Carrasco-Sánchez Francisco J, Pérez-Calvo Juan I, Morales-Rull José L, Galisteo-Almeda Luis, Páez-Rubio Inmaculada, Barón-Franco Bosco, Aguayo-Canela Mariano, Pujol-De la llave Emilio
aDepartment of Internal Medicine, Hospital Juan Ramón Jiménez, Huelva bDepartment of Internal Medicine, Hospital Clinic University 'Lozano Blesa', Zaragoza cDepartment of Clinical Chemistry and Laboratory Medicine, Hospital Juan Ramón Jiménez, Huelva, Spain.
J Cardiovasc Med (Hagerstown). 2014 Feb;15(2):115-21. doi: 10.2459/JCM.0b013e3283654bab.
Changes in N-terminal pro B-type natriuretic peptide (NT-proBNP) levels and cystatin C (CysC) are predictors of adverse outcomes in acute heart failure. This study assess whether NT-proBNP variations might provide independent information in addition to that obtained from CysC levels.
NT-proBNP levels were assessed in patients admitted due to acute heart failure using an observational study. Patients were classified as follows: group 1, those with a decrease in NT-proBNP levels of at least 30% from admission to 4 weeks after discharge; group 2, those with no significant changes in levels; and group 3, those who showed an increase in NT-proBNP of 30%. A multivariable Cox regression model and c-statistics were used. The primary end-point was all-cause mortality at 1-year follow-up.
A total of 195 patients completed the follow-up. The mortality rate reached 20.5% (40 patients); 14 out of the 32 in group 3. The cumulative incidence of death, according to the change in NT-proBNP and Kaplan-Meier analysis, showed a significant increase in group 3 (log-rank P = 0.004). In the multivariable analysis, NT-proBNP variation for group 3 (hazard ratio 4.27; P <0.001) and for group 2 (hazard ratio 2.19; P = 0.043) in comparison with group 1 were independently associated with all-cause mortality, as well as anemia, hyponatremia, and admission CysC levels. Patients in group 3, and those with levels of serum CysC above the median, were also associated with slight increase in mortality.
An increase of at least 30% in NT-proBNP levels after hospitalization is related to all-cause mortality in patients with acute heart failure and provides supplementary prognostic information in patients with high levels of CysC. A decrease in NT-proBNP of at least 30% is a desirable target to achieve.
N 末端 B 型利钠肽原（NT-proBNP）水平和胱抑素 C（CysC）的变化是急性心力衰竭不良结局的预测指标。本研究评估 NT-proBNP 变化是否除了从 CysC 水平获得的信息之外还能提供独立信息。
采用观察性研究评估因急性心力衰竭入院患者的 NT-proBNP 水平。患者分为以下几组：第 1 组，NT-proBNP 水平从入院到出院后 4 周至少降低 30%的患者；第 2 组，水平无显著变化的患者；第 3 组，NT-proBNP 升高 30%的患者。使用多变量 Cox 回归模型和 c 统计量。主要终点是 1 年随访时的全因死亡率。
共有 195 名患者完成随访。死亡率达到 20.5%（40 例患者）；第 3 组 32 例中有 14 例。根据 NT-proBNP 变化和 Kaplan-Meier 分析，第 3 组的累积死亡发生率显著增加（对数秩 P = 0.004）。在多变量分析中，与第 1 组相比，第 3 组（风险比 4.27；P < 0.001）和第 2 组（风险比 2.19；P = 0.043）的 NT-proBNP 变化与全因死亡率独立相关，也与贫血、低钠血症和入院时 CysC 水平相关。第 3 组患者以及血清 CysC 水平高于中位数的患者也与死亡率略有增加相关。
住院后 NT-proBNP 水平至少升高 30%与急性心力衰竭患者的全因死亡率相关，并为 CysC 水平高的患者提供补充预后信息。NT-proBNP 至少降低 30%是一个理想的目标。
