Wang Fang, Li Wei, Huang Jie, Wang Li, Bian Wen-yan, Pang Hui-min, Wang Yang, Xu Zhi-min, Li Yi-shi
Center of Clinic Trial, Fu Wai Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100037, China.
Zhonghua Xin Xue Guan Bing Za Zhi. 2006 Jan;34(1):28-32.
Heart failure is responsible for a huge burden in hospital care. Our goal was to evaluate the value of N-terminal-pro-brain natriuretic peptide (Nt-proBNP) on predicting death or hospital readmission after hospital discharge in patients with chronic heart failure (CHF).
From March 2003 to April 2005, 135 consecutive patients (97 male and 38 female, mean age 60.7 years +/- 13.1 years) with chronic heart failure [dilated cardiomyopathy (44%) and coronary heart disease (35%)] were included in this study. Plasma concentrations of the Nt-proBNP were measured by ELISA on admission. All patients received conventional therapy and were followed up for 24 months. The primary end point was death or readmission.
(1) During the follow up period (640 days +/- 100 days), 11 patients died and 39 patients rehospitalized, the median Nt-proBNP level on admission was significantly higher in patients died during the follow up period (5908 ng/L) than that of rehospitalized patients (2768 ng/L, P = 0.038). Plasma Nt-proBNP level on admission were significantly higher in primary end point group (n = 50, 2947 ng/L) than that in non-primary end point group (n = 85, 917 ng/L, P < 0.01). (2) Variables associated with an increased hazard of death and/or rehospitalization were Nt-proBNP and NYHA degree when analyzed by logistic regression models. Increased Log Nt-proBNP was the strongest independent predictor of an adverse outcome of CHF (odds ratio 13.8, 95% confidence interval 2.29 to 2.78, P < 0.01). (3) Area under the curve for Nt-proBNP in evaluating prognosis of CHF patients was 0.885 (positive predictive value 88.5%, negative predictive value 11.5%).
Nt-proBNP level on admission is a strong predictor of rehospitalization and death within 24 months after hospital discharge in patients with chronic heart failure.
心力衰竭在医院护理中造成了巨大负担。我们的目标是评估N末端脑钠肽前体（Nt-proBNP）对预测慢性心力衰竭（CHF）患者出院后死亡或再次入院的价值。
2003年3月至2005年4月，本研究纳入了135例连续的慢性心力衰竭患者（97例男性，38例女性，平均年龄60.7岁±13.1岁）[扩张型心肌病（44%）和冠心病（35%）]。入院时通过酶联免疫吸附测定法（ELISA）测量血浆Nt-proBNP浓度。所有患者均接受常规治疗，并随访24个月。主要终点是死亡或再次入院。
（1）在随访期（640天±100天）内，11例患者死亡，39例患者再次住院，随访期内死亡患者入院时Nt-proBNP水平中位数（5908 ng/L）显著高于再次住院患者（2768 ng/L，P = 0.038）。主要终点组（n = 50，2947 ng/L）入院时血浆Nt-proBNP水平显著高于非主要终点组（n = 85，917 ng/L，P < 0.01）。（2）通过逻辑回归模型分析，与死亡和/或再次住院风险增加相关的变量是Nt-proBNP和纽约心脏协会（NYHA）分级。Log Nt-proBNP升高是CHF不良结局的最强独立预测因素（比值比13.8，95%置信区间2.29至2.78，P < 0.01）。（3）Nt-proBNP评估CHF患者预后的曲线下面积为0.885（阳性预测值88.5%，阴性预测值11.5%）。
入院时Nt-proBNP水平是慢性心力衰竭患者出院后24个月内再次住院和死亡的有力预测指标。
