Manzano-Fernández Sergio, Januzzi James L, Boronat García Miguel, Bonaque-González Juan C, Muñoz-Esparza Carmen, Albaladejo-Otón María D, Pastor-Pérez Francisco J, Pastor Patricia, Valdés Mariano, Pascual-Figal Domingo A
Departamento de Cardiología, Hospital Universitario Virgen de la Arrixaca, Murcia, España.
Rev Esp Cardiol. 2011 May;64(5):365-72. doi: 10.1016/j.recesp.2010.10.017. Epub 2011 Mar 11.
Urinary concentrations of amino-terminal pro-B type natriuretic peptide (NT-proBNP) may be prognostically meaningful; however, direct comparison to plasma concentrations of this marker have not been performed in patients with acutely decompensated heart failure (ADHF). The aims of this study were to compare the prognostic value of plasma versus urinary NT-proBNP concentration for the risk stratification of patients with ADHF.
Consecutive hospitalized patients with ADHF were prospectively studied. Blood and urine samples were simultaneously collected on hospital arrival to determine NT-proBNP concentrations. Clinical follow-up was obtained, and the occurrence of mortality and heart failure hospitalization was registered.
The study included 138 patients (median, 74 years [interquartile range, 67-80]; 54% men). During a median follow-up period of 387 days [interquartile range, 161-559], 65 patients (47%) suffered adverse clinical events. Plasma NT-proBNP concentration was higher among patients who presented adverse events (4561 pg/mL [2191-8631] vs 2906 pg/mL [1643-5823]; P=.03), whereas urinary NT-proBNP was similar in both groups (P=.62). After multivariable Cox regression analyses, plasma NT-proBNP concentration was associated with a higher risk of adverse events, whether considered continuously (per 100 pg/mL; hazard ratio [HR]=1.004; 95% confidence interval [CI], 1.001-1.007; P=.003) or categorically (≥3345 pg/mL; HR=2.35; 95%CI, 1.41-3.93; P=.001). In contrast, urinary NT-proBNP concentration was not associated with adverse outcomes.
Plasma NT-proBNP concentration is superior to urinary NT-proBNP concentration for the prediction of adverse clinical outcomes among unselected patients with ADHF.
氨基末端B型利钠肽原（NT-proBNP）的尿浓度可能具有预后意义；然而，对于急性失代偿性心力衰竭（ADHF）患者，尚未对该标志物的尿浓度与血浆浓度进行直接比较。本研究的目的是比较血浆与尿NT-proBNP浓度对ADHF患者进行危险分层的预后价值。
对连续住院的ADHF患者进行前瞻性研究。入院时同时采集血样和尿样以测定NT-proBNP浓度。进行临床随访，并记录死亡率和心力衰竭住院情况。
该研究纳入了138例患者（中位数为74岁[四分位间距为67 - 80岁]；54%为男性）。在中位随访期387天[四分位间距为161 - 559天]内，65例患者（47%）发生了不良临床事件。发生不良事件的患者血浆NT-proBNP浓度较高（4561 pg/mL[2191 - 8631] vs 2906 pg/mL[1643 - 5823]；P = 0.03），而两组患者的尿NT-proBNP相似（P = 0.62）。经过多变量Cox回归分析，血浆NT-proBNP浓度与不良事件风险较高相关，无论是连续分析（每100 pg/mL；风险比[HR]=1.004；95%置信区间[CI]，1.001 - 1.007；P = 0.003）还是分类分析（≥3345 pg/mL；HR = 2.35；95%CI，1.41 - 3.93；P = 0.001）。相比之下，尿NT-proBNP浓度与不良结局无关。
对于未选择的ADHF患者，血浆NT-proBNP浓度在预测不良临床结局方面优于尿NT-proBNP浓度。
