J Am Coll Cardiol, 2007; 49:1943-1950, doi:10.1016/j.jacc.2007.02.037 (Published online 30 April 2007

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


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.


COMMENTARIES:

Patients with acute decompensated heart failure (ADHF) whose brain natriuretic peptide (BNP) levels are elevated on admission to hospital are at increased risk of dying in hospital, report US researchers.

Measuring BNP levels on admission may therefore help physicians decide which patients need more intensive treatment and monitoring, they say.

The researchers compared in-hospital mortality rates across quartiles (Qs) of BNP levels. For Q1 (BNP <430 pg/ml), Q2 (430-839 pg/ml), Q3 (840-1729 pg/ml), and Q4 (≥1730 pg/ml) 6.0%, the rates were 1.9%, 2.8%, 3.8%, and 6.0%, respectively.

This reflected a near-linear relationship, and BNP was highly predictive of mortality after adjustment for age, gender, systolic blood pressure, blood urea nitrogen, creatinine, sodium, pulse, and dyspnea at rest. The odds ratio of in-hospital death for Q4 versus Q1 was 2.23.