Fu Shihui, Xie Leixing, Li Dongyun, Ye Ping, Luo Leiming
Department of Geriatric Cardiology, Chinese People's Liberation Army General Hospital, Beijing, People's Republic of China ; Department of Cardiology and Hainan Branch, Chinese People's Liberation Army General Hospital, Beijing, People's Republic of China.
Department of Cardiology and Hainan Branch, Chinese People's Liberation Army General Hospital, Beijing, People's Republic of China.
Clin Interv Aging. 2015 Jan 27;10:359-65. doi: 10.2147/CIA.S77417. eCollection 2015.
This study was conducted to research the prognostic utility of N-terminal pro-B-type natriuretic peptide (NT-proBNP), compare the utility of the Seattle Heart Failure Score (SHFS) with NT-proBNP, develop a risk-evaluation model based on NT-proBNP, assess the associations of NT-proBNP with patient characteristics, and screen for decisive factors of NT-proBNP in Chinese elderly with chronic heart failure (CHF).
There were 306 patients (≥60 years) with CHF chosen as study subjects. Each one received an assessment of NT-proBNP on serum. The end point was all-cause mortality during a mean follow-up period of 471 days.
Subjects had a median age of 85 (60-100) years, a median NT-proBNP of 1,743.4 pg/mL, and a median SHFS of 1.87. During the follow-up period, 104 deaths occurred. NT-proBNP was significantly related to mortality (odds ratio 1.603, 95% confidence interval 1.407-1.826; P<0.001) and the significance persisted after full adjustment (odds ratio 1.282, 95% confidence interval 1.103-1.489; P=0.001). Age, New York Heart Association class IV CHF, plasma albumin, and neutrophils/lymphocytes were also independent predictors for mortality (P<0.05 for all). NT-proBNP and the SHFS showed similar predictive capacities (0.736 versus 0.796, P=0.105). The addition of NT-proBNP to the SHFS (0.818 versus 0.796, P=0.168) generated marginal growth in the c-statistic. The model based on NT-proBNP consisting of all selected predictors in this study, including age, New York Heart Association class IV CHF, plasma albumin, neutrophils/lymphocytes, and NT-proBNP, had a moderately higher c-statistic compared with the SHFS (0.846 versus 0.796, P=0.066). NT-proBNP was bound with the SHFS (r=0.500, P<0.001). Characteristics regarding general condition, inflammation, and cardiac and renal function were the decisive factors of NT-proBNP (P<0.05 for all).
As a comprehensive representation of the patient characteristics described earlier, NT-proBNP values provided significant prognostic power similar to the SHFS in Chinese elderly with CHF. A novel model based on NT-proBNP could offer help for risk stratification.
本研究旨在探讨N末端B型利钠肽原（NT-proBNP）的预后价值，比较西雅图心力衰竭评分（SHFS）与NT-proBNP的价值，建立基于NT-proBNP的风险评估模型，评估NT-proBNP与患者特征的相关性，并筛选中国老年慢性心力衰竭（CHF）患者中NT-proBNP的决定性因素。
选取306例年龄≥60岁的CHF患者作为研究对象。每位患者均接受血清NT-proBNP评估。终点为平均随访471天期间的全因死亡率。
研究对象的年龄中位数为85（60 - 100）岁，NT-proBNP中位数为1743.4 pg/mL，SHFS中位数为1.87。随访期间，发生104例死亡。NT-proBNP与死亡率显著相关（比值比1.603，95%置信区间1.407 - 1.826；P<0.001），完全调整后该显著性仍然存在（比值比1.282，95%置信区间1.103 - 1.489；P = 0.001）。年龄、纽约心脏协会IV级CHF、血浆白蛋白和中性粒细胞/淋巴细胞也是死亡率的独立预测因素（均P<0.05）。NT-proBNP和SHFS显示出相似的预测能力（分别为0.736和0.796，P = 0.105）。将NT-proBNP加入SHFS中（分别为0.818和0.796，P = 0.168），c统计量有少量增长。基于NT-proBNP的模型，包含本研究中所有选定的预测因素，包括年龄、纽约心脏协会IV级CHF、血浆白蛋白、中性粒细胞/淋巴细胞和NT-proBNP，与SHFS相比，c统计量略高（分别为0.846和0.796，P = 0.066）。NT-proBNP与SHFS相关（r = 0.500，P<0.001）。一般状况、炎症以及心脏和肾功能方面的特征是NT-proBNP的决定性因素（均P<0.05）。
作为上述患者特征的综合体现，NT-proBNP值在预测中国老年CHF患者预后方面具有与SHFS相似的显著价值。基于NT-proBNP的新模型可为风险分层提供帮助。
