[Prognostic value of N-terminal-pro-brain natriuretic peptide on admission in patients with chronic heart failure].

OBJECTIVE

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).

METHODS

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.

RESULTS

(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%).

CONCLUSION

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.