Department of Clinical Biochemistry, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark.
Copenhagen Primary Care Laboratory (CopLab) Database, Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
Clin Chem. 2018 Dec;64(12):1723-1731. doi: 10.1373/clinchem.2018.293480. Epub 2018 Oct 15.
Measurement of B-type natriuretic peptide (BNP) in plasma may have its greatest potential in primary care, as general practitioners need to rapidly identify patients who warrant further medical review. The aim of the present study was to examine the prognostic information of BNP measurement on all-cause mortality in a large Danish primary care cohort.
This study covered a cohort of Danish primary care patients (n = 61665) with a median follow-up period of 4.36 years (interquartile range, 2.29-6.62 years). BNP was measured in plasma using the ADVIA Centaur/CentaurXP platform. The association of BNP with mortality was assessed with a hazard ratio for all-cause mortality from a multivariable Cox proportional hazards model.
Kaplan-Meier curves showed decreasing survival probability with increasing BNP ( < 0.001). Each doubling of BNP increased mortality by 32.3% (95% CI, 30.8-33.8) when adjusted for sex and age, and by 25.3% (95% CI, 23.8-26.8) when further adjusted for Charlson comorbidity index, hemoglobin, estimated glomerular filtration rate, glycohemoglobin, and thyroid-stimulating hormone. Also, in a subcohort (n = 10824) without biochemical signs of severe kidney failure, anemia, polycythemia, hypothyroidism or hyperthyroidism, or dysregulated diabetes, each doubling of BNP increased mortality by 28.6% (95% CI, 22.8-34.7).
Our results show that even in a primary care population, BNP measurements contain prognostic information regarding all-cause mortality.
在初级保健中，血浆 B 型利钠肽（BNP）的测量可能具有最大的潜力，因为全科医生需要快速识别需要进一步医学检查的患者。本研究的目的是在丹麦大型初级保健队列中检查 BNP 测量对全因死亡率的预后信息。
本研究涵盖了丹麦初级保健患者队列（n = 61665），中位随访时间为 4.36 年（四分位距，2.29-6.62 年）。使用 ADVIA Centaur/CentaurXP 平台测量血浆中的 BNP。使用多变量 Cox 比例风险模型评估 BNP 与死亡率的相关性，以全因死亡率的风险比表示。
Kaplan-Meier 曲线显示，随着 BNP 的增加，生存概率逐渐降低（<0.001）。在调整性别和年龄后，BNP 每增加一倍，死亡率增加 32.3%（95%CI，30.8-33.8），进一步调整 Charlson 合并症指数、血红蛋白、估计肾小球滤过率、糖化血红蛋白和促甲状腺激素后，死亡率增加 25.3%（95%CI，23.8-26.8）。此外，在一个没有严重肾衰竭、贫血、红细胞增多症、甲状腺功能减退或甲状腺功能亢进或血糖调节失调的生化迹象的亚队列（n = 10824）中，BNP 每增加一倍，死亡率增加 28.6%（95%CI，22.8-34.7）。
我们的结果表明，即使在初级保健人群中，BNP 测量也包含与全因死亡率相关的预后信息。
