Highlights
- •We evaluated heterogeneity of the prognostic significance of BNP levels in AHFS.
- •Usefulness of BNP as a prognostic factor may be weakened in hyponatremic patients.
- •Prognostic significance of BNP seems weaker in patients with renal dysfunction.
- •High BNP levels may not be associated with higher mortality in hypertensive etiology.
- •Overall, high BNP levels were an important prognostic indicator in AHFS patients.
Abstract
Background
We hypothesized that variation in baseline characteristics of patients with acute
heart failure syndromes (AHFS) affects the prognostic significance of B-type natriuretic
peptide (BNP) levels because of heterogeneity of this patient population. We evaluated
the association of elevated BNP levels on admission with an increased risk of adverse
clinical outcomes in subgroups of patients hospitalized for AHFS.
Methods
This study included patients from the acute decompensated heart failure syndromes
(ATTEND) study, a multicenter prospective cohort of 4501 AHFS patients with BNP data
on admission.
Results
The geometric mean BNP level was 654.9 pg/mL (95% confidence interval: 636.1–674.2), and the optimal cut-off value for all-cause
death was 1157 pg/mL. All-cause mortality after admission was significantly higher in patients with
high BNP levels (>1157 pg/mL) than in those with low BNP levels (≤1157 pg/mL) (median follow-up: 508 days, log-rank P < 0.001). Subgroup analyses were performed to evaluate the heterogeneity of the prognostic
significance of BNP levels. The effect of high BNP levels on the risk of all-cause
mortality was significantly greater in the subgroup of patients with a non-hypertensive
etiology, low creatinine levels (<1.3 mg/dL), and high sodium levels (≥135 mEq/L) than in those without these factors (P = 0.024, P < 0.001, and P < 0.001 for the interaction, respectively).
Conclusions
The present analysis shows that underlying etiology of heart failure (i.e., hypertensive),
renal function, and sodium levels should be considered for assessing the clinical
significance of elevated BNP levels on admission in relation to the risk of adverse
outcome after hospitalization for AHFS.
Keywords
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Article info
Publication history
Published online: February 12, 2016
Accepted:
January 25,
2016
Received in revised form:
December 29,
2015
Received:
November 18,
2015
Identification
Copyright
© 2016 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
