title: Brain natriuretic peptide at discharge as a predictor of 6-month mortality in acute decompensated heart failure.
abstract: BACKGROUND
  Brain natriuretic peptide (BNP) is well established in detecting acute decompensation of heart failure (ADHF). The role of BNP at discharge in predicting mortality is less established. Accumulating evidence suggests that inflammatory cytokines play an important role in the development of heart failure. We aimed to examine the contribution of BNP, interleukin 6, and procalcitonin to mortality in ADHF.
  
  
  METHODS
  A cohort of 33 patients with ADHF was identified between March 2009 and June 2010 at Rambam Health Care Campus, Haifa, Israel. The cohort was followed up for all-cause mortality during 6 months after hospital discharge. Cox proportional hazard model was used to assess the association between BNP, interleukin-6 and procalcitonin and all-cause mortality.
  
  
  RESULTS
  As compared to BNP at admission, BNP at discharge was more predictive for all-cause mortality. The area under the curve for BNP at admission and discharge was 0.810 (P=.004) and 0.864 (P=.001) respectively. Eleven patients (33.3%) patients who died during the follow-up period had higher BNP levels, median 2031.4 (IQR, 1173.4-2707.2), than those who survived; median 692.5 (IQR, 309.9-1159.9), (P = .001). On multivariate analysis, BNP remained an independent predictor for 6 month all-cause mortality HR 9.58 (95% CI, 2.0-45.89) for levels above the median compared to lower levels, (P=.005). Albumin, procalcitonin and interleukin 6 were not associated with all-cause mortality.
  
  
  CONCLUSIONS
  BNP at discharge is an independent predictor for all-cause mortality in patients with ADHF. Compared with BNP at admission, BNP at discharge has slightly higher predictive accuracy with regard to 6-month all-cause mortality.
authors.affiliation: Department of Internal Medicine B, Rambam Health Care Campus, Haifa, Israel; Ruth & Bruce Rappaport Faculty of Medicine.
authors.forename: Mohammad
authors.initials: M
authors.lastname: Naffaa
authors.affiliation: Department of Internal Medicine B, Rambam Health Care Campus, Haifa, Israel; Ruth & Bruce Rappaport Faculty of Medicine.
authors.forename: Badira F
authors.initials: BF
authors.lastname: Makhoul
authors.affiliation: Department of Internal Medicine B, Rambam Health Care Campus, Haifa, Israel; Ruth & Bruce Rappaport Faculty of Medicine.
authors.forename: Amjad
authors.initials: A
authors.lastname: Tobia
authors.affiliation: Department of Internal Medicine B, Rambam Health Care Campus, Haifa, Israel.
authors.forename: Mishel
authors.initials: M
authors.lastname: Jarous
authors.affiliation: Ruth & Bruce Rappaport Faculty of Medicine; The Laboratory of Clinical Biochemistry, Rambam Health Care Campus, Haifa, Israel.
authors.forename: Marielle
authors.initials: M
authors.lastname: Kaplan
authors.affiliation: Ruth & Bruce Rappaport Faculty of Medicine; Heart Institute, Rambam Health Care Campus, Haifa, Israel; The Rappaport Family Institute for Research in the Medical Sciences. Technion, Israel Institute of Technology, Haifa, Israel.
authors.forename: Doron
authors.initials: D
authors.lastname: Aronson
authors.affiliation: Ruth & Bruce Rappaport Faculty of Medicine; Internal Medicine C, Ha'emek Medical Center, Afula, Israel.
authors.forename: Walid
authors.initials: W
authors.lastname: Saliba
authors.affiliation: Department of Internal Medicine B, Rambam Health Care Campus, Haifa, Israel; Ruth & Bruce Rappaport Faculty of Medicine; The Rappaport Family Institute for Research in the Medical Sciences. Technion, Israel Institute of Technology, Haifa, Israel. Electronic address: z_azzam@rambam.health.gov.il.
authors.forename: Zaher S
authors.initials: ZS
authors.lastname: Azzam
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D002116:Calcitonin / Q000097:blood; D015740:Calcitonin Gene-Related Peptide; D015331:Cohort Studies; D005260:Female; D006333:Heart Failure / Q000097:blood / Q000401:mortality*; D006801:Humans; D015850:Interleukin-6 / Q000097:blood; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010351:Patient Discharge / Q000706:statistics & numerical data; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011498:Protein Precursors / Q000097:blood
chemical_list: C000606589:CALCA protein, human; D015850:Interleukin-6; D011498:Protein Precursors; D020097:Natriuretic Peptide, Brain; D002116:Calcitonin; D015740:Calcitonin Gene-Related Peptide