title: N-terminal pro-brain natriuretic peptide is a strong predictor of mortality in systemic sclerosis.
abstract: OBJECTIVE
  Cardiovascular involvement is a major contributor to mortality in systemic sclerosis (SSc). We examined whether N-terminal pro-brain natriuretic peptide (NT-proBNP) is a reliable predictor of mortality in SSc.
  
  
  RESULTS
  This multicentre prospective cohort study included 523 patients presenting with SSc, whose mean age was 54±13years, mean disease duration 8±9years, and diffuse cutaneous form in 168. Plasma NT-proBNP was measured at baseline and the patients were followed yearly. Overall mortality was measured at 3years. At baseline, cardiovascular involvement was present in 37 patients, including 17 with pulmonary artery hypertension (PAH) and 20 with a left ventricular ejection fraction (LVEF) <55%. At 3years, 32 (7%) patients had died. The median [25th-75th percentile] NT-proBNP concentration was 203ng/l [129-514] in patients who died within 3years, versus 88ng/l [47-167] in survivors (P<0.001). NT-proBNP was an independent predictor of 3-years mortality in multivariate analysis (P=0.046). The optimal cut-off derived from the ROC curve was 129ng/l; sensitivity and specificity to predict 3y mortality were 78.1 and 66.7%. Using the previously recommended 125-ng/l concentration as threshold value, NT-proBNP reliably and independently predicted 3year mortality, with a sensitivity of 78.1 and a negative predictive value of 97.6%, respectively (P=0.006). The consideration of SSc patients without PAH or LVEF<55% at baseline yielded similar results.
  
  
  CONCLUSIONS
  NT-proBNP appears as a reliable and independent predictor of mortality in patients with SSc.
authors.affiliation: Department of Rheumatology A, Paris Descartes University, Cochin Hospital, INSERM U1016, Paris, France.
authors.forename: Yannick
authors.initials: Y
authors.lastname: Allanore
authors.affiliation: Heart Centre, Clinic Centre, University of Pécs, Pécs, Hungary.
authors.forename: Andras
authors.initials: A
authors.lastname: Komocsi
authors.affiliation: Department of Clinical and Experimental Medicine, Rheumatology Unit, Second University of Naples, Italy.
authors.forename: Serena
authors.initials: S
authors.lastname: Vettori
authors.affiliation: CHRU Lille, Département de Médecine Interne et Immunologie Clinique, Université de Lille, Inserm U995, FHU Immune-Mediated Inflammatory Diseases and Targeted Therapies, F-59000 Lille, France.
authors.forename: Eric
authors.initials: E
authors.lastname: Hachulla
authors.affiliation: Department of Dermatology, Köln University, Köln, Germany.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Hunzelmann
authors.affiliation: Department of Internal Medicine 3 and Institute for Clinical Immunology, Friedrich-Alexander-University Erlangen-Nuremberg, Germany.
authors.forename: Jörg
authors.initials: J
authors.lastname: Distler
authors.affiliation: Department of Rheumatology A, Paris Descartes University, Cochin Hospital, INSERM U1016, Paris, France.
authors.forename: Jérôme
authors.initials: J
authors.lastname: Avouac
authors.affiliation: Department of Biochemistry, Paris Descartes University, Cochin Hospital, Paris, France.
authors.forename: Camille
authors.initials: C
authors.lastname: Gobeaux
authors.affiliation: CHRU Lille, Département de Médecine Interne et Immunologie Clinique, Université de Lille, Inserm U995, FHU Immune-Mediated Inflammatory Diseases and Targeted Therapies, F-59000 Lille, France.
authors.forename: David
authors.initials: D
authors.lastname: Launay
authors.affiliation: Department of Rheumatology and Immunology, Clinic Centre, University of Pécs, Pécs, Hungary.
authors.forename: Laszlo
authors.initials: L
authors.lastname: Czirjak
authors.affiliation: Department of Rheumatology A, Paris Descartes University, Cochin Hospital, INSERM U1016, Paris, France.
authors.forename: André
authors.initials: A
authors.lastname: Kahan
authors.affiliation: Department of Cardiology, Paris 13 University, Avicenne Hospital, Bobigny, France; UMR S-942, Paris, France. Electronic address: christophe.meune@aphp.fr.
authors.forename: Christophe
authors.initials: C
authors.lastname: Meune
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D005858:Germany / Q000453:epidemiology; D006801:Humans; D006814:Hungary / Q000453:epidemiology; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D012595:Scleroderma, Systemic / Q000097:blood* / Q000401:mortality*; D015996:Survival Rate / Q000639:trends; D013997:Time Factors
chemical_list: D015415:Biomarkers; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain
keywords: Cardiovascular mortality; N-terminal pro-brain natriuretic peptide; Pulmonary artery hypertension; Systemic sclerosis