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

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概要

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• 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)

• 一般社団法人 日本循環器学会の論文

著者

• Frigerio Maria

  Cardiovascular Department Niguarda Ca Granda Hospital

• Ricci Vitoantonio

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

• 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

• Raimondo Rosa

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

• 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

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

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