N端前脑钠肽与西班牙裔肺动脉高压患者临床病情恶化时间的关联
The Association of N-Terminal Pro-Brain Natriuretic Peptide With Time to Clinical Worsening in Hispanic Patients With Pulmonary Arterial Hypertension.
作者信息
Khatab Yacoub, Ghafouri Sayed Reshad, Alkhateeb Haider, Mukherjee Debabrata, Garcia Hernando, Nickel Nils Patrick
机构信息
Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, TX 79905, USA.
Department of Internal Medicine, Texas Tech University Health Sciences Center, El Paso, TX 79905, USA.
出版信息
Cardiol Res. 2022 Apr;13(2):73-80. doi: 10.14740/cr1362. Epub 2022 Apr 5.
BACKGROUND
Measurement of N-terminal pro-brain natriuretic peptide (NT-proBNP) level is an important parameter in the risk assessment of patients with pulmonary arterial hypertension (PAH). Data about the prognostic value of NT-proBNP in the Hispanic PAH population are lacking. Historically, clinical trials in PAH have only included a minority of Hispanic patients. It has been reported that baseline NT-proBNP levels differ between different ethnicities. Furthermore, NT-proBNP levels can be impacted by declining renal function, making its interpretation difficult regarding clinical decision making.
METHODS
In a retrospective single-center cohort analysis, Hispanic patients with PAH had a baseline outpatient NT-proBNP level drawn during a period of clinical stability and were followed for 1 year to monitor for time to clinical worsening (TTCW). The association of baseline NT-proBNP and TTCW was assessed in patients with normal and abnormal renal function.
RESULTS
A total of 26 patients (22%) met the clinical endpoint of clinical worsening. Twenty-seven patients (24%) had chronic kidney disease (CKD). At baseline NT-proBNP levels showed a significant inverse correlation with 6-min walk test (6MWD, r = -0.382, P = 0.02), and a significant positive correlation with renal function (r = 0.273, P = 0.05). NT-proBNP levels did not correlate with age (r = 0.19, P = 0.11) or body mass index (BMI) (r = -0.292, P = 0.061). NT-proBNP levels of > 1,415 ng/L were significantly associated with shorter TTCW (P < 0.01) in all patients and in patients with CKD (P = 0.03). A stepwise increase in NT-proBNP levels by 100 ng/L was associated with a higher risk of meeting the clinical endpoint of TTCW in patients with normal renal function (hazard ratio (HR) = 1.8, P < 0.01) and CKD (HR = 1.5, P < 0.01).
CONCLUSIONS
In Hispanic patients with PAH, NT-proBNP is a valuable tool to predict 1-year TTCW, independent of renal function.
背景
测量N端前脑钠肽（NT-proBNP）水平是评估肺动脉高压（PAH）患者风险的重要参数。目前缺乏关于NT-proBNP在西班牙裔PAH人群中预后价值的数据。历史上，PAH的临床试验仅纳入了少数西班牙裔患者。据报道，不同种族之间的基线NT-proBNP水平存在差异。此外，NT-proBNP水平会受到肾功能下降的影响，这使得其在临床决策中的解读变得困难。
方法
在一项回顾性单中心队列分析中，患有PAH的西班牙裔患者在临床稳定期抽取基线门诊NT-proBNP水平，并随访1年以监测临床恶化时间（TTCW）。在肾功能正常和异常的患者中评估基线NT-proBNP与TTCW之间的关联。
结果
共有26例患者（22%）达到临床恶化的临床终点。27例患者（24%）患有慢性肾脏病（CKD）。基线时NT-proBNP水平与6分钟步行试验（6MWD，r = -0.382，P = 0.02）呈显著负相关，与肾功能呈显著正相关（r = 0.273，P = 0.05）。NT-proBNP水平与年龄（r = 0.19，P = 0.11）或体重指数（BMI）（r = -0.292，P = 0.061）无相关性。NT-proBNP水平>1415 ng/L在所有患者以及CKD患者中均与较短的TTCW显著相关（P < 0.01）（P = 0.03）。在肾功能正常（风险比（HR）= 1.8，P < 0.01）和CKD（HR = 1.5，P < 0.01）的患者中，NT-proBNP水平每增加100 ng/L，达到TTCW临床终点的风险就更高。
结论
在患有PAH的西班牙裔患者中，NT-proBNP是预测1年TTCW的有价值工具，与肾功能无关。
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