Department of Advanced Medical & Surgical Sciences, University of Campania 'L. Vanvitelli', Naples, Italy.
Unit of Infectious and Transplant Medicine, AORN Ospedali Dei Colli-Monaldi Hospital, Piazzale Ettore Ruggieri, 80131, Naples, Italy.
Infection. 2022 Dec;50(6):1465-1474. doi: 10.1007/s15010-022-01813-y. Epub 2022 Apr 16.
To explore the prognostic value and the correlates of NT-proBNP in patients with acute infective endocarditis, a life-threatening disease, with an often unpredictable outcome given by the lack of reliable prognostic parameters.
We retrospectively studied 337 patients admitted to our centre between January 1, 2006 and September 30, 2020 with available NT-proBNP level at admission. Our analyses were performed considering NT-proBNP as both a categorical variable, using the median value as the cut-off level, and numerical variable. Study end points were in-hospital mortality, cardiac surgery and 1 year survival.
NT-proBNP was an independent predictor of in-hospital mortality (OR 14.9 [95%C.I. 2.46-90.9]; P = .003). Levels below 2926 pg/mL were highly predictive of a favorable in-hospital outcome (negative predictive value 96.6%). Patients with higher NT-proBNP levels showed a significantly lower survival rate at 1 year follow-up (log-rank P = .005). NT-proBNP was strongly associated with chronic kidney disease (P < .001) and significantly higher in patients with prior chronic heart failure (P = .001). NT-proBNP was tightly related to staphylococcal IE (P = .001) as well as with higher CRP and hs-troponin I (P = 0.023, P < .001, respectively).
Our results confirm the remarkable prognostic role of NT-proBNP in patients with IE and provide novel evidences of its multifaceted correlates in this unique clinical setting. Our data strongly support the incorporation of NT-proBNP into the current diagnostic work-up of IE.
探讨 NT-proBNP 在急性感染性心内膜炎（一种危及生命的疾病）患者中的预后价值及其相关因素。由于缺乏可靠的预后参数，该病的预后往往难以预测。
我们回顾性研究了 2006 年 1 月 1 日至 2020 年 9 月 30 日期间因急性感染性心内膜炎在我院住院的 337 例患者，这些患者在入院时均有 NT-proBNP 水平。我们将 NT-proBNP 既作为分类变量（以中位数为截断值），也作为数值变量进行分析。研究终点为院内死亡率、心脏手术和 1 年生存率。
NT-proBNP 是院内死亡率的独立预测因子（OR 14.9[95%CI 2.46-90.9]；P=0.003）。水平低于 2926pg/ml 对院内预后良好有高度预测价值（阴性预测值 96.6%）。NT-proBNP 水平较高的患者在 1 年随访时的生存率显著降低（对数秩检验 P=0.005）。NT-proBNP 与慢性肾脏病密切相关（P<0.001），在既往慢性心力衰竭患者中显著升高（P=0.001）。NT-proBNP 与葡萄球菌性 IE 显著相关（P=0.001），与 CRP 和高敏肌钙蛋白 I 水平也显著相关（P=0.023、P<0.001）。
我们的研究结果证实了 NT-proBNP 在 IE 患者中具有显著的预后作用，并提供了其在这一独特临床环境中的多方面相关性的新证据。我们的数据强烈支持将 NT-proBNP 纳入 IE 的现行诊断评估中。
