title: A comparison of NT-proBNP and albuminuria for predicting cardiac events in patients with diabetes mellitus.
abstract: OBJECTIVE
  Cardiovascular events are the most relevant events in patients with diabetes mellitus. We aimed to compare the predictive values of N-terminal pro-brain natriuretic peptide (NT-proBNP) and the state-of-the-art marker, albuminuria, for cardiac events in diabetic patients.
  
  
  METHODS
  In this prospective observational study we recruited 1071 patients with diabetes mellitus. NT-proBNP and albuminuria ⊟ defined as a urinary albumin/creatinine ratio >30 mg/g were measured at baseline. Patients were followed during a mean observation period of 33.1 months. A total of 103 patients reached the defined endpoint (unplanned hospitalization due to a cardiac event or death).
  
  
  RESULTS
  The mean duration of diabetes was 15 ± 12 years and the mean HbA(1c) was 7.5 ± 3.1%. At baseline, 23.7% of the patients presented with albuminuria and 36.6% had plasma NT-proBNP values >125 pg/ml. Multiple Cox regression analysis including age, gender, duration of diabetes HbA(1c), albuminuria, and lnNT-proBNP revealed that lnNT-proBNP (hazard ratio 2.314; 95% CI 1.914-2.798, p < 0.001) was a better predictor than albuminuria (HR 1.544; 95% CI 1.007-2.368, p = 0.047) or age (HR 1.030; 95% CI 1.008-1.053, p = 0.007). Calculating different Cox-models with (A) albuminuria, (B) NT-proBNP, or (C) both in the model revealed that the C-index was best if NT-proBNP was entered in the model (C-index for A 0.735, for B 0.809, and for C 0.786). Kaplan-Meier analysis demonstrated that albuminuria does not add substantial information if NT-proBNP is entered into the model.
  
  
  CONCLUSIONS
  NT-proBNP was superior to albuminuria for predicting cardiac events.
authors.affiliation: Department of Internal Medicine II, Division of Cardiology, Medical University Vienna, Austria.
authors.forename: Martin
authors.initials: M
authors.lastname: Clodi
authors.forename: Michael
authors.initials: M
authors.lastname: Resl
authors.forename: Stephanie
authors.initials: S
authors.lastname: Neuhold
authors.forename: Martin
authors.initials: M
authors.lastname: Hülsmann
authors.forename: Greisa
authors.initials: G
authors.lastname: Vila
authors.forename: Marie
authors.initials: M
authors.lastname: Elhenicky
authors.forename: Guido
authors.initials: G
authors.lastname: Strunk
authors.forename: Heidemarie
authors.initials: H
authors.lastname: Abrahamian
authors.forename: Rudolf
authors.initials: R
authors.lastname: Prager
authors.forename: Anton
authors.initials: A
authors.lastname: Luger
authors.forename: Richard
authors.initials: R
authors.lastname: Pacher
mesh_terms: D000419:Albuminuria / Q000150:complications* / Q000453:epidemiology; D001317:Austria / Q000453:epidemiology; D002318:Cardiovascular Diseases / Q000097:blood / Q000453:epidemiology* / Q000209:etiology; D048909:Diabetes Complications / Q000097:blood / Q000453:epidemiology*; D003920:Diabetes Mellitus / Q000097:blood*; D005260:Female; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D011379:Prognosis; D011446:Prospective Studies; D011498:Protein Precursors
chemical_list: D006442:Glycated Hemoglobin; D020097:Natriuretic Peptide, Brain; D010446:Peptide Fragments; D011498:Protein Precursors; C109794:pro-brain natriuretic peptide (1-76)