Predictors of mortality in adult patients with congestive heart failure receiving nesiritide - Retrospective analysis showing a potential adverse interaction between neseritide and acute renal dysfunction

Background. A recent meta-analysis has suggested that nesiritide (NES), a new agent for the treatment of congestive heart failure (CHF), is associated with an increased risk of short-term mortality. Methods. We retrospectively examined this issue among 1407 consecutive elderly CHF patients by Pearson's chi-squared test, and determined independent risk factors for 60-day mortality by multivariate analysis in a cohort of 682 patients for whom we had sufficient clinical and laboratory data. Results. Univariate analysis revealed that NES usage was associated with increased mortality (n = 1407, 10 vs 6%, P = 0.011; n = 682, 19 vs 12.5%, P = 0.046). However, by forward stepwise regression analysis, NES usage did not survive as an independent predictor of mortality. The following variables were independent predictors of mortality: development of acute renal failure (ARF) defined as an increase of serum creatinine (SCr) ≥0.5 mg/dl; lack of β-adrenergic blockade; increased admission blood urea nitrogen; digoxin use; and increased admission brain natriuretic peptide. When patients were stratified according to NES usage, ARF emerged as an independent risk factor for mortality only among patients who received NES. Strikingly, among CHF patients who developed ARF (n = 102), NES usage emerged as the only independent predictor of mortality (P = 0.006, OR = 3.73, 95% CI 1.45-9.56). Conclusion. We conclude that, while NES per se is not independently associated with an increased risk for mortality, the development of ARF in association with NES use may confer an increased risk of mortality.