisons, a P value < 0.05 was considered statistically significant.
  
  
  RESULTS
  BNP median (interquartile range (IQR)) value at admission was 822 (412 - 1390) pg\mL; at 24 hours was 593 (270 - 1953) and at discharge was 325 (160 - 725). A BNP reduction of >46% at discharge had an area under curve (AUC) of 0.70 (P < 0.001) for predicting future adverse events. There were 78 events through follow up and in 58 of these patients the BNP level at discharge was >300 pg/mL. A BNP reduction of 25.9% after 24 hours had an AUC at ROC curve of 0.64 for predicting adverse events (P < 0.001). The odds ratio of the patients whose BNP level at discharge was <300 pg/mL and whose percentage decrease at discharge was <46% compared to the group whose BNP level at discharge was <300 pg/mL and whose percentage decrease at discharge was >46% was 4.775 (95% confidence interval (CI) 1.76 - 12.83, P < 0.002). The odds ratio of the patients whose BNP level at discharge was >300 pg/mL and whose percentage decrease at discharge was <46% compared to the group whose BNP level at discharge was <300 pg/mL and whose percentage decrease at discharge was >46% was 9.614 (CI 4.51 - 20.47, P < 0.001).
  
  
  CONCLUSIONS
  A reduction of BNP >46% at hospital discharge compared to the admission levels coupled with a BNP absolute value < 300 pg/mL seems to be a very powerful negative prognostic value for future cardiovascular outcomes in patients hospitalized with ADHF.
authors.affiliation: Emergency Medicine Department, II Medical School University La Sapienza, Sant'Andrea Hospital, via di Grottarossa, 1039 Roma 00189, Italy. salvatore.disomma@uniroma1.it
authors.forename: Salvatore
authors.initials: S
authors.lastname: Di Somma
authors.forename: Laura
authors.initials: L
authors.lastname: Magrini
authors.forename: Valerio
authors.initials: V
authors.lastname: Pittoni
authors.forename: Rossella
authors.initials: R
authors.lastname: Marino
authors.forename: Antonella
authors.initials: A
authors.lastname: Mastrantuono
authors.forename: Enrico
authors.initials: E
authors.lastname: Ferri
authors.forename: Paola
authors.initials: P
authors.lastname: Ballarino
authors.forename: Andrea
authors.initials: A
authors.lastname: Semplicini
authors.forename: Giuliano
authors.initials: G
authors.lastname: Bertazzoni
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Carpinteri
authors.forename: Paolo
authors.initials: P
authors.lastname: Mulè
authors.forename: Maria
authors.initials: M
authors.lastname: Pazzaglia
authors.forename: Kevin
authors.initials: K
authors.lastname: Shah
authors.forename: Alan
authors.initials: A
authors.lastname: Maisel
authors.forename: Paul
authors.initials: P
authors.lastname: Clopton
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006333:Heart Failure / Q000097:blood* / Q000150:complications / Q000503:physiopathology; D006801:Humans; D007297:Inpatients; D007558:Italy; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011379:Prognosis
chemical_list: D020097:Natriuretic Peptide, Brain