Lai Min-Yu, Kan Wei-Chih, Huang Ya-Ting, Chen John, Shiao Chih-Chung
Department of Nursing, Saint Mary's Hospital Luodong, Luodong, Yilan 26546, Taiwan.
Department of Nephrology, Department of Internal medicine, Chi Mei Medical Center, Yongkang District, Tainan City 710, Taiwan.
J Clin Med. 2019 Mar 13;8(3):357. doi: 10.3390/jcm8030357.
Plasma N-terminal pro-brain natriuretic peptide (NT-proBNP) is an excellent prognostic⁻predictive tool in heart failure (HF) patients, but its plasma level changes following therapy. The comparison of prognosis⁻predictivity of a single measurement of plasma NT-pro BNP in different follow-up periods in acute HF patients has been less studied. This study aimed to evaluate whether the association between initial plasma NT-proBNP levels and all-cause mortality would decrease along with an increased follow-up period in patients with acute HF. The retrospective study was carried out, enrolling adult patients with hospitalization-requiring acute HF who fulfilled the predefined criteria from January 1, 2011, to December 31, 2013. We evaluated the independent predictors of 12-month mortality, and subsequently compared the predictivity of NT-proBNP level at initial presentation for 1-, 3-, 6-, 9- and 12-month mortality. In total, 269 patients (mean age, 74.45 ± 13.59 years; female, 53.9%) were enrolled. The independent predictors of 12-month mortality included higher "Charlson Comorbidity Index" (adjusted hazard ratio (aHR) = 1.22; 95% confidence interval (CI), 1.10⁻1.34), increased "age" (aHR = 1.07; 95% CI, 1.04⁻1.10), "administration of vasopressor" (aHR = 3.43; 95% CI, 1.76⁻6.71), "underwent cardiopulmonary resuscitation" (aHR = 4.59; 95% CI, 1.76⁻6.71), and without "angiotensin-converting enzyme inhibitors/angiotensin receptor blocker" (aHR = 0.41; 95% CI, 1.86⁻11.31) (all <0.001). "Plasma NT-pro BNP level ≧11,755 ng/L" was demonstrated as an independent predictor in 1-month (aHR = 2.37; 95% CI, 1.10⁻5.11; = 0.028) and 3-month mortality (aHR = 1.98; 95% CI, 1.02⁻3.86; = 0.045) but not in more extended follow-up. The outcome predictivity of plasma NT-proBNP levels diminished in a longer follow-up period in hospitalized acute HF patients. In conclusion, these findings remind physicians to act with caution when using a single plasma level of NT-proBNP to predict patient outcomes with a longer follow-up period.
血浆N末端脑钠肽前体（NT-proBNP）是心力衰竭（HF）患者中一种出色的预后预测工具，但其血浆水平会随治疗而变化。急性HF患者在不同随访期单次测量血浆NT-proBNP的预后预测性比较研究较少。本研究旨在评估急性HF患者初始血浆NT-proBNP水平与全因死亡率之间的关联是否会随着随访期延长而降低。进行了一项回顾性研究，纳入2011年1月1日至2013年12月31日期间符合预定标准、需要住院治疗的成年急性HF患者。我们评估了12个月死亡率的独立预测因素，随后比较了初始就诊时NT-proBNP水平对1、3、6、9和12个月死亡率的预测性。总共纳入了269例患者（平均年龄74.45±13.59岁；女性占53.9%）。12个月死亡率的独立预测因素包括较高的“查尔森合并症指数”（校正风险比（aHR）=1.22；95%置信区间（CI），1.10 - 1.34）、年龄增加（aHR = 1.07；95%CI，1.04 - 1.10）、“使用血管升压药”（aHR = 3.43；95%CI，1.76 - 6.71）、“接受心肺复苏”（aHR = 4.59；95%CI，1.76 - 6.71）以及未使用“血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂”（aHR = 0.4；95%CI，1.86 - 11.31）（均P<0.001）。“血浆NT-proBNP水平≧11,755 ng/L”在1个月（aHR = 2.37；95%CI，1.10 - 5.11；P = 0.028）和3个月死亡率中被证明是独立预测因素，但在更长时间的随访中并非如此。住院急性HF患者在更长随访期内，血浆NT-proBNP水平的预后预测性降低。总之，这些发现提醒医生在使用单次血浆NT-proBNP水平预测较长随访期患者预后时要谨慎行事。
