Logeart Damien, Thabut Gabriel, Jourdain Patrick, Chavelas Christophe, Beyne Pascale, Beauvais Florence, Bouvier Erik, Solal Alain Cohen
Service de Cardiologie, Hôpital Beaujon, Clichy, France.
J Am Coll Cardiol. 2004 Feb 18;43(4):635-41. doi: 10.1016/j.jacc.2003.09.044.
The aim of this study was to determine the value of serial B-type natriuretic peptide (BNP) assay for predicting post-discharge outcome of patients admitted for decompensated congestive heart failure (CHF).
Patients hospitalized for decompensated CHF are frequently re-admitted. Thus, identification of high-risk patients before their discharge is a major issue that remains challenging. B-type natriuretic peptide measurement could be useful.
Serial BNP measurements were performed from admission to discharge in two samples of consecutive patients. Survivors were monitored for six months; the main end point combined death or first re-admission for CHF.
Among the 105 survivors of the derivation study, all serial BNP values, percentage change in BNP levels, and predischarge Doppler mitral pattern correlated with the outcome. In contrast, clinical variables and left ventricular ejection fraction were poorly predictive. The predischarge BNP assay had the best discriminative power (area under the receiver operating characteristic [ROC] curve = 0.80) and remained the lone significant variable in multivariate analysis (hazard ratio [HR] = 1.14 [95% confidence interval [CI], 1.02 to 1.28], p = 0.027). Among the 97 survivors of the validation study, the predischarge BNP assay was also the most predictive parameter (area under the ROC curve = 0.83). The risk of death or re-admission increased in stepwise fashion across increasing predischarge BNP ranges (p < 0.0001). After adjustment for baseline covariables, the HRs were 5.1 [95% CI 2.8 to 9.1] for BNP levels between 350 and 700 ng/l and 15.2 [95% CI 8.5 to 27] for BNP levels >700 ng/l, compared with BNP <350 ng/l.
High predischarge BNP assay is a strong, independent marker of death or re-admission after decompensated CHF, more relevant than common clinical or echocardiographic parameters and more relevant than changes in BNP levels during acute cares.
本研究旨在确定连续检测B型利钠肽（BNP）对预测失代偿性充血性心力衰竭（CHF）患者出院后结局的价值。
因失代偿性CHF住院的患者经常再次入院。因此，在出院前识别高危患者是一个仍然具有挑战性的主要问题。BNP检测可能会有所帮助。
对两组连续患者样本从入院到出院进行连续BNP检测。对存活者进行6个月的监测；主要终点为死亡或首次因CHF再次入院。
在推导研究的105名存活者中，所有连续BNP值、BNP水平的百分比变化以及出院前的多普勒二尖瓣血流模式均与结局相关。相比之下，临床变量和左心室射血分数的预测性较差。出院前BNP检测具有最佳的鉴别能力（受试者操作特征曲线下面积[ROC] = 0.80），并且在多变量分析中仍然是唯一显著的变量（风险比[HR] = 1.14 [95%置信区间[CI]，1.02至1.28]，p = 0.027）。在验证研究的97名存活者中，出院前BNP检测也是最具预测性的参数（ROC曲线下面积 = 0.83）。随着出院前BNP范围的增加，死亡或再次入院的风险呈逐步上升趋势（p < 0.0001）。在对基线协变量进行调整后，与BNP < 350 ng/l相比，BNP水平在350至700 ng/l之间时HR为5.1 [95% CI 2.8至9.1]，BNP水平> 700 ng/l时HR为15.2 [95% CI 8.5至27]。
出院前BNP检测是失代偿性CHF后死亡或再次入院的一个强有力的独立标志物，比常见的临床或超声心动图参数更具相关性，并且比急性治疗期间BNP水平的变化更具相关性。
