Changes of natriuretic peptides predict hospital admissions in patients with chronic heart failure: a meta-analysis.
OBJECTIVE
The goal of this study was to explore the association between changes in B-type natriuretic peptide (BNP) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) plasma levels and risk of hospital admission for heart failure (HF) worsening in patients with chronic HF.


BACKGROUND
The relationship between BNP and NT-proBNP plasma levels and risk of cardiovascular events in patients with chronic HF has been previously demonstrated. However, it is unclear whether changes in BNP and NT-proBNP levels predict morbidity in patients with chronic HF.


METHODS
The MEDLINE, Cochrane, ISI Web of Science, and SCOPUS databases were searched for papers about HF treatment up to August 2013. Randomized trials enrolling patients with systolic HF, assessing BNP and/or NT-proBNP at baseline and at end of follow-up, and reporting hospital stay for HF were included in the analysis. Meta-regression analysis was performed to test the relationship between BNP and NT-proBNP changes and the clinical endpoint. Sensitivity analysis was performed to assess the influence of baseline variables on results. Egger's linear regression was used to assess publication bias.


RESULTS
Nineteen trials enrolling 12,891 participants were included. The median follow-up was 9.5 months (interquartile range: 6 to 18 months), and 22% of patients were women. Active treatments significantly reduced the risk of hospital stay for HF worsening. In meta-regression analysis, changes in BNP and NT-proBNP were significantly associated with risk of hospital stay for HF worsening. Results were confirmed by using sensitivity analysis. No publication bias was detected.


CONCLUSIONS
In patients with HF, reduction of BNP or NT-proBNP levels was associated with reduced risk of hospital stay for HF worsening.
Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy.
Gianluigi
G
Savarese
Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy.
Francesca
F
Musella
Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy.
Carmen
C
D'Amore
Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy.
Enrico
E
Vassallo
Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy.
Teresa
T
Losco
Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy.
Francesco
F
Gambardella
Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy.
Milena
M
Cecere
Department of Translational Medical Sciences, Federico II University of Naples, Naples, Italy.
Laura
L
Petraglia
Department of Translational Medical Sciences, Federico II University of Naples, Naples, Italy.
Gennaro
G
Pagano
Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy.
Luigi
L
Fimiani
Department of Translational Medical Sciences, Federico II University of Naples, Naples, Italy.
Giuseppe
G
Rengo
Department of Translational Medical Sciences, Federico II University of Naples, Naples, Italy.
Dario
D
Leosco
Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy.
Bruno
B
Trimarco
Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy. Electronic address: fpperron@unina.it.
Pasquale
P
Perrone-Filardi
D000368:Aged; D002908:Chronic Disease; D005260:Female; D006333:Heart Failure / Q000097:blood / Q000628:therapy*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000378:metabolism*; D010446:Peptide Fragments / Q000378:metabolism*; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D016896:Treatment Outcome
D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain
B-type natriuretic peptide; BNP; N-terminal pro–B-type natriuretic peptide; NT-proBNP; heart failure; meta-analysis