title: Predictors of natriuretic peptide non-response in patients hospitalized with acute heart failure.
abstract: Increasing natriuretic peptide (NP) levels are associated with worse heart failure (HF) outcomes. Predictors of NP nonresponse have not been studied. The aim of this study was to identify predictors of nondecreasing NP levels during episodes of acute HF. A retrospective analysis was conducted in patients prospectively included in a registry of acute HF, with the primary diagnosis of acute HF. The objective under analysis was B-type NP (BNP) response, defined as a >30% decrease in BNP during hospitalization. Percentage of BNP variation was calculated as: % BNP variation = [(admission BNP - discharge BNP)/admission BNP] × 100. A logistic regression analysis was performed to study potential predictors of NP nonresponse. A multivariate model was built. A total of 496 patients were studied: 28.2% were considered nonresponders to the implemented HF treatment strategy. Identified predictors of nonresponse were older age, chronic HF, lower admission systolic blood pressure, anemia, renal dysfunction, and lower sodium on admission, as well as lower admission albumin and lower admission total cholesterol. Admission BNP was not a predictor of response. The only identified independent predictor of nonresponse was a low admission total cholesterol level (cutoff 125 mg/dl), with an odds ratio of 2.55 (95% confidence interval 1.59 to 4.11). This remained valid when the analysis was stratified according to admission BNP (cutoff 2,000 pg/ml) and according to statin use. In conclusion, a low admission total cholesterol level was a strong and independent predictor of BNP nonresponse in patients admitted with acute HF. The ability of cholesterol to predict BNP nonresponse was valid for patients with intrinsically low cholesterol and in those with statin-induced low cholesterol.
authors.affiliation: Serviço de Medicina Interna, Centro Hospitalar São João, Porto, Portugal. Electronic address: anamfr@gmail.com.
authors.forename: Ana
authors.initials: A
authors.lastname: Ribeiro
authors.affiliation: Serviço de Medicina Interna, Centro Hospitalar São João, Porto, Portugal; Faculdade de Medicina da Universidade do Porto, Unidade I&D Cardiovascular do Porto, Porto, Portugal.
authors.forename: Patrícia
authors.initials: P
authors.lastname: Lourenço
authors.affiliation: Serviço de Medicina Interna, Centro Hospitalar São João, Porto, Portugal; Instituto de Anatomia da Faculdade de Medicina da Universidade do Porto, Porto, Portugal.
authors.forename: Sérgio
authors.initials: S
authors.lastname: Silva
authors.affiliation: Serviço de Medicina Interna, Centro Hospitalar São João, Porto, Portugal.
authors.forename: Francisco
authors.initials: F
authors.lastname: Cunha
authors.affiliation: Serviço de Medicina Interna, Centro Hospitalar São João, Porto, Portugal.
authors.forename: João
authors.initials: J
authors.lastname: Vilaça
authors.affiliation: Serviço de Medicina Interna, Centro Hospitalar São João, Porto, Portugal.
authors.forename: Filipa
authors.initials: F
authors.lastname: Gomes
authors.affiliation: Serviço de Medicina Interna, Centro Hospitalar São João, Porto, Portugal; Faculdade de Medicina da Universidade do Porto, Unidade I&D Cardiovascular do Porto, Porto, Portugal.
authors.forename: José Paulo
authors.initials: JP
authors.lastname: Araújo
authors.affiliation: Serviço de Medicina Interna, Centro Hospitalar São João, Porto, Portugal; Faculdade de Medicina da Universidade do Porto, Unidade I&D Cardiovascular do Porto, Porto, Portugal.
authors.forename: Paulo
authors.initials: P
authors.lastname: Bettencourt
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000097:blood* / Q000628:therapy; D006760:Hospitalization / Q000639:trends*; D006801:Humans; D008297:Male; D045265:Natriuretic Peptides / Q000097:blood*; D011237:Predictive Value of Tests; D011379:Prognosis; D012042:Registries; D012189:Retrospective Studies
chemical_list: D015415:Biomarkers; D045265:Natriuretic Peptides