bnp vs ntprobnp copia

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RE S EAR C H Open Access Direct comparison of serial B-type natriuretic peptide and NT-proBNP levels for prediction of short- and long-term outcome in acute decompensated heart failure Markus Noveanu 1,2* , Tobias Breidthardt 1 , Mihael Potock i 2 , Tobias Reichlin 2 , Raphael Twerenbold 1 , Heiko Uthoff 1 , Thenral Socrat es 1 , Nisha Arenja 1 , Miriam Reiter 1 , Julia Meissner 1 , Corinna Heinisch 1 , Sybil le Stalder 1 , Christian Mueller 1 Abstract Introduction: Monitoring treatment efficacy and assessing outcome by serial measurements of natriuretic peptides in acute decompensated heart failure (ADHF) patients may help to improve outcome. Methods: This was a prospective multi-center study of 171 consecutive patients (mean age 80 73-85 years) presenting to the emergency department with ADHF. Measurement of BNP and NT-proBNP was performed at presentation, 24 hours, 48 hours and at discharge. The primary endpoint was one-year all-cause mortality; secondary endpoints were 30-days all-cause mortality and one-year heart failure (HF) readmission. Results: During one-year follow-up, a total of 60 (35%) patients died. BNP and NT-proBNP levels were higher in non-survivors at all time points (all P < 0.001). In survivors, treatment reduced BNP and NT-proBNP levels by more than 50% ( P < 0.001), while in non-survivors treatment did not lower BNP and NT-proBNP levels. The area under the ROC curve (AUC) for the prediction of one-year mortality increased during the course of hospitalization for BNP (AUC presentation: 0.67; AUC 24 h: 0.77; AUC 48 h: 0.78; AUC discharge: 0.78) and NT-proBNP (AUC presentation: 0.67; AUC 24 h: 0.73; AUC 48 h: 0.75; AUC discharge: 0.77). In multivariate analysis, BNP at 24 h (1.02 [1.01-1.04], P = 0.003), 48 h (1.04 [1.02-1.06], P < 0.001) and discharge (1.02 [1.01-1.03], P < 0.001) independently predicted one-year mortality, while only pre-discharge NT-proBNP was predictive (1.07 [1.01-1.13], P = 0.016). Comparable results could be obtained for the secondary endpoint 30-days mortality but not for one-year HF readmissions. Conclusions: BNP and NT-proBNP reliably predict one-year mortality in patients with ADHF. Prognostic accuracy of both biomarker increases during the course of hospitalization. In survivors BNP levels decline more rapidly than NT- proBNP levels and thus seem to allow earlier assessment of treatment efficacy. Ability to predict one-year HF readmission was poor for BNP and NT-proBNP. Trial registration: ClinicalTrials.gov identifier: NCT00514384. Introduction Acute decompensated heart failure (ADHF) is the lead- ing cause of hospitalization in adults over 65 years [ 1]. Despite medical progress, ADHF is still the most costly cardiovascular disorder in Western countries and is associated with a very poor prognosis [ 1-3]. Early prediction of a patient’s clinical course is pivotal for selecting appropriate management strategies for patients with ADHF. However, risk stratification in these patients is still difficult. The tools used for the evaluation of disease severity and prognosis in the past have been criticized because epidemiological and clinical factors like age, New York Heart Association (NYHA) functional class, or Killip class were shown to be inade- quately sensitive [4]. Left ventricular ejection fraction (LVEF) determined by echocardiography was once * Correspondence: [email protected] 1 Department of Internal Medicine, University Hospital Basel, Petersgraben 4, 4053 Basel, Switzerland Full list of author information is available at the end of the article Noveanu et al . Critical Care 2011, 15:R1 http://ccforum.com/content/15/1/R1 © 2011 Noveanu et al.; licensee BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://crea tivecommons .org/licenses/by /2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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http://creativecommons.org/licenses/by/2.0

mailto:[email protected]

http://www.clinicaltrials.gov/ct2/show/NCT00514384

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