title: Prognostic prediction in acute heart failure patients with extreme BNP values.
abstract: BACKGROUND
  Some patients have good prognosis despite elevated B-type natriuretic peptide (BNP), while others have ominous outcome with low BNP. We aimed at characterising these groups of patients.
  
  
  METHODS
  We analysed patients prospectively included in an acute HF registry. Vital status within 1-year post discharge was ascertained. A receiver-operating characteristic curve was used to define discharge BNP cut-offs for 1-year death prediction. Among survivors, we compared patients with low and not-low BNP (cut-off 400 pg/mL); and among non-survivors those with high vs not-high BNP (cut-off 2000 pg/mL). In the specific subgroups of patients with low and high BNP, mortality predictors were assessed with multivariate Cox-regression analysis.
  
  
  RESULTS
  We studied 584 patients, median age 78 years, 62.5% had HF with reduced ejection fraction; and 199 (34.1%) died during the first year. Non-survivors were very homogeneous irrespective of BNP, survivors were substantially different. In patients discharged with BNP <400 pg/mL, increasing age independently predicted death; when BNP ≥2000 pg/mL death predictors were higher NYHA class, and non-use of evidence-based therapy. BNP was outcome associated in both groups.
  
  
  CONCLUSIONS
  Different prognostic predictors may play a role in different BNP levels. We suggest that risk stratification in HF would probably be more accurate if made on top of BNP knowledge.
authors.affiliation: a Department of Internal Medicine , Centro Hospitalar São João , Portugal.
authors.forename: Patrícia
authors.initials: P
authors.lastname: Lourenço
authors.affiliation: a Department of Internal Medicine , Centro Hospitalar São João , Portugal.
authors.forename: Ana
authors.initials: A
authors.lastname: Ribeiro
authors.affiliation: a Department of Internal Medicine , Centro Hospitalar São João , Portugal.|b Faculdade de Medicina da Universidade do Porto; Unidade I&D Cardiovascular do Porto , Portugal.
authors.forename: Mariana
authors.initials: M
authors.lastname: Pintalhão
authors.affiliation: c Department of Endocrinology, Diabetes and Metabolism , Centro Hospitalar São João , Portugal.
authors.forename: Filipe M
authors.initials: FM
authors.lastname: Cunha
authors.affiliation: a Department of Internal Medicine , Centro Hospitalar São João , Portugal.
authors.forename: Joana
authors.initials: J
authors.lastname: Pereira
authors.affiliation: a Department of Internal Medicine , Centro Hospitalar São João , Portugal.
authors.forename: Pedro
authors.initials: P
authors.lastname: Marques
authors.affiliation: a Department of Internal Medicine , Centro Hospitalar São João , Portugal.
authors.forename: João Pedro
authors.initials: JP
authors.lastname: Vilaça
authors.affiliation: a Department of Internal Medicine , Centro Hospitalar São João , Portugal.
authors.forename: Marta
authors.initials: M
authors.lastname: Amorim
authors.affiliation: a Department of Internal Medicine , Centro Hospitalar São João , Portugal.
authors.forename: Sérgio
authors.initials: S
authors.lastname: Silva
authors.affiliation: a Department of Internal Medicine , Centro Hospitalar São João , Portugal.|b Faculdade de Medicina da Universidade do Porto; Unidade I&D Cardiovascular do Porto , Portugal.
authors.forename: Paulo
authors.initials: P
authors.lastname: Bettencourt
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000378:metabolism*; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000378:metabolism* / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000378:metabolism*; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D012016:Reference Values; D012042:Registries / Q000706:statistics & numerical data*; D013318:Stroke Volume; D016019:Survival Analysis
chemical_list: D015415:Biomarkers; D020097:Natriuretic Peptide, Brain
keywords: Acute heart failure; natriuretic peptides; prognosis; relative insufficiency