title: Discharge BNP is a stronger predictor of 6-month mortality in acute heart failure compared with baseline BNP and admission-to-discharge percentage BNP reduction.
abstract: BACKGROUND
  Prior studies found a significant relationship between admission B-type natriuretic peptide (BNP), discharge BNP and admission-to-discharge percentage BNP reduction and post-discharge mortality in acute heart failure (HF).
  
  
  METHODS
  The ESCAPE trial data was utilized to identify which of these BNP parameters best predicts 6-month all-cause mortality.
  
  
  RESULTS
  433 patients (mean age 56years, 74% men) included in our analysis had an admission BNP, discharge BNP and admission-to-discharge percentage BNP reduction of 1009pg/mL, 743pg/mL and -70%, respectively. There were significant differences between survivors and nonsurvivors with regards to admission BNP (P=0.001), discharge BNP (P=0.0001) and admission-to-discharge percentage BNP reduction (P=0.01). Discharge BNP had the highest area under the curve (AUC) for predicting mortality (AUC=0.702, P<0.001) followed by admission BNP (AUC=0.633, P=0.0006) then percentage BNP reduction (AUC=0.620, P=0.008). Comparison of AUC revealed a significant difference between discharge BNP and admission BNP (difference between areas 0.087, P=0.0223) and a trend towards significance when comparing AUC of discharge BNP with percentage BNP reduction (P=0.0637). Kaplan-Meier analysis showed a significant difference in survival according to optimum cutoff values of discharge BNP of 319pg/mL (log-rank P<0.001), admission BNP of 912pg/mL (P<0.001) and percentage BNP reduction of 7.71% (P=0.008). Cox-proportional-hazard-analysis revealed that discharge BNP is an independent predictor of 6-month mortality (hazard ratio=1.063, 95% CI=1.037-1.089, P<0.001). The combination of a discharge BNP ≤319pg/mL and percentage BNP reduction ≥7.71% was associated with significantly lower mortality (4.8% versus 27.2%, relative risk=0.134, 95% CI=0.046-0.387, P<0.001).
  
  
  CONCLUSIONS
  The absolute BNP value at discharge is a more accurate predictor of 6-month mortality than the magnitude of percentage in-hospital BNP reduction and baseline BNP.
authors.affiliation: Internal Medicine Department, Mercy Medical Center, Clinton, Iowa, USA. Electronic address: hesham.omar@apogeephysicians.com.
authors.forename: Hesham R
authors.initials: HR
authors.lastname: Omar
authors.affiliation: Division of Cardiovascular Medicine, Linda and Jack Gill Heart Institute, University of Kentucky, Lexington, KY, USA.
authors.forename: Maya
authors.initials: M
authors.lastname: Guglin
mesh_terms: D000208:Acute Disease; D061827:Dimensional Measurement Accuracy; D005260:Female; D006333:Heart Failure / Q000097:blood / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000032:analysis / Q000097:blood; D010351:Patient Discharge; D010359:Patient Readmission / Q000706:statistics & numerical data; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods; D014481:United States / Q000453:epidemiology
chemical_list: D020097:Natriuretic Peptide, Brain
keywords: B-type natriuretic peptide; Heart failure; Mortality; Rehospitalization