title: Incremental utility of prognostic variables at discharge for risk prediction in hospitalized patients with acutely decompensated chronic heart failure.
abstract: OBJECTIVE
  To assess the incremental prognostic utility of discharge serum creatinine (SCr), systolic blood pressure (SBP), and NT-proBNP and sodium concentrations in hospitalized patients with acutely decompensated chronic heart failure.
  
  
  BACKGROUND
  Whether key prognostic variables at discharge provide incremental prognostic information beyond that provided by a model based on admission variables (referent) remains incompletely defined.
  
  
  METHODS
  The primary outcome was a composite of death, urgent heart transplantation, or ventricular assist device implantation at 1 year. The gain in predictive performance was assessed using C index, Bayesian Information Criterion, and Net Reclassification Improvement.
  
  
  RESULTS
  The best fit was obtained when discharge NT-proBNP was added to the referent model. No interaction between admission and discharge NT-proBNP was found. Discharge SCr, SBP, and sodium did not improve goodness-of-fit.
  
  
  CONCLUSIONS
  Admission and discharge NT-proBNP provide complementary and independent prognostic information; as such, they should be taken into account concurrently.
authors.affiliation: Division of Cardiology and Cardiac Rehabilitation, "S. Maugeri" Foundation, IRCCS, Institute of Cassano Murge, Bari, Italy. Electronic address: domenico.scrutinio@fsm.it.
authors.forename: Domenico
authors.initials: D
authors.lastname: Scrutinio
authors.affiliation: Division of Cardiology and Cardiac Rehabilitation, "S. Maugeri" Foundation, IRCCS, Institute of Cassano Murge, Bari, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Passantino
authors.affiliation: Division of Cardiology and Cardiac Rehabilitation, "S. Maugeri" Foundation, IRCCS, Institute of Cassano Murge, Bari, Italy.
authors.forename: Pietro
authors.initials: P
authors.lastname: Guida
authors.affiliation: Cardiothoracic and Vascular Department, Niguarda Ca' Granda Hospital, Milan, Italy.
authors.forename: Enrico
authors.initials: E
authors.lastname: Ammirati
authors.affiliation: Cardiothoracic and Vascular Department, Niguarda Ca' Granda Hospital, Milan, Italy.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Oliva
authors.affiliation: Division of Cardiology and Cardiac Rehabilitation, "S. Maugeri" Foundation, IRCCS, Institute of Cassano Murge, Bari, Italy.
authors.forename: Rocco
authors.initials: R
authors.lastname: Lagioia
authors.affiliation: Division of Cardiology and Cardiac Rehabilitation, "S. Maugeri" Foundation, IRCCS, Institute of Tradate, Varese, Italy.
authors.forename: Simona
authors.initials: S
authors.lastname: Sarzi Braga
authors.affiliation: Centro Cardiologico Monzino, IRCCS, Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
authors.forename: Piergiuseppe
authors.initials: P
authors.lastname: Agostoni
authors.affiliation: Cardiothoracic and Vascular Department, Niguarda Ca' Granda Hospital, Milan, Italy.
authors.forename: Maria
authors.initials: M
authors.lastname: Frigerio
mesh_terms: D000368:Aged; D001499:Bayes Theorem; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D016027:Heart Transplantation; D006353:Heart-Assist Devices; D006760:Hospitalization / Q000639:trends; D006801:Humans; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D008297:Male; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment / Q000706:statistics & numerical data*; D012307:Risk Factors; D013997:Time Factors
keywords: Acutely decompensated chronic heart failure; Admission N-terminal Pro-B-Type natriuretic peptide; Discharge N-terminal Pro-B-Type natriuretic peptide; Prognosis; Risk stratification