Admission NT-proBNP levels, renal insufficiency and age as predictors of mortality in elderly patients hospitalized for acute dyspnea☆
Received 18 July 2007; received in revised form 20 January 2008; accepted 9 March 2008. published online 30 April 2008.
Abstract
Background
Assay of baseline B-type peptide (BNP and NT-proBNP) is useful for heart failure (HF) prognostication. In contrast, the prognostic value of NT-proBNP assay performed on admission of elderly subjects for acute dyspnea is uncertain. The aim of this study was to determine the vital prognostic value of NT-proBNP assay and other relevant variables available on admission in elderly patients hospitalized for acute dyspnea.
Methods
254 patients over 70 years of age who were initially hospitalized with acute dyspnea were prospectively studied. The log-rank test and Cox proportional-hazards regression models were used to determine the prognostic value of NT-proBNP and creatinine clearance, measured within 24 h of initial admission, as well as age, gender, vascular risk factors and other clinical variables.
Results
Mean age was 81±7 years, and 52% of the patients were women. During a median follow-up of 34 months, 134 patients (55%) died and 9 patients (4%) were lost to follow-up. The median survival time was 25 months, and almost half the deaths occurred during the first 6 months. In multivariate analysis the following three variables were independently associated with mortality (shown with their accompanying hazard ratios (HR)): NT-proBNP>2856 pg/mL (median), HR=1.6[95%CI:1.3–5.2]; creatinine clearance <30 mL/min, HR=1.7[95%CI:1.2–2.5]; and age>80 years, HR=1.7[95%CI:1.1–2.6]. The median survival time among patients with an admission NT-proBNP level of >2856 pg/mL (median) was 14 months, compared to >36 months in the rest of the population.
Conclusion
The admission NT-proBNP level, age, and creatinine clearance are predictive of vital outcome in elderly patients hospitalized for acute dyspnea.
Service de Cardiologie (PB, SS), Service d’Information Médicale (CV), Laboratoire de Biochimie (IB), Département de Médecine Interne (JLR), Béziers Hospital, France
Corresponding author. Service de Cardiologie, Centre Hospitalier de Béziers, 2 rue Valentin Haüy, 34500 Béziers Cedex, France. Tel.: +33 4 67 35 71 34; fax: +33 4 67 35 71 32.
☆ The study was funded by a grant from Programme Hospitalier de Recherche Clinique (Ministère chargé de la Santé, PHRC, sponsor: Centre Hospitalier de Béziers).
ABSTRACT