Yebra Yebra Miguel, Sáenz de Urturi Rodríguez Alejandro, González García Sergio, de Peralta García Paula, Asenjo Martínez Maria, Rueda Camino Jose Antonio, Barba Martín Raquel
Departamento de Medicina Interna, Hospital Universitario Rey Juan Carlos, Móstoles, Madrid, España; Unidad de Insuficiencia Cardíaca, Departamento de Medicina Interna, Hospital Universitario Rey Juan Carlos, Móstoles, Madrid, España.
Departamento de Medicina Interna, Hospital Universitario Rey Juan Carlos, Móstoles, Madrid, España.
Med Clin (Barc). 2025 Jul;165(1):106990. doi: 10.1016/j.medcli.2025.106990. Epub 2025 May 22.
To evaluate the prognostic value of extreme levels of the N-terminal pro-brain natriuretic peptide (NT-proBNP) measured at any time during hospitalization for heart failure (HF).
A retrospective cohort study including patients hospitalized for HF in a secondary-level hospital with at least one NT-proBNP measurement. Two groups were defined: patients with extreme NT-proBNP levels (>50,000pg/mL) and those with elevated NT-proBNP levels (>1800pg/mL and <20,000pg/mL). The primary outcome was a composite of (1) in-hospital mortality; (2) HF readmission, and (3) 6-month mortality. Cox survival models were used for analysis.
A total of 83 patients with extreme NT-proBNP levels and 100 with elevated NT-proBNP levels were included; 61% were women, with a median age of 87 years. Comorbidity burden was high and similar between groups (median Charlson index: 8). The primary outcome was more frequent in patients with extreme NT-proBNP levels: 25.02 vs. 10.53 events per 100 patient-months (HR 2.07; 95% CI: 1.37-3.14). Both in-hospital and 6-month mortality were significantly higher in the extreme NT-proBNP group, while HF readmissions were numerically higher but not statistically significant. These results remained consistent after multivariable adjustment.
Patients hospitalized for HF with NT-proBNP levels>50,000pg/mL have a worse prognosis than those with NT-proBNP<20,000pg/mL, representing a high-risk subgroup with short-term mortality.
评估心力衰竭（HF）住院期间任何时间测得的N末端前脑钠肽（NT-proBNP）极高水平的预后价值。
一项回顾性队列研究，纳入在二级医院因HF住院且至少有一次NT-proBNP测量值的患者。定义两组：NT-proBNP水平极高（>50,000pg/mL）的患者和NT-proBNP水平升高（>1800pg/mL且<20,000pg/mL）的患者。主要结局为以下三者的复合：（1）住院死亡率；（2）HF再入院率；（3）6个月死亡率。采用Cox生存模型进行分析。
共纳入83例NT-proBNP水平极高的患者和100例NT-proBNP水平升高的患者；61%为女性，中位年龄87岁。两组的合并症负担均较高且相似（中位Charlson指数：8）。NT-proBNP水平极高的患者中主要结局更常见：每100患者月发生25.02次事件，而NT-proBNP水平升高的患者为10.53次事件（风险比2.07；95%置信区间：1.37 - 3.14）。NT-proBNP水平极高组的住院死亡率和6个月死亡率均显著更高，而HF再入院率在数值上更高但无统计学意义。多变量调整后这些结果仍保持一致。
因HF住院且NT-proBNP水平>50,000pg/mL的患者比NT-proBNP<20,000pg/mL的患者预后更差，代表了一个具有短期死亡率的高危亚组。
