Department of Geriatric Cardiology, Chinese People's Liberation Army General Hospital, Medical School of Chinese People's Liberation Army, Beijing, 100853, China.
Department of Cardiology, Hainan Hospital of Chinese People's Liberation Army General Hospital, Sanya, China.
BMC Geriatr. 2019 Feb 28;19(1):56. doi: 10.1186/s12877-019-1051-0.
Atrial fibrillation (AF) is the most common arrhythmia and has increased prevalence in older patients, leading to poor prognosis for these patients. There is a need for a biomarker or a model of prognostic evaluation in older patients with AF, especially in China. CHADS and CHADSVASc scores have been applied to evaluate their prognosis in patients with AF. This analysis was designed to examine whether N-terminal pro-brain natriuretic peptide (NT-proBNP) levels significantly improved the evaluation of all-cause mortality in older Chinese patients with AF when added to CHADS and CHADSVASc scores.
There were 219 older patients with AF, and follow-up was 100% complete over an average of 1.11 years. Cox regression analysis was applied to determine the variables independently associated with all-cause mortality.
Median age was 85 years, and all-cause mortality was 24.2% (53 patients). Plasma NT-proBNP levels were significantly associated with all-cause mortality in univariate [hazard ratio (HR): 1.842; 95% confidence interval (CI): 1.530-2.218] and multivariate (HR: 1.377; 95% CI: 1.063-1.785) Cox regression analyses and had significantly higher c-statistic (0.771; 95% CI: 0.698-0.845) than CHADS (0.639; 95% CI: 0.552-0.726) and CHADSVASc (0.633; 95% CI: 0.546-0.720) scores (P < 0.05 for all). The addition of NT-proBNP levels to CHADS (0.783; 95% CI: 0.713-0.854) and CHADSVASc (0.775; 95% CI: 0.704-0.846) scores significantly increased their c-statistics (P < 0.001 for all). Model based on NT-proBNP levels including age, hemoglobin, fasting blood glucose, glomerular filtration rate and NT-proBNP levels had a significantly higher c-statistic (0.890; 95% CI: 0.841-0.938) than CHADS and CHADSVASc scores (P < 0.001 for all). Model based on NT-proBNP levels had significantly higher c-statistic than the addition of NT-proBNP levels to CHADS and CHADSVASc scores (P < 0.05).
NT-proBNP levels were an independent biomarker associated with an increased all-cause mortality in older Chinese patients with AF, and had an independent and added ability to evaluate their all-cause mortality compared with CHADS and CHADSVASc scores.
心房颤动（AF）是最常见的心律失常，在老年患者中发病率更高，导致这些患者的预后较差。因此，对于老年 AF 患者，尤其是中国的老年 AF 患者，需要一种生物标志物或预后评估模型。CHADS 和 CHADSVASc 评分已被用于评估 AF 患者的预后。本分析旨在研究在 CHADS 和 CHADSVASc 评分中加入 N 末端脑钠肽前体（NT-proBNP）水平是否能显著改善老年 AF 患者全因死亡率的评估。
纳入 219 例老年 AF 患者，平均随访 1.11 年，随访率为 100%。采用 Cox 回归分析确定与全因死亡率独立相关的变量。
中位年龄为 85 岁，全因死亡率为 24.2%（53 例）。单因素 [危险比（HR）：1.842；95%置信区间（CI）：1.530-2.218] 和多因素（HR：1.377；95% CI：1.063-1.785）Cox 回归分析显示，血浆 NT-proBNP 水平与全因死亡率显著相关，且 NT-proBNP 水平的 C 统计量（0.771；95% CI：0.698-0.845）显著高于 CHADS（0.639；95% CI：0.552-0.726）和 CHADSVASc（0.633；95% CI：0.546-0.720）评分（均 P<0.05）。在 CHADS（0.783；95% CI：0.713-0.854）和 CHADSVASc（0.775；95% CI：0.704-0.846）评分中加入 NT-proBNP 水平显著提高了 C 统计量（均 P<0.001）。基于 NT-proBNP 水平、年龄、血红蛋白、空腹血糖、肾小球滤过率和 NT-proBNP 水平的模型具有更高的 C 统计量（0.890；95% CI：0.841-0.938），显著高于 CHADS 和 CHADSVASc 评分（均 P<0.001）。基于 NT-proBNP 水平的模型的 C 统计量显著高于在 CHADS 和 CHADSVASc 评分中加入 NT-proBNP 水平的模型（P<0.05）。
NT-proBNP 水平是与老年 AF 患者全因死亡率增加相关的独立生物标志物，与 CHADS 和 CHADSVASc 评分相比，其具有独立和附加的评估全因死亡率的能力。
