title: Incremental value of B-type natriuretic peptide for early risk prediction of infective endocarditis.
abstract: BACKGROUND
  Early and accurate risk prediction is an unmet clinical need in patients with infective endocarditis (IE). The aim of this study was to determine the value of B-type natriuretic peptide (BNP) levels obtained on admission for the prediction of in-hospital death in IE patients.
  
  
  METHODS
  Between 2009 and 2011, consecutive patients with IE diagnosed using the revised Duke criteria and admitted to the emergency department were evaluated prospectively. BNP levels were measured on admission. Death during hospitalization was the primary endpoint.
  
  
  RESULTS
  Among 104 consecutive patients with IE and with available BNP levels, 34 (32.7%) died in hospital. BNP levels were significantly higher in patients who died as compared to survivors (709.0 pg/ml vs. 177.5 pg/ml, p<0.001). The accuracy of BNP to predict death as quantified by the area under the receiver operating characteristics curve was 0.826 (95% confidence interval (CI) 0.747-0.905). The value of BNP was additive to that provided by clinical, microbiological, and echocardiography assessment. On multivariate analysis, new heart failure (hazard ratio (HR) 2.02, 95% CI 1.15-3.57, p=0.015), sepsis (HR 2.10, 95% CI 1.25-3.55, p=0.005), Staphylococcus aureus endocarditis (HR 2.67, 95% CI 1.60-4.45, p<0.001), left ventricular ejection fraction ≤55% (HR 1.63, 95% CI 1.00-2.65, p=0.047), and BNP (HR 1.04, 95% CI 1.02-1.06, p<0.001) were independent predictors of in-hospital mortality.
  
  
  CONCLUSIONS
  Among patients with IE, BNP levels obtained on admission provide incremental value for early and accurate risk prediction.
authors.affiliation: Heart Institute (InCor), University of São Paulo Medical School, Av. Dr. Eneas de Carvalho Aguiar, 44, Bloco 1, sala CCIH, Cerqueira Cesar, São Paulo, SP 05403-000, Brazil. Electronic address: rinaldo_focaccia@uol.com.br.
authors.forename: Rinaldo Focaccia
authors.initials: RF
authors.lastname: Siciliano
authors.affiliation: Heart Institute (InCor), University of São Paulo Medical School, Av. Dr. Eneas de Carvalho Aguiar, 44, Bloco 1, sala CCIH, Cerqueira Cesar, São Paulo, SP 05403-000, Brazil.
authors.forename: Danielle Menosi
authors.initials: DM
authors.lastname: Gualandro
authors.affiliation: Cardiology, University Hospital Basel, Basel, Switzerland.
authors.forename: Christian
authors.initials: C
authors.lastname: Mueller
authors.affiliation: Heart Institute (InCor), University of São Paulo Medical School, Av. Dr. Eneas de Carvalho Aguiar, 44, Bloco 1, sala CCIH, Cerqueira Cesar, São Paulo, SP 05403-000, Brazil.
authors.forename: Luis Fernando Bernal da Costa
authors.initials: LF
authors.lastname: Seguro
authors.affiliation: Heart Institute (InCor), University of São Paulo Medical School, Av. Dr. Eneas de Carvalho Aguiar, 44, Bloco 1, sala CCIH, Cerqueira Cesar, São Paulo, SP 05403-000, Brazil.
authors.forename: Priscila Gherardi
authors.initials: PG
authors.lastname: Goldstein
authors.affiliation: Heart Institute (InCor), University of São Paulo Medical School, Av. Dr. Eneas de Carvalho Aguiar, 44, Bloco 1, sala CCIH, Cerqueira Cesar, São Paulo, SP 05403-000, Brazil.
authors.forename: Tania Mara Varejao
authors.initials: TM
authors.lastname: Strabelli
authors.affiliation: Heart Institute (InCor), University of São Paulo Medical School, Av. Dr. Eneas de Carvalho Aguiar, 44, Bloco 1, sala CCIH, Cerqueira Cesar, São Paulo, SP 05403-000, Brazil.
authors.forename: Vanessa
authors.initials: V
authors.lastname: Arias
authors.affiliation: Heart Institute (InCor), University of São Paulo Medical School, Av. Dr. Eneas de Carvalho Aguiar, 44, Bloco 1, sala CCIH, Cerqueira Cesar, São Paulo, SP 05403-000, Brazil.
authors.forename: Tarso Augusto Duenhas
authors.initials: TA
authors.lastname: Accorsi
authors.affiliation: Heart Institute (InCor), University of São Paulo Medical School, Av. Dr. Eneas de Carvalho Aguiar, 44, Bloco 1, sala CCIH, Cerqueira Cesar, São Paulo, SP 05403-000, Brazil.
authors.forename: Max
authors.initials: M
authors.lastname: Grinberg
authors.affiliation: Heart Institute (InCor), University of São Paulo Medical School, Av. Dr. Eneas de Carvalho Aguiar, 44, Bloco 1, sala CCIH, Cerqueira Cesar, São Paulo, SP 05403-000, Brazil.
authors.forename: Alfredo Jose
authors.initials: AJ
authors.lastname: Mansur
authors.affiliation: Heart Institute (InCor), University of São Paulo Medical School, Av. Dr. Eneas de Carvalho Aguiar, 44, Bloco 1, sala CCIH, Cerqueira Cesar, São Paulo, SP 05403-000, Brazil.
authors.forename: Mucio Tavares
authors.initials: MT
authors.lastname: de Oliveira
mesh_terms: D004697:Endocarditis, Bacterial / Q000097:blood / Q000401:mortality*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D011446:Prospective Studies; D012372:ROC Curve; D012307:Risk Factors
chemical_list: D020097:Natriuretic Peptide, Brain
keywords: B-type natriuretic peptide; Endocarditis; Mortality; Risk prediction