Januzzi James L, Sakhuja Rahul, O'donoghue Michelle, Baggish Aaron L, Anwaruddin Saif, Chae Claudia U, Cameron Renee, Krauser Daniel G, Tung Roderick, Camargo Carlos A, Lloyd-Jones Donald M
Department of Internal Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, USA.
Arch Intern Med. 2006 Feb 13;166(3):315-20. doi: 10.1001/archinte.166.3.315.
Amino-terminal pro-brain natriuretic peptide (NT-proBNP) is useful for diagnosis and triage of patients with dyspnea, but its role for predicting outcomes in such patients remains undefined.
A total of 599 breathless patients treated in the emergency department were prospectively enrolled, and a sample of blood was obtained for NT-proBNP measurements. After 1 year, the vital status of each patient was ascertained, and the association between NT-proBNP values at presentation and mortality was assessed.
At 1 year, 91 patients (15.2%) had died. Median NT-proBNP concentrations at presentation among decedents were significantly higher than those of survivors (3277 vs 299 pg/mL; P<.001). The optimal NT-proBNP cut point for predicting 1-year mortality was 986 pg/mL. In a multivariable model, an NT-proBNP concentration greater than 986 pg/mL at presentation was the single strongest predictor of death at 1 year (hazard ratio [HR], 2.88; 95% confidence interval, 1.64-5.06; P<.001), independent of a diagnosis of heart failure. Other factors associated with death included age (by decade; HR, 1.20), heart rate (by decile; HR, 1.13), urea nitrogen level (by decile; HR, 1.20), systolic blood pressure less than 100 mm Hg (HR, 1.94), heart murmur (HR, 1.92), and New York Heart Association classification (HR, 1.38 for each increase in class). The NT-proBNP concentration alone had an area under the receiver operating characteristic curve (AUC) of 0.76 for predicting mortality; the other significant covariates combined had an AUC of 0.80. The final model for predicting death, combining NT-proBNP with other covariates associated with mortality, had a superior AUC of 0.82.
In addition to assisting in emergency department diagnosis and triage, NT-proBNP concentrations at presentation are strongly predictive of 1-year mortality in dyspneic patients.
氨基末端脑钠肽前体（NT-proBNP）对呼吸困难患者的诊断和分诊有用，但其在此类患者预后预测中的作用仍不明确。
前瞻性纳入599例在急诊科接受治疗的呼吸困难患者，并采集血样进行NT-proBNP检测。1年后，确定每位患者的生命状态，并评估就诊时NT-proBNP值与死亡率之间的关联。
1年后，91例患者（15.2%）死亡。死亡患者就诊时NT-proBNP浓度中位数显著高于存活患者（3277 vs 299 pg/mL；P<0.001）。预测1年死亡率的最佳NT-proBNP切点为986 pg/mL。在多变量模型中，就诊时NT-proBNP浓度大于986 pg/mL是1年时死亡的最强单一预测因素（风险比[HR]，2.88；95%置信区间，1.64 - 5.06；P<0.001），与心力衰竭诊断无关。其他与死亡相关的因素包括年龄（每增加十岁；HR，1.20）、心率（每增加十分位数；HR，1.13）、尿素氮水平（每增加十分位数；HR，1.20）、收缩压低于100 mmHg（HR，1.94）、心脏杂音（HR，1.92）以及纽约心脏协会分级（每增加一级；HR，1.38）。单独NT-proBNP浓度预测死亡率的受试者工作特征曲线下面积（AUC）为0.76；其他显著协变量组合的AUC为0.80。将NT-proBNP与其他与死亡率相关的协变量相结合的最终死亡预测模型具有更高的AUC，为0.82。
除了有助于急诊科诊断和分诊外，就诊时NT-proBNP浓度强烈预测呼吸困难患者的1年死亡率。
