Prognostic value of short-term follow-up BNP in hospitalized patients with heart failure

BMC Cardiovascular Disorders. 2017;17(1):1-10 DOI 10.1186/s12872-017-0632-0

 

Journal Homepage

Journal Title: BMC Cardiovascular Disorders

ISSN: 1471-2261 (Online)

Publisher: BMC

LCC Subject Category: Medicine: Internal medicine: Specialties of internal medicine: Diseases of the circulatory (Cardiovascular) system

Country of publisher: United Kingdom

Language of fulltext: English

Full-text formats available: PDF, HTML

 

AUTHORS


Sayma Sabrina Khanam (Department of Cardiology, Wonju College of Medicine, Yonsei University)

Jung-Woo Son (Department of Cardiology, Wonju College of Medicine, Yonsei University)

Jun-Won Lee (Department of Cardiology, Wonju College of Medicine, Yonsei University)

Young Jin Youn (Department of Cardiology, Wonju College of Medicine, Yonsei University)

Junghan Yoon (Department of Cardiology, Wonju College of Medicine, Yonsei University)

Seung-Hwan Lee (Department of Cardiology, Wonju College of Medicine, Yonsei University)

Jang-Young Kim (Department of Cardiology, Wonju College of Medicine, Yonsei University)

Sung Gyun Ahn (Department of Cardiology, Wonju College of Medicine, Yonsei University)

Min-Soo Ahn (Department of Cardiology, Wonju College of Medicine, Yonsei University)

Byung-Su Yoo (Department of Cardiology, Wonju College of Medicine, Yonsei University)

EDITORIAL INFORMATION

Open peer review

Editorial Board

Instructions for authors

Time From Submission to Publication: 19 weeks

 

Abstract | Full Text

Abstract Background B-type natriuretic peptide (BNP) has prognostic significance in heart failure (HF), and reductions in BNP may predict clinical improvement. However, there are limited data regarding the prognostic value of BNP during short-term follow-up. The aim of this study was to evaluate the relationship between short-term follow-up BNP and mortality after discharge in patients with HF. Methods We analyzed 427 patients hospitalized with HF from the Wonju Severance Christian Hospital Heart Failure Registry from April 2011 to December 2013, with a planned follow-up period through February 2016. Of the 427 patients, 240 (mean age, 75 years; 102 males, 42.5%) had BNP measured on admission and within the short-term follow-up period (3 months). We compared all-cause mortality during the clinical follow-up period (median length of follow-up, 709.5 days) according to the median value of BNP on admission (as a baseline value) and over a short-term follow-up period after discharge. Results Median BNP at admission was 816.5 pg/ml, and median follow-up BNP was 369.7 pg/ml. Multivariate analysis revealed a positive association between risk of death and high BNP. High BNP during follow-up was significantly associated with a greater risk of all-cause mortality compared to low BNP (P < 0.001). Initial BNP was not significantly associated with all-cause mortality. A multivariate model showed that follow-up BNP and percent change in BNP were independently associated with all-cause mortality after adjustment for covariates. Of the 3 BNP measurement strategies, BNP after discharge (IDI of 0.072, P < .0001 and NRI of 0.707, P < .0001) and percent change in BNP (IDI of 0.113, P < .0001 and NRI of 0.782, P < .0001) demonstrated the greatest increase in discrimination and net reclassification for mortality. Unfortunately, we did not find any significant value with initial BNP. Kaplan-Meier survival analysis was performed to assess mortality stratified by BNP according to the median value, high median of follow-up BNP and percent change in BNP were associated with significantly higher mortality compared to the below median (log-rank, p < 0.001). Conclusions Short-term follow-up BNP and percent change in BNP level are significant prognostic factors of all-cause mortality. These values will be clinically useful when evaluating prognosis in hospitalized patients with heart failure.