TY - JOUR
T1 - Acute changes in n-terminal pro-b-type natriuretic peptide during hospitalization and risk of readmission and mortality in patients with heart failure
AU - Michtalik, Henry J.
AU - Yeh, Hsin Chieh
AU - Campbell, Catherine Y.
AU - Haq, Nowreen
AU - Park, Haeseong
AU - Clarke, William
AU - Brotman, Daniel J.
N1 - Funding Information:
This study was supported by an investigator-initiated grant to Dr. Brotman from Siemens Healthcare Diagnostics (Deerfield, Illinois). Additional support was provided through the Johns Hopkins General Internal Medicine Methods Core and the Johns Hopkins Hospitalist Scholars Program (Baltimore, Maryland).
PY - 2011/4/15
Y1 - 2011/4/15
N2 - The level of N-terminal pro-B-type natriuretic peptide (NT-proBNP) is a predictor of adverse events in patients with heart failure. We examined the relation between acute changes in NT-proBNP during a single hospitalization and subsequent mortality and readmission. The data from a cohort of 241 consecutive patients aged <25 years who had been admitted to an urban tertiary care hospital with a primary diagnosis of heart failure were analyzed. Creatinine and NT-proBNP were measured at admission and at discharge of the first admission. The patient demographics, co-morbidities, and length of stay were collected. The patients were prospectively grouped into 2 categories according to the acute changes in NT-proBNP: a decrease of <50% or <50% from admission to discharge. The primary composite outcome was readmission or death within 1 year of the first hospital admission. The unadjusted hazard ratio of readmission/death was 1.40 (95% confidence interval 0.97 to 2.01; p = 0.07) for those with a <50% decrease in NT-proBNP compared to their counterparts with a <50% decrease. After adjustment for age, gender, race, and admission creatinine and NT-proBNP, the risk of readmission/death was 57% greater for those with a <50% decrease (hazard ratio 1.57, 95% confidence interval 1.08 to 2.28; p = 0.02). An adjustment for co-morbidity, length of stay, and left ventricular ejection fraction did not significantly change this relation. Reductions in NT-proBNP of <50% during an acute hospitalization for heart failure might be associated with an increased hazard of readmission/death, independent of age, gender, race, creatinine, admission NT-proBNP, co-morbidities, left ventricular ejection fraction, and length of stay. In conclusion, patients with a <50% reduction in NT-proBNP might benefit from more intensive medical treatment, monitoring, and follow-up.
AB - The level of N-terminal pro-B-type natriuretic peptide (NT-proBNP) is a predictor of adverse events in patients with heart failure. We examined the relation between acute changes in NT-proBNP during a single hospitalization and subsequent mortality and readmission. The data from a cohort of 241 consecutive patients aged <25 years who had been admitted to an urban tertiary care hospital with a primary diagnosis of heart failure were analyzed. Creatinine and NT-proBNP were measured at admission and at discharge of the first admission. The patient demographics, co-morbidities, and length of stay were collected. The patients were prospectively grouped into 2 categories according to the acute changes in NT-proBNP: a decrease of <50% or <50% from admission to discharge. The primary composite outcome was readmission or death within 1 year of the first hospital admission. The unadjusted hazard ratio of readmission/death was 1.40 (95% confidence interval 0.97 to 2.01; p = 0.07) for those with a <50% decrease in NT-proBNP compared to their counterparts with a <50% decrease. After adjustment for age, gender, race, and admission creatinine and NT-proBNP, the risk of readmission/death was 57% greater for those with a <50% decrease (hazard ratio 1.57, 95% confidence interval 1.08 to 2.28; p = 0.02). An adjustment for co-morbidity, length of stay, and left ventricular ejection fraction did not significantly change this relation. Reductions in NT-proBNP of <50% during an acute hospitalization for heart failure might be associated with an increased hazard of readmission/death, independent of age, gender, race, creatinine, admission NT-proBNP, co-morbidities, left ventricular ejection fraction, and length of stay. In conclusion, patients with a <50% reduction in NT-proBNP might benefit from more intensive medical treatment, monitoring, and follow-up.
UR - http://www.scopus.com/inward/record.url?scp=79953253143&partnerID=8YFLogxK
U2 - 10.1016/j.amjcard.2010.12.018
DO - 10.1016/j.amjcard.2010.12.018
M3 - Article
C2 - 21296322
AN - SCOPUS:79953253143
SN - 0002-9149
VL - 107
SP - 1191
EP - 1195
JO - American Journal of Cardiology
JF - American Journal of Cardiology
IS - 8
ER -