title: Direct comparison of serial B-type natriuretic peptide and NT-proBNP levels for prediction of short- and long-term outcome in acute decompensated heart failure.
abstract: BACKGROUND
  Monitoring treatment efficacy and assessing outcome by serial measurements of natriuretic peptides in acute decompensated heart failure (ADHF) patients may help to improve outcome.
  
  
  METHODS
  This was a prospective multi-center study of 171 consecutive patients (mean age 80 73-85 years) presenting to the emergency department with ADHF. Measurement of BNP and NT-proBNP was performed at presentation, 24 hours, 48 hours and at discharge. The primary endpoint was one-year all-cause mortality; secondary endpoints were 30-days all-cause mortality and one-year heart failure (HF) readmission.
  
  
  RESULTS
  During one-year follow-up, a total of 60 (35%) patients died. BNP and NT-proBNP levels were higher in non-survivors at all time points (all P < 0.001). In survivors, treatment reduced BNP and NT-proBNP levels by more than 50% (P < 0.001), while in non-survivors treatment did not lower BNP and NT-proBNP levels. The area under the ROC curve (AUC) for the prediction of one-year mortality increased during the course of hospitalization for BNP (AUC presentation: 0.67; AUC 24 h: 0.77; AUC 48 h: 0.78; AUC discharge: 0.78) and NT-proBNP (AUC presentation: 0.67; AUC 24 h: 0.73; AUC 48 h: 0.75; AUC discharge: 0.77). In multivariate analysis, BNP at 24 h (1.02 [1.01-1.04], P = 0.003), 48 h (1.04 [1.02-1.06], P < 0.001) and discharge (1.02 [1.01-1.03], P < 0.001) independently predicted one-year mortality, while only pre-discharge NT-proBNP was predictive (1.07 [1.01-1.13], P = 0.016). Comparable results could be obtained for the secondary endpoint 30-days mortality but not for one-year HF readmissions.
  
  
  CONCLUSIONS
  BNP and NT-proBNP reliably predict one-year mortality in patients with ADHF. Prognostic accuracy of both biomarker increases during the course of hospitalization. In survivors BNP levels decline more rapidly than NT-proBNP levels and thus seem to allow earlier assessment of treatment efficacy. Ability to predict one-year HF readmission was poor for BNP and NT-proBNP.
  
  
  BACKGROUND
  ClinicalTrials.gov identifier: NCT00514384.
authors.affiliation: Department of Internal Medicine, University Hospital Basel, Petersgraben 4, 4053 Basel, Switzerland. noveanum@uhbs.ch
authors.forename: Markus
authors.initials: M
authors.lastname: Noveanu
authors.forename: Tobias
authors.initials: T
authors.lastname: Breidthardt
authors.forename: Mihael
authors.initials: M
authors.lastname: Potocki
authors.forename: Tobias
authors.initials: T
authors.lastname: Reichlin
authors.forename: Raphael
authors.initials: R
authors.lastname: Twerenbold
authors.forename: Heiko
authors.initials: H
authors.lastname: Uthoff
authors.forename: Thenral
authors.initials: T
authors.lastname: Socrates
authors.forename: Nisha
authors.initials: N
authors.lastname: Arenja
authors.forename: Miriam
authors.initials: M
authors.lastname: Reiter
authors.forename: Julia
authors.initials: J
authors.lastname: Meissner
authors.forename: Corinna
authors.initials: C
authors.lastname: Heinisch
authors.forename: Sybille
authors.initials: S
authors.lastname: Stalder
authors.forename: Christian
authors.initials: C
authors.lastname: Mueller
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D004636:Emergency Service, Hospital; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000097:blood* / Q000401:mortality / Q000628:therapy; D006801:Humans; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D013557:Switzerland / Q000453:epidemiology; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain