CLINICAL RESEARCH: HEART FAILURE
Admission B-Type Natriuretic Peptide Levels and In-Hospital Mortality in Acute Decompensated Heart Failure
Gregg C. Fonarow, MD, FACC*,*,
William F. Peacock, MD ,
Christopher O. Phillips, MD, MPH ,
Michael M. Givertz, MD, FACC ,
Margarita Lopatin, MS|| ADHERE Scientific Advisory Committee and Investigators
* Ahmanson–UCLA Cardiomyopathy Center, University of California, Los Angeles Medical Center, Los Angeles, California
Department of Emergency Medicine
Department of Medicine, The Cleveland Clinic Foundation, Cleveland, Ohio
Department of Medicine, Brigham & Women's Hospital, Boston, Massachusetts
|| Department of Biostatistics, Scios Inc., Mountain View, California.
Manuscript received November 20, 2006;
revised manuscript received January 3, 2007,
accepted February 5, 2007.
* Reprint requests and correspondence: Dr. Gregg C. Fonarow, University of California, Los Angeles, Division of Cardiology, 10833 Le Conte Avenue, Los Angeles, California 90095. (Email: gfonarow{at}mednet.ucla.edu).
Objectives: This study was designed to determine whether admission B-type natriuretic peptide (BNP) levels are predictive of in-hospital mortality in acute decompensated heart failure (HF).
Background: Levels of BNP have been demonstrated to facilitate the diagnosis of HF and predict mortality in chronic systolic HF.
Methods: B-type natriuretic peptide levels within 24 h of presentation were obtained in 48,629 (63%) of 77,467 hospitalization episodes entered in ADHERE (Acute Decompensated Heart Failure National Registry). In-hospital mortality was assessed by BNP quartiles in the entire cohort and in patients with reduced (n = 19,544) as well as preserved (n = 18,164) left ventricular systolic function using chi-square and logistic regression models.
Results: Quartiles (Q) of BNP were Q1 (<430), Q2 (430 to 839), Q3 (840 to 1,729), and Q4 ( 1,730 pg/ml). The BNP levels were <100 pg/ml in 3.3% of the total cohort. Patients in Q1 versus Q4 were younger, more likely to be women, and had lower creatinine and higher left ventricular ejection fraction. There was a near-linear relationship between BNP quartiles and in-hospital mortality: Q1 (1.9%), Q2 (2.8%), Q3 (3.8%), and Q4 (6.0%), p < 0.0001. B-type natriuretic peptide quartile remained highly predictive of mortality even after adjustment for age, gender, systolic blood pressure, blood urea nitrogen, creatinine, sodium, pulse, and dyspnea at rest, Q4 versus Q1 (adjusted odds ratio 2.23 [95% confidence interval 1.91 to 2.62, p < 0.0001]). The BNP quartiles independently predicted mortality in patients with reduced and preserved systolic function.
Conclusions: An elevated admission BNP level is a significant predictor of in-hospital mortality in acute decompensated HF with either reduced or preserved systolic function, independent of other clinical and laboratory variables. (Registry for Acute Decompensated Heart Failure Patients; http://www.clinicaltrials.gov/show/NCT00366639; NCT00366639
[ClinicalTrials.gov]
).
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Abbreviations and Acronyms
| | BMI = body mass index | | BNP = B-type natriuretic peptide | | BUN = blood urea nitrogen | | HF = heart failure | | LV = left ventricular | | LVEF = left ventricular ejection fraction | | NT-proBNP = N-terminal pro-B-type natriuretic peptide | | Q = quartile |
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