Renal Dysfunction and Accuracy of N-Terminal Pro-B-Type Natriuretic Peptide in Predicting Mortality for Hospitalized Patients With Heart Failure

• Scrutinio Domenico

  Division of Cardiology and Cardiac Rehabilitation, “S. Maugeri” Foundation, IRCCS, Institute of Cassano Murge

• Mastropasqua Filippo

  Division of Cardiology and Cardiac Rehabilitation, “S. Maugeri” Foundation, IRCCS, Institute of Cassano Murge

• Guida Pietro

  Division of Cardiology and Cardiac Rehabilitation, “S. Maugeri” Foundation, IRCCS, Institute of Cassano Murge

• Ammirati Enrico

  Cardiothoracic and Vascular Department, Niguarda Cà Granda Hospital San Raffaele Scientific Institute and University

• Ricci Vitoantonio

  Division of Cardiology and Cardiac Rehabilitation, “S. Maugeri” Foundation, IRCCS, Institute of Cassano Murge

• Raimondo Rosa

  Division of Cardiology and Cardiac Rehabilitation, “S. Maugeri” Foundation, IRCCS, Institute of Tradate

• Frigerio Maria

  Cardiothoracic and Vascular Department, Niguarda Cà Granda Hospital

• Lagioia Rocco

  Division of Cardiology and Cardiac Rehabilitation, “S. Maugeri” Foundation, IRCCS, Institute of Cassano Murge

• Oliva Fabrizio

  Cardiothoracic and Vascular Department, Niguarda Cà Granda Hospital

抄録

Background:Renal dysfunction may confound the clinical interpretation of N-terminal pro-B-type natriuretic peptide (NT-proBNP) concentration. This study investigated whether renal dysfunction influences the prognostic accuracy of NT-proBNP in acute decompensated heart failure (ADHF).Methods and Results:We studied 908 ADHF patients. The primary outcome was 12-month mortality. Interaction between estimated glomerular filtration rate (eGFR) and NT-proBNP in predicting mortality was tested with the likelihood ratio test. The patients were classified into 3 eGFR strata: ≥60, 30–59, and <30 ml·min^–1·1.73 m^–2. Cox models were used to calculate the adjusted hazard ratios (HR) for NT-proBNP, modeled as a dichotomous or categorized variable, within each level of eGFR. NT-proBNP was categorized using optimal cut-offs defined in ROC analysis for each eGFR level. A total of 234 patients (25.8%) died. Testing for interaction was not significant (χ²=0.29; P=0.5928). The adjusted HR for NT-proBNP >5,180 pg/ml was 2.09 (P<0.001) in the highest, 1.7 (P<0.001) in the intermediate, and 3.33 (P=0.010) in the lowest eGFR level. The adjusted HR for NT-proBNP above the optimal cut-offs defined on ROC analysis were 1.5 (P=0.239), 2.2 (P<0.001), and 3.24 (P=0.002), respectively. The models incorporating NT-proBNP as a dichotomous or categorized variable had equivalent C-statistics.Conclusions:There was no evidence of interaction between eGFR and NT-proBNP in predicting mortality. The NT-proBNP cut-off of 5,180 ng/L provided independent prognostic information, irrespective of the level of residual renal function. (Circ J 2014; 78: 2439–2446)

収録刊行物

• Circulation Journal

  Circulation Journal 78 (10), 2439-2446, 2014

  一般社団法人 日本循環器学会

キーワード

• Acute decompensated heart failure
• Mortality
• N-terminal pro-B-type natriuretic peptide
• Prognosis
• Renal function

詳細情報

• CRID: 1390282680082829312
• NII論文ID: 130004690789
• NII書誌ID: AA11591968
• DOI: 10.1253/circj.cj-14-0405
• COI: 1:STN:280:DC%2BC2M%2FmtFSjsA%3D%3D
• ISSN: 13474820
• ISSN: 13469843
• NDL書誌ID: 025797881
• PubMed: 25168191
• Web Site: https://ndlsearch.ndl.go.jp/books/R000000004-I025797881
• Web Site: https://www.jstage.jst.go.jp/article/circj/78/10/78_CJ-14-0405/_pdf
• Web Site: https://search.jamas.or.jp/link/ui/2015277872
• 本文言語コード: en
• データソース種別:
  • JaLC
  • NDL
  • Crossref
  • PubMed
  • CiNii Articles
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