title: NT-proBNP and Its Correlation with In-Hospital Mortality in the Very Elderly without an Admission Diagnosis of Heart Failure.
abstract: BACKGROUND
  The diagnosis of heart failure (HF) is often difficult and underestimated in very elderly comorbid patients, especially when an echocardiographic evaluation is not available or feasible.
  
  
  OBJECTIVE
  to evaluate NT-proBNP values and their correlation with in-hospital mortality in a population of very elderly hospitalized for medical conditions other than HF.
  
  
  METHODS
  We performed a prospective observational study on 403 very elderly admitted to an Internal Medicine and Geriatrics Department. Exclusion criterion was an admission diagnosis of HF. Patients with at least one symptom or sign compatible with HF were tested for NT-proBNP. NT-proBNP values < 300 pg/ml were considered as an age-independent exclusion criterion for HF (high negative predictive value), while NT-proBNP values ≥ 1800 pg/ml were considered as a diagnostic criterion. Main comorbidities and laboratory parameters were considered to adjust regression analyses between NT-proBNP and in-hospital mortality.
  
  
  RESULTS
  NT-proBNP values ≥ 1800 pg/ml were present in 61.0% of patients and 32.8% of patients laid between 300 ≤ NT-proBNP < 1800 pg/ml values. NT-proBNP values were associated with the main indices of disease severity/organ failure considered such as reduced eGFR, reduced albumin and elevated CRP. NT-proBNP values ≥ 1800 pg/ml and ln(NT-proBNP) values were significantly associated with in-hospital mortality independently from the main comorbidities and lab parameters considered. The patients, who were already taking ACE inhibitors/Angiotensin Receptor Blockers before admission, showed lower in-hospital mortality.
  
  
  CONCLUSIONS
  Testing for NT-proBNP should be strongly recommended in the hospitalized very elderly, because of the very high prevalence of underlying HF and its impact on in-hospital mortality, to identify an underlying cardiac involvement that requires appropriate treatment.
authors.affiliation: Italian National Research Centre on Aging "U.Sestilli", IRCCS-INRCA, Ancona, Italy.|Internal Medicine and Geriatrics, Department of Clinical and Molecular Sciences, University "Politecnica delle Marche", Ancona, Italy.
authors.forename: Riccardo
authors.identifier: http://orcid.org/0000-0002-5159-0181
authors.initials: R
authors.lastname: Sarzani
authors.affiliation: Italian National Research Centre on Aging "U.Sestilli", IRCCS-INRCA, Ancona, Italy.|Internal Medicine and Geriatrics, Department of Clinical and Molecular Sciences, University "Politecnica delle Marche", Ancona, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Spannella
authors.affiliation: Italian National Research Centre on Aging "U.Sestilli", IRCCS-INRCA, Ancona, Italy.|Internal Medicine and Geriatrics, Department of Clinical and Molecular Sciences, University "Politecnica delle Marche", Ancona, Italy.
authors.forename: Federico
authors.initials: F
authors.lastname: Giulietti
authors.affiliation: Italian National Research Centre on Aging "U.Sestilli", IRCCS-INRCA, Ancona, Italy.
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Fedecostante
authors.affiliation: Italian National Research Centre on Aging "U.Sestilli", IRCCS-INRCA, Ancona, Italy.|Internal Medicine and Geriatrics, Department of Clinical and Molecular Sciences, University "Politecnica delle Marche", Ancona, Italy.
authors.forename: Piero
authors.initials: P
authors.lastname: Giordano
authors.affiliation: Italian National Research Centre on Aging "U.Sestilli", IRCCS-INRCA, Ancona, Italy.|Internal Medicine and Geriatrics, Department of Clinical and Molecular Sciences, University "Politecnica delle Marche", Ancona, Italy.
authors.forename: Pisana
authors.initials: P
authors.lastname: Gattafoni
authors.affiliation: Italian National Research Centre on Aging "U.Sestilli", IRCCS-INRCA, Ancona, Italy.|Internal Medicine and Geriatrics, Department of Clinical and Molecular Sciences, University "Politecnica delle Marche", Ancona, Italy.
authors.forename: Emma
authors.initials: E
authors.lastname: Espinosa
authors.affiliation: Italian National Research Centre on Aging "U.Sestilli", IRCCS-INRCA, Ancona, Italy.|Clinical Analysis Laboratory, Italian National Research Centre on Aging "U.Sestilli", IRCCS-INRCA, Ancona, Italy.
authors.forename: Franco
authors.initials: F
authors.lastname: Busco
authors.affiliation: Clinical Analysis Laboratory, Italian National Research Centre on Aging "U.Sestilli", IRCCS-INRCA, Ancona, Italy.
authors.forename: Gina
authors.initials: G
authors.lastname: Piccinini
authors.affiliation: Italian National Research Centre on Aging "U.Sestilli", IRCCS-INRCA, Ancona, Italy.|Internal Medicine and Geriatrics, Department of Clinical and Molecular Sciences, University "Politecnica delle Marche", Ancona, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Dessì-Fulgheri
mesh_terms: D000369:Aged, 80 and over; D005260:Female; D006333:Heart Failure / Q000175:diagnosis*; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000378:metabolism*; D010446:Peptide Fragments / Q000378:metabolism*; D011446:Prospective Studies
chemical_list: D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain