title: BNP and NT-proBNP as prognostic markers in persons with acute decompensated heart failure: a systematic review.
abstract: A systematic review was undertaken to examine the evidence for B-type natriuretic peptides (BNP and NT-proBNP) as independent predictors of mortality, morbidity, or combined mortality and morbidity outcomes in persons with acute decompensated heart failure (ADHF). Electronic databases (Medline(®), Embase™, AMED, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and CINAHL) were searched from 1989 to June 2012. Reference lists of included articles, systematic reviews, and the gray literature were also searched. English language studies were eligible if they included subjects with ADHF and measured BNP/NT-proBNP using FDA approved assays. Standardized forms were used to select studies, extract data, and assess risk of bias. Seventy-nine studies, ranging over followup intervals from 14 days to 7 years, evaluating levels of BNP (n = 38), NT-proBNP (n = 35), or both (n = 6) were eligible. The majority of studies predicted mortality outcomes for admission BNP/NT-proBNP levels, with fewer studies evaluating serial, change from admission, or discharge levels. In general, higher levels of admission BNP or NT-proBNP predicted greater risk for all outcomes. Decreased levels post-admission predicted decreased risk. Overall, these studies were rated as having moderate risk of bias. This systematic review shows that BNP and NT-proBNP are independent predictors of mortality (all-cause and cardiovascular) in ADHF despite different cutpoints, time intervals, and prognostic models. Findings for morbidity and composite outcomes were less frequently evaluated and showed inconsistency. Further research is required to assess cutpoints for admission, serial measurements, change following admission, and discharge levels to assist clinical decision-making.
authors: Department of Epidemiology and Biostatistics, McMaster University, Hamilton, Canada, Santag@mcmaster.ca.
authors: Pasqualina L
authors: PL
authors: Santaguida
authors: Andrew C
authors: AC
authors: Don-Wauchope
authors: Mark
authors: M
authors: Oremus
authors: Robert
authors: R
authors: McKelvie
authors: Usman
authors: U
authors: Ali
authors: Stephen A
authors: SA
authors: Hill
authors: Cynthia
authors: C
authors: Balion
authors: Ronald A
authors: RA
authors: Booth
authors: Judy A
authors: JA
authors: Brown
authors: Amy
authors: A
authors: Bustamam
authors: Nazmul
authors: N
authors: Sohel
authors: Parminder
authors: P
authors: Raina
mesh_terms: D014943:Global Health; D006333:Heart Failure / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology; D006801:Humans; D009017:Morbidity; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D011379:Prognosis; D015996:Survival Rate
chemical_list: D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain