Martín Sánchez Francisco Javier, Covarrubias Marisa, Terán Claudia, Llorens Pere, Herrero Pablo, Jacob Javier, Gil Víctor, Fernández Cristina, Miró Oscar
Servicio de Urgencias, Hospital Clínico San Carlos, Madrid, España.
Rev Esp Geriatr Gerontol. 2013 Jul-Aug;48(4):155-60. doi: 10.1016/j.regg.2012.11.010. Epub 2013 Mar 23.
To determine prognostic role of NT-proBNP as predictor of 30 day-mortality and readmission in the elderly with acute heart failure (AHF) treated in Spanish Emergency Departments (EDs), and to analyse the confounding factors when the NT-proBNP value is interpreted.
A multicentre and multi-purpose cohort study with prospective follow-up was conducted on all patients aged 65 years or older with AHF treated in Spanish EDs. The variables recorded include demographic characteristics, comorbidity, details of episode, and NT-proBNP value. The outcome variables were 30 day-mortality and readmission. An NT-proBNP ≥ 5,180 pg/ml was adopted as the cut-off limit. The statistical package SPSS 18.0 was used to analyse the data.
A total of 585 patients were included, with a mean age of 80.4 (SD: 6.9) years old. The cut-off NT-proBNP ≥ 5,180 pg/ml was independently associated with a severely impaired glomerular filtration (<30 ml/h) (P < .001) and severe episode (NYHA II-IV) (P = .012). The NT-proBNP area under curve (AUC) for 30 day-mortality was 0.71 (CI 95%: 0.63-0.77; P < .001) and for 30 day-readmission, was 0.50 (CI 95%: 0.45-0.56; P = .846). A multivariable analysis showed that the cut-off NT-proBNP ≥ 5,180 pg/ml was an independent factor associated with 30 day-mortality in the elderly with AHF attended in Spanish EDs.
The NT-proBNP value is associated with short-term mortality in the elderly with AHF attended in the EDs independently of the presence of confounding factors, such as the severity of the episode and glomerular filtration reduction, but not with 30 day-readmission.
确定N末端B型利钠肽原（NT-proBNP）作为西班牙急诊科治疗的老年急性心力衰竭（AHF）患者30天死亡率和再入院预测指标的预后作用，并分析解读NT-proBNP值时的混杂因素。
对西班牙急诊科治疗的所有65岁及以上AHF患者进行了一项多中心、多用途的前瞻性队列研究。记录的变量包括人口统计学特征、合并症、发病细节和NT-proBNP值。结局变量为30天死亡率和再入院率。采用NT-proBNP≥5180 pg/ml作为截断值。使用统计软件包SPSS 18.0分析数据。
共纳入585例患者，平均年龄80.4（标准差：6.9）岁。截断值NT-proBNP≥5180 pg/ml与严重受损的肾小球滤过率（<30 ml/h）（P<.001）和严重发病（纽约心脏协会II-IV级）（P=.012）独立相关。30天死亡率的NT-proBNP曲线下面积（AUC）为0.71（95%可信区间：0.63-0.77；P<.001），30天再入院率的AUC为0.50（95%可信区间：0.45-0.56；P=.846）。多变量分析显示，截断值NT-proBNP≥5180 pg/ml是西班牙急诊科就诊的老年AHF患者30天死亡率的独立相关因素。
NT-proBNP值与急诊科就诊的老年AHF患者的短期死亡率相关独立于混杂因素的存在，如发病严重程度和肾小球滤过率降低，但与30天再入院率无关。
