An Admission-to-Discharge BNP Increase Is a Predictor of Six-Month All-Cause Death in ADHF Patients: Inferences from Multivariate Analysis Including Admission BNP and Various Clinical Measures of Congestion
Autor: | C. Baldi, Carmelina Ariano, Renato De Vecchis |
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Rok vydání: | 2016 |
Předmět: |
acute decompensated heart failure
B-type natriuretic peptide retrospective cohort study mortality medicine.medical_specialty Orthopnea Acute decompensated heart failure medicine.drug_class lcsh:Medicine 030204 cardiovascular system & hematology Inferior vena cava Article 03 medical and health sciences 0302 clinical medicine Weight loss Internal medicine medicine Natriuretic peptide 030212 general & internal medicine cardiovascular diseases business.industry Hazard ratio lcsh:R Retrospective cohort study General Medicine medicine.disease Surgery Blood pressure medicine.vein Cardiology cardiovascular system medicine.symptom business hormones hormone substitutes and hormone antagonists |
Zdroj: | Journal of Clinical Medicine Journal of Clinical Medicine, Vol 5, Iss 11, p 99 (2016) Journal of Clinical Medicine; Volume 5; Issue 11; Pages: 99 |
ISSN: | 2077-0383 |
Popis: | Background: According to some authors, a single isolated measurement of serum B-type natriuretic peptide (BNP) executed on hospital admission would not be a sufficiently accurate method to predict the outcome of patients with acute decompensated heart failure (ADHF). Aims: To verify this assumption, a retrospective study was conducted on patients hospitalized for ADHF. Our main objective was to ascertain whether there was any difference in midterm mortality among patients with increasing BNP at discharge as compared with those with decreasing BNP at discharge. Methods: Medical records were examined so as to make a partition of the ADHF patient population into two groups, the former characterized by a rise in BNP during hospitalization, and the latter exhibiting a decrease in BNP in the measurement taken at hospital discharge. Results: 177 patients were enrolled in a retrospective study. Among them, 53 patients (30%) had increased BNP at the time of discharge, whereas 124 (70%) showed decreases in serum BNP during their hospital stay. The group with patients who exhibited BNP increases at the time of discharge had a higher degree of congestion evident in the higher frequency of persistent jugular venous distention and persistent orthopnea at discharge. Moreover, patients with increased BNP at the time of discharge had a lower reduction in inferior vena cava maximum diameter (1.58 ± 2.2 mm vs. 6.32 ± 1.82 mm; p (one-way ANOVA) = 0.001). In contrast, there was no significant difference in weight loss when patients with increased BNP at discharge were compared with those with no such increase. A total of 14 patients (7.9%) died during the six-month follow-up period. Multivariable Cox proportional-hazards regression analysis revealed that a BNP increase at the time of discharge was an independent predictor of six-month all-cause mortality after adjustment for persistent jugular venous distention, persistent orthopnea, reduction in inferior vena cava maximum diameter at discharge, weight loss, serum urea, systolic blood pressure at admission, and BNP at admission (hazard ratio = 30.5424; 95% CI: 1.7409–535.8294, p = 0.0199). Conclusions: Among patients with a history of ADHF, more elevated BNP levels at the time of discharge from the hospital compared with those detected at admission identify a patient subset with a higher grade of congestion and higher six-month mortality. |
Databáze: | OpenAIRE |
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