Schou Morten, Gustafsson Finn, Corell Pernille, Kistorp Caroline N, Kjaer Andreas, Hildebrandt Per R
Department of Cardiology and Endocrinology, Clinic E, Frederiksberg University Hospital, Frederiksberg, Denmark.
Am Heart J. 2007 Jul;154(1):123-9. doi: 10.1016/j.ahj.2007.04.002.
N-terminal pro-brain natriuretic peptide (NT-proBNP) carries prognostic information in patients with chronic heart failure and predicts risk for mortality and cardiovascular events. It is unknown whether NT-proBNP predicts risk for hospitalization for any cause. Furthermore, a clinically useful algorithm for risk stratification based on NT-proBNP as a continuous variable has not yet been described. We therefore evaluated NT-proBNP as a risk marker for mortality and hospitalization and developed a simple algorithm for risk stratification based on NT-proBNP as a continuous variable.
Data from 345 patients with chronic heart failure were collected prospectively in our heart failure clinic, and the patients were followed for 28 months (median). Seventy patients died, and 201 patients were hospitalized. Cox proportional hazard models for mortality and hospitalization were constructed with NT-proBNP as a dichotomous (median 1381 pg/mL) and a continuous variable (log2 NT-proBNP).
Patients with supramedian levels of NT-proBNP had a 2.40-fold (95% CI 1.40-4.10) increased risk for mortality and 1.71-fold (95% CI 1.24-2.36) increased risk for hospitalization. The effect of doubling NT-proBNP on adjusted hazard ratios was 1.56 (95% CI 1.32-1.85) for mortality and 1.19 (95% CI 1.09-1.31) for hospitalization. We observed a curvilinear relationship between NT-proBNP and risk for mortality and hospitalization in the whole range of NT-proBNP.
N-terminal pro-brain natriuretic peptide predicts risk for hospitalization and mortality. A simple algorithm indicates that every time NT-proBNP is doubled, estimated hazard ratio for death increases by a factor of 1.56 (56%) and by a factor of 1.19 (19%) for hospitalization. Finally, the relationship between NT-proBNP and risk is curvilinear if NT-proBNP is considered as a continuous variable.
N末端前脑钠肽（NT-proBNP）可提供慢性心力衰竭患者的预后信息，并预测死亡风险和心血管事件风险。NT-proBNP是否能预测任何原因导致的住院风险尚不清楚。此外，尚未有基于NT-proBNP作为连续变量的临床实用风险分层算法被描述。因此，我们评估了NT-proBNP作为死亡和住院风险标志物的作用，并开发了一种基于NT-proBNP作为连续变量的简单风险分层算法。
前瞻性收集了我们心力衰竭门诊345例慢性心力衰竭患者的数据，患者随访28个月（中位数）。70例患者死亡，201例患者住院。以NT-proBNP作为二分变量（中位数1381 pg/mL）和连续变量（log2 NT-proBNP）构建死亡和住院的Cox比例风险模型。
NT-proBNP水平高于中位数的患者死亡风险增加2.40倍（95%CI 1.40-4.10），住院风险增加1.71倍（95%CI 1.24-2.36）。NT-proBNP翻倍对校正风险比的影响，死亡为1.56（95%CI 1.32-1.85），住院为1.19（95%CI 1.09-1.31）。在NT-proBNP的整个范围内，我们观察到NT-proBNP与死亡和住院风险之间呈曲线关系。
N末端前脑钠肽可预测住院和死亡风险。一种简单的算法表明，每次NT-proBNP翻倍，死亡的估计风险比增加1.56倍（56%），住院增加1.19倍（19%）。最后，如果将NT-proBNP视为连续变量，NT-proBNP与风险之间的关系是曲线的。
