title: Heterogeneity of the prognostic significance of B-type natriuretic peptide levels on admission in patients hospitalized for acute heart failure syndromes.
abstract: BACKGROUND
  We hypothesized that variation in baseline characteristics of patients with acute heart failure syndromes (AHFS) affects the prognostic significance of B-type natriuretic peptide (BNP) levels because of heterogeneity of this patient population. We evaluated the association of elevated BNP levels on admission with an increased risk of adverse clinical outcomes in subgroups of patients hospitalized for AHFS.
  
  
  METHODS
  This study included patients from the acute decompensated heart failure syndromes (ATTEND) study, a multicenter prospective cohort of 4501 AHFS patients with BNP data on admission.
  
  
  RESULTS
  The geometric mean BNP level was 654.9pg/mL (95% confidence interval: 636.1-674.2), and the optimal cut-off value for all-cause death was 1157pg/mL. All-cause mortality after admission was significantly higher in patients with high BNP levels (>1157pg/mL) than in those with low BNP levels (≤1157pg/mL) (median follow-up: 508days, log-rank P<0.001). Subgroup analyses were performed to evaluate the heterogeneity of the prognostic significance of BNP levels. The effect of high BNP levels on the risk of all-cause mortality was significantly greater in the subgroup of patients with a non-hypertensive etiology, low creatinine levels (<1.3mg/dL), and high sodium levels (≥135mEq/L) than in those without these factors (P=0.024, P<0.001, and P<0.001 for the interaction, respectively).
  
  
  CONCLUSIONS
  The present analysis shows that underlying etiology of heart failure (i.e., hypertensive), renal function, and sodium levels should be considered for assessing the clinical significance of elevated BNP levels on admission in relation to the risk of adverse outcome after hospitalization for AHFS.
authors.affiliation: Department of Cardiology, Tokyo Women's Medical University, Tokyo 162-8666, Japan. Electronic address: yuichiro24@celery.ocn.ne.jp.
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Minami
authors.affiliation: Division of Cardiology, Towa Hospital, Tokyo 120-0003, Japan.
authors.forename: Katsuya
authors.initials: K
authors.lastname: Kajimoto
authors.affiliation: Internal Medicine, Cardiology, and Intensive Care Unit, Nippon Medical School Musashi-Kosugi Hospital, Kawasaki 211-8533, Japan.
authors.forename: Naoki
authors.initials: N
authors.lastname: Sato
authors.affiliation: Department of Cardiology, Tokyo Women's Medical University, Tokyo 162-8666, Japan.
authors.forename: Nobuhisa
authors.initials: N
authors.lastname: Hagiwara
authors.affiliation: Department of Internal Medicine, Nippon Medical School, Tokyo 113-8603, Japan.
authors.forename: Teruo
authors.initials: T
authors.lastname: Takano
authors.affiliation: University Paris Diderot, PRES Sorbonne Paris Cité and Department of Anesthesiology and Critical Care Medicine, Hôpitaux Universitaires Saint-Louis-Lariboisière, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris 75010, France.
authors.forename: Alexandre
authors.initials: A
authors.lastname: Mebazaa
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D003404:Creatinine / Q000097:blood; D005260:Female; D006333:Heart Failure / Q000097:blood*; D006760:Hospitalization; D006801:Humans; D007564:Japan; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D009026:Mortality; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D018570:Risk Assessment / Q000379:methods*; D012964:Sodium / Q000097:blood
chemical_list: D020097:Natriuretic Peptide, Brain; D012964:Sodium; D003404:Creatinine
keywords: B-type natriuretic peptide; Heart failure; Prognosis; Risk stratification