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Prognostic value of short-term follow-up BNP in hospitalized patients with heart failure

BACKGROUND: B-type natriuretic peptide (BNP) has prognostic significance in heart failure (HF), and reductions in BNP may predict clinical improvement. However, there are limited data regarding the prognostic value of BNP during short-term follow-up. The aim of this study was to evaluate the relatio...

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Autores principales: Khanam, Sayma Sabrina, Son, Jung-Woo, Lee, Jun-Won, Youn, Young Jin, Yoon, Junghan, Lee, Seung-Hwan, Kim, Jang-Young, Ahn, Sung Gyun, Ahn, Min-Soo, Yoo, Byung-Su
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5543427/
https://www.ncbi.nlm.nih.gov/pubmed/28774268
http://dx.doi.org/10.1186/s12872-017-0632-0
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author Khanam, Sayma Sabrina
Son, Jung-Woo
Lee, Jun-Won
Youn, Young Jin
Yoon, Junghan
Lee, Seung-Hwan
Kim, Jang-Young
Ahn, Sung Gyun
Ahn, Min-Soo
Yoo, Byung-Su
author_facet Khanam, Sayma Sabrina
Son, Jung-Woo
Lee, Jun-Won
Youn, Young Jin
Yoon, Junghan
Lee, Seung-Hwan
Kim, Jang-Young
Ahn, Sung Gyun
Ahn, Min-Soo
Yoo, Byung-Su
author_sort Khanam, Sayma Sabrina
collection PubMed
description BACKGROUND: B-type natriuretic peptide (BNP) has prognostic significance in heart failure (HF), and reductions in BNP may predict clinical improvement. However, there are limited data regarding the prognostic value of BNP during short-term follow-up. The aim of this study was to evaluate the relationship between short-term follow-up BNP and mortality after discharge in patients with HF. METHODS: We analyzed 427 patients hospitalized with HF from the Wonju Severance Christian Hospital Heart Failure Registry from April 2011 to December 2013, with a planned follow-up period through February 2016. Of the 427 patients, 240 (mean age, 75 years; 102 males, 42.5%) had BNP measured on admission and within the short-term follow-up period (3 months). We compared all-cause mortality during the clinical follow-up period (median length of follow-up, 709.5 days) according to the median value of BNP on admission (as a baseline value) and over a short-term follow-up period after discharge. RESULTS: Median BNP at admission was 816.5 pg/ml, and median follow-up BNP was 369.7 pg/ml. Multivariate analysis revealed a positive association between risk of death and high BNP. High BNP during follow-up was significantly associated with a greater risk of all-cause mortality compared to low BNP (P < 0.001). Initial BNP was not significantly associated with all-cause mortality. A multivariate model showed that follow-up BNP and percent change in BNP were independently associated with all-cause mortality after adjustment for covariates. Of the 3 BNP measurement strategies, BNP after discharge (IDI of 0.072, P < .0001 and NRI of 0.707, P < .0001) and percent change in BNP (IDI of 0.113, P < .0001 and NRI of 0.782, P < .0001) demonstrated the greatest increase in discrimination and net reclassification for mortality. Unfortunately, we did not find any significant value with initial BNP. Kaplan-Meier survival analysis was performed to assess mortality stratified by BNP according to the median value, high median of follow-up BNP and percent change in BNP were associated with significantly higher mortality compared to the below median (log-rank, p < 0.001). CONCLUSIONS: Short-term follow-up BNP and percent change in BNP level are significant prognostic factors of all-cause mortality. These values will be clinically useful when evaluating prognosis in hospitalized patients with heart failure.
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spelling pubmed-55434272017-08-07 Prognostic value of short-term follow-up BNP in hospitalized patients with heart failure Khanam, Sayma Sabrina Son, Jung-Woo Lee, Jun-Won Youn, Young Jin Yoon, Junghan Lee, Seung-Hwan Kim, Jang-Young Ahn, Sung Gyun Ahn, Min-Soo Yoo, Byung-Su BMC Cardiovasc Disord Research Article BACKGROUND: B-type natriuretic peptide (BNP) has prognostic significance in heart failure (HF), and reductions in BNP may predict clinical improvement. However, there are limited data regarding the prognostic value of BNP during short-term follow-up. The aim of this study was to evaluate the relationship between short-term follow-up BNP and mortality after discharge in patients with HF. METHODS: We analyzed 427 patients hospitalized with HF from the Wonju Severance Christian Hospital Heart Failure Registry from April 2011 to December 2013, with a planned follow-up period through February 2016. Of the 427 patients, 240 (mean age, 75 years; 102 males, 42.5%) had BNP measured on admission and within the short-term follow-up period (3 months). We compared all-cause mortality during the clinical follow-up period (median length of follow-up, 709.5 days) according to the median value of BNP on admission (as a baseline value) and over a short-term follow-up period after discharge. RESULTS: Median BNP at admission was 816.5 pg/ml, and median follow-up BNP was 369.7 pg/ml. Multivariate analysis revealed a positive association between risk of death and high BNP. High BNP during follow-up was significantly associated with a greater risk of all-cause mortality compared to low BNP (P < 0.001). Initial BNP was not significantly associated with all-cause mortality. A multivariate model showed that follow-up BNP and percent change in BNP were independently associated with all-cause mortality after adjustment for covariates. Of the 3 BNP measurement strategies, BNP after discharge (IDI of 0.072, P < .0001 and NRI of 0.707, P < .0001) and percent change in BNP (IDI of 0.113, P < .0001 and NRI of 0.782, P < .0001) demonstrated the greatest increase in discrimination and net reclassification for mortality. Unfortunately, we did not find any significant value with initial BNP. Kaplan-Meier survival analysis was performed to assess mortality stratified by BNP according to the median value, high median of follow-up BNP and percent change in BNP were associated with significantly higher mortality compared to the below median (log-rank, p < 0.001). CONCLUSIONS: Short-term follow-up BNP and percent change in BNP level are significant prognostic factors of all-cause mortality. These values will be clinically useful when evaluating prognosis in hospitalized patients with heart failure. BioMed Central 2017-08-03 /pmc/articles/PMC5543427/ /pubmed/28774268 http://dx.doi.org/10.1186/s12872-017-0632-0 Text en © The Author(s). 2017 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Khanam, Sayma Sabrina
Son, Jung-Woo
Lee, Jun-Won
Youn, Young Jin
Yoon, Junghan
Lee, Seung-Hwan
Kim, Jang-Young
Ahn, Sung Gyun
Ahn, Min-Soo
Yoo, Byung-Su
Prognostic value of short-term follow-up BNP in hospitalized patients with heart failure
title Prognostic value of short-term follow-up BNP in hospitalized patients with heart failure
title_full Prognostic value of short-term follow-up BNP in hospitalized patients with heart failure
title_fullStr Prognostic value of short-term follow-up BNP in hospitalized patients with heart failure
title_full_unstemmed Prognostic value of short-term follow-up BNP in hospitalized patients with heart failure
title_short Prognostic value of short-term follow-up BNP in hospitalized patients with heart failure
title_sort prognostic value of short-term follow-up bnp in hospitalized patients with heart failure
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5543427/
https://www.ncbi.nlm.nih.gov/pubmed/28774268
http://dx.doi.org/10.1186/s12872-017-0632-0
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